Three Essays in Health Economics.

다국어 초록 (Multilingual Abstract)

In chapter 1, I examine the effect of the Medicaid expansions on drug-related foster care removals. Child removals into foster care have increased by 8.6% from 2010 to 2016. With over one-third of children being removed due to a parent with drug dependency, the opioid epidemic has led to an overflow of children being placed into foster care. The Medicaid expansion provided health insurance to many previously uninsured individuals, and existing literature has shown that the expansion increased access to treatment for substance use disorder but also increased access to prescription opioids. This paper is the first to examine the impact of the state-level Medicaid expansions on drug-related foster care removals in the United States. I use yearly data from the Adoption and Foster Care Analysis and Reporting System (AFCARS) on county-level drug-related foster care removal rates from 2010 to 2016. I use variation in the timing of the Medicaid expansions across states to identify the effects of the expansions and find that overall the expansions had no significant effect on drug-related foster care removals, or non-drug-related foster care removals. I find that the West saw large increases in drug-related foster care removals after expanding. I further show that the West saw large increases in prescription opioid painkillers reimbursed by Medicaid and relatively smaller increases in medications used for treatment of substance use disorder. This suggests that the Medicaid expansion in the West led to an increase in access to opioids, without as much of an improvement in substance use treatment, which could explain the increases in drug-related foster care removals in this region.In chapter 2, I explore the effect of naloxone access laws on opioid-related mortality rates. On average, 130 Americans die each day from an opioid overdose. To combat this growing epidemic, every state has passed some form of legislation that aims to increase the availability of naloxone – a prescription drug that can reverse the effect of an opioid overdose. This paper examines the impact of state-level naloxone access laws on opioid-related mortality in the United States, using monthly data from the Centers of Disease Control and Prevention (CDC) on county-level mortality rates from 2010 to 2017. I use variation in the timing of access laws across states to identify the effects of naloxone access and find that states that passed naloxone access laws prior to 2013 saw reductions in opioid-related mortality. After 2015, states with a naloxone access law saw increases in opioid-related mortality. These findings are consistent with changes in the timing of fentanyl distribution in the United States, suggesting a limited role for naloxone when fentanyl contaminates the heroin supply. Finally, in chapter 3, I study examines the impact of a large-scale workfare program, the National Rural Employment Guarantee Scheme (NREGS), on child marriage in India. We use two rounds of data from the District Level Household & Facility Surveys and estimate a difference-in-differences model by comparing changes in child marriage rates between a cohort of young women and a cohort of older women before and after the program was implemented. We find that NREGS is associated with an increase in the probability of marriage before 18 Heterogeneity analysis shows that the effects are largest in districts with higher prevalence of arranged marriages and dowry deaths at baseline, which is consistent with dowry practices affecting marriage decisions when resource constraints are relaxed.