UC Riverside

The United States per capita health care spending is the highest in the world. This dissertation addresses the impact of additional health care spending/medical service usage on health status. First two chapters investigate the role of insurance on medical service use in understudied dental market. The third chapter examines the effectiveness of additional health care spending on infant health outcomes.

The first chapter estimates the causal relationship between adult Medicaid dental benefits and dental service usage for low-income adults by using difference-in-differences technique exploiting the state-level variation in adult Medicaid dental benefit. The results suggest that adult Medicaid dental benefit increases the possibility of dental visit by 16.4 - 22 percent. The evidence that the increased dental service use improves dental health among low-income people is also presented. The second chapter investigates the relationship between dental insurance and dental service use among older populations. Between ages of 61 and 68, 24 percent of people with at least high school diploma lose dental insurance. The decrease in dental coverage is primarily driven by the loss of employer provided dental benefit with retirement. Utilizing this rapid drop in the number of people with dental insurance at around age 65, I find that there is no evidence of a decrease in dental service usage among older populations.

The third chapter, which is co-authored with Marks, addresses the benefit of additional health care spending for newborns. We use the number of infants born on a given day in a given location as an identifying variable to generate exogenous variation in health care spending. Using detailed information on every hospital birth in California from 2002 to 2006, we find that hospital stays are less intensive when the hospitalization region is more crowded. The second stage analysis suggests that the additional health care spending on infants born on less crowded days does not improve infant health status measured by mortality rate and readmission rate.