Dissertation
Three essays on effects of economic policies on maternal and infant health
University of Iowa
Doctor of Philosophy (PhD), University of Iowa
Autumn 2021
DOI: 10.17077/etd.006315
Abstract
This thesis consists of three essays in health economics, examining the effects of economic policies, mainly state-level earned income tax credits (EITC) on maternal health, access to healthcare services, and minimum wage and EITC on infant health using quasi-experimental designs. The first essay examines the effects of state EITC on general health outcomes of low-educated single mothers in the U.S. The second essay examines the effects of refundable state EITC on access to medical and dental care services and explores the interaction between state EITC and Medicaid parental eligibility. The last essay investigates the effects of minimum wage and state EITC on infant health. The innovation of the third essay is to provide new causal evidence of the effects on infant health accounting for local time-varying confounders.The first chapter highlights the significance, innovation, and the conceptual framework of effects from minimum wage and state EITC on maternal health and infant health.
The second chapter examines the effects of refundable and non-refundable state EITC programs on health of single low-educated women of childbearing age with two or more children, the group receiving the highest credits on average. The data comes from the Behavioral Risk Factors Surveillance Survey (BRFSS). The research design accounts for time-invariant differences between states and national trends shared across states using a difference-in-difference model and adjusts for other state policies. Overall, findings suggest that an increase in refundable state EITC improves the health of single women of childbearing age with low income and two or more children; this may also lead to better preconception health. Estimates for non-refundable EITC programs are smaller and not statistically significant. As expected, there are small and statistically insignificant refundable EITC effects for single low-educated childless women, who receive low state EITC benefits on average.
The third chapter examines the effects of refundable state EITC on access to medical and dental care services using a similar design and group to the first paper in chapter 2. This study examines the effects on access averaging across the 12 past months from the interview time but also focuses on the period closest to the disbursement of the EITC refund. The findings show a small albeit weak evidence of some increase in access to care including a reduction in forgone care due to cost and an increase in dental visit within the months immediately following disbursement of EITC refund during May to December and June to November. The estimates however are sensitive to specifications in that there is a negative association with some of the access measures when pooling across the 12 past months, suggesting recall bias and differences in effects of EITC on healthcare utilization relative to disbursement month.
The fourth chapter examines the effects of minimum wage and refundable state EITC and explores their interaction on health of infants born to single low-educated mothers. The outcomes include birth weight, low birth weight, preterm birth, gestation weeks and fetal growth. The data comes from restricted use of Natality Birth Certificates from National Center for Health Statistics (NCHS). The empirical approaches are innovative in several ways. The first approach uses a general difference-in-difference model to examine the effects of the minimum wage and state EITC at the county level aggregated data both pooling and stratifying by birth order; the second approach addresses unobserved local time-varying confounders using a contiguous boarder county-pair approach at the county-level aggregated data. This approach allows to control for systematic differences between cross-border counties at local levels since counties sharing a state border provide better control groups than other randomly selected counties in the U.S, and they should have relatively similar economic condition and outcome trends. The identification relies on that changes in outcomes only come from within county-pairs variations in minimum wage increase or EITC policy change. The general difference-in-difference estimates show significant positive effects of both minimum wage and refundable state EITC on infant health outcomes. However, the state EITC effects are implausibly large. In contrast, the effects become much smaller and statistically insignificant in the contiguous county-pair design controlling for local time-varying confounders. Further, the estimate rules out large effects. Finally, there is overall no evidence of significant interactive effects between these two policies on infant health.
Details
- Title: Subtitle
- Three essays on effects of economic policies on maternal and infant health
- Creators
- Haobing Qian
- Contributors
- George Wehby (Advisor)Kanika Arora (Committee Member)Dan Shane (Committee Member)Hari Sharma (Committee Member)Xi Zhu (Committee Member)
- Resource Type
- Dissertation
- Degree Awarded
- Doctor of Philosophy (PhD), University of Iowa
- Degree in
- Health Services and Policy
- Date degree season
- Autumn 2021
- DOI
- 10.17077/etd.006315
- Publisher
- University of Iowa
- Number of pages
- xii, 166 pages
- Copyright
- Copyright 2021 Haobing Qian
- Language
- English
- Description illustrations
- color illustrations
- Description bibliographic
- Includes bibliographical references.
- Public Abstract (ETD)
This thesis consists of three essays examining the effects of economic policies, mainly state level earned income tax credits (EITC) on maternal health and access to healthcare services, and minimum wage and state EITC on infant health using survey data and Birth Certificates. The conceptual framework is that EITC and minimum wage encourage employment and boost earnings especially among single low educated mothers who benefit most. The income effects from EITC and minimum wage improve maternal health through increase in access to medical and dental services, reduced forgone care due to cost. Better maternal health leads to better infant health. The first essay examines the effects of state EITC on maternal health. Our findings show that refundable state EITC programs are associated with better general health, physical health, and mental health; the second essay examines the effects of state EITC on access to medical and dental care. The findings show small but limited evidence of some increase in access to care including a reduction in forgone care due to cost and an increase in dental visit within the months immediately following disbursement of EITC refund during later interview months. The estimates are sensitive to model specifications, and there are some negative effects when pooling across the last 12 months, suggestive of unobserved confounders and recall bias. The third essay evaluates the effects of two income enhancing policies-minimum wage and state EITC on infant health in the same research design. Our findings show that in a general difference-in-difference model, both minimum wage and refundable state EITC programs are associated with an increase in birth weight, decrease in preterm birth, increase in gestation weeks, and increase in fetal growth rate and the estimates are implausibly large particularly for EITC. In contrast, in the contiguous county-pair approach controlling for local time-varying confounders, the effects become much smaller and statistically insignificant, and magnitudes are comparable with previous studies evaluating income effects on infant health. There is no evidence of significant interactive effects.
- Academic Unit
- Health Management and Policy
- Record Identifier
- 9984210444202771
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