Three essays in health economics

Health economists have long recognized that financial incentives can influence health care decisions. This dissertation is composed of three essays examining the impact of both financial and non-financial factors such as out-of-pocket costs and demographic characteristics on health care utilization.; In the first essay, I analyze the decision of individuals to continue treatment for infertility. The benefit of continuing treatment is the increased chance of pregnancy and the costs are the money, time and psychological costs of the procedure. Using a competing risk duration model I estimate the conditional probability of couples leaving treatment. I find that out-of-pocket costs and age of the woman significantly influence couples decision regards treatment. Simulation results indicate that the demand curve for infertility treatment is relatively inelastic suggesting that perhaps time or psychological costs are high.; The next two essays investigate effect of incentives on providers and hospitals in the mental health area. The first essay compares the effect of service use under a brokered case management program with standard treatment. I investigate the effect of case management on treatment using 2 approaches by comparing use of services before and after a patient is assigned a case manager, and using a difference-in-difference approach, where the difference in service use for patients assigned a case manager is compared to the difference in service use over the same period for a control group of patients. I find no significant difference in use of inpatient hospitalization and ER by patients in different treatments.; The second essay investigates the long-term effect of shorter hospital stays on future hospital use. Hospitals have been trying to reduce use of hospital days for a variety of reasons. While shorter hospital stays lower costs in the short term they may not necessarily do so in the long run. Regression analysis is used to investigate length of stays for a sample of individuals suffering from Schizophrenia. I find that shorter lengths of hospital stays did not yield more frequent readmissions or longer subsequent hospitalization. The results on GAF scores are consistent with criteria for admission and discharge during this time.