UC Santa Cruz

This dissertation explores health care utilization and provision for the elderly. My research aims to answer questions about the health effects of specific types of care, government and insurance policies, and major life events.

The first chapter, entitled "Retirement and Health: Evidence from England," investigates the effects of retirement on individual health. With many governments actively considering incentivizing longer working lives by raising the minimum age for pension programs, I examine the discontinuity at the State Pension Age in order to find the causal effect of retirement on health behaviors, health outcomes, health care utilization, and mortality. I focus on England due to a clearly-defined pension age and lack of confounding government programs, and use a full range of novel datasets, including census records, large nationwide surveys, and mortality records. I find that retirement substantially improves well-being, self-reported health, and decreases the proportion of people reporting long-term illnesses and disabilities. However, there is no evidence of an immediate effect on cognitive ability, health behaviors, or health care utilization. Consistent with this, I further show that there is no effect of retirement on mortality. Finally, I show that individuals' show signs of lower stress, with changes to both health markers and day-to-day activities. My estimates are generally more precise than those found in previous literature, and this paper is the first to examine a full range of health-related outcomes with administrative and survey data in a unified context.

The second chapter investigates the effect of skilled nursing facilities. Here, I leverage a Medicare policy that induces a sharp change in the probability of being discharged to a skilled nursing facility (SNF) in order to generate causal estimates of the health effects of this type of care. Despite being a significant source of health care spending and of Medicare's annual budget, SNF care has been understudied, with systematic differences in individuals that enter into a SNF. The identification of this paper uses Medicare's requirement of a three-day stay in order to cover SNF care. Using inpatient and emergency department records, I find that those that narrowly made the cutoff experience a substantial increase in the probability of being discharged to a SNF, and a subsequent decrease in readmission probability.

The third chapter explores the long-term effects of month of birth on self-reported health and morality rates. I use data from the Census of England and Wales and death certificates from the Office of National Statistics to examine these effects, focusing on a large sample of individuals born between 1940 and 1960. I find that individuals born in fall and early winter months are less likely to report being in poor health and have better mortality rates, particularly compared to those born in late spring and summer.