| The health economics literature places significant emphasis on the modeling of provider-client interactions; such interactions are important in determining clients' health care use. This dissertation provides empirical evidence on such interactions and shows how these interactions affect the quantities and choices of health care use.; The first essay considers three types of mechanisms that providers can use to influence quantity of health care use: rationing, effort, and persuasion. By rationing, I refer to a quantity limit set by a provider; effort, the productive inputs supplied to increase a client's demand; persuasion, the unproductive inputs used to induce demand. I construct a theoretical model incorporating all three mechanisms as special cases. I then test for the presence of each mechanism using data on clients receiving outpatient treatment for alcohol abuse in the Maine Addiction Treatment System. I find evidence for rationing and persuasion, but not effort.; The second essay investigates how clients react to providers' medical instructions; this is known as patient compliance in the medical literature. I develop and structurally estimate a sequential model of alcohol abuse client compliance decisions, where compliance is defined as attendance at recommended outpatient sessions. I find that clients who choose to comply (i.e. attend the sessions) are different from those who do not (i.e., missing the session or dropping out the program) mostly in their unobserved characteristics. Policy experiments suggest that better or more treatment has small impacts on the level of compliance and the chance of abstinence at discharge. A more effective way to achieve abstinence is to mandate clients to participate a required regimen of sessions.; The third essay studies how providers' networks restrict clients' health care choices. Using data on baby deliveries in acute hospitals in Massachusetts between 1995 and 1999, I find that enrollees of managed care plans (a strict network) use different hospitals than those of Medicaid (a loose network), even accounting for residence as indicated by zip code. In addition, such a difference is mostly attributed to different physicians that each managed plan contracts with; this shows the inter-dependence between a hospital and physician network. |
