Essays in Children's Access to Pediatric Health Care.

Abstract

This dissertation consists of three essays on factors related to children’s access to and utilization of health care. The family is acknowledged as an important contextual factor in a child’s access to health care. In the first and second essays, I investigate how changes that occur to a family’s composition are likely to play an important role in a child’s health care. I start by examining how the number of children in the household is related to a child’s access to medical and dental care. By exploiting parental preferences for a mixed sibling-sex composition to instrument for family size, I find evidence that the direction of the relationship depends on the ability of parents to schedule and coordinate visits between children. In the second essay, I use panel data taken from the Survey of Income and Program Participation to further examine how siblings can impact a child’s health care utilization. The results indicate a significant and meaningful relationship between both family size and birth order and a child’s utilization of health care. I document how the addition of a newborn sibling impacts a child’s use of health care, and how this relationship is context dependent, as both the type of care and age of the child matter importantly to the relationship’s magnitude and direction. I also find that, for young children, second born children receive less medical care and more dental care than do first born children. The third essay, written with Tom Buchmueller, examines the effects of recent changes to state’s public insurance programs on the insurance coverage of low-income children. We find that decisions on program design can have large impacts on children’s insurance coverage. An increase in public coverage among Medicaid eligible children was most pronounced in states that expanded existing Medicaid programs, relative to states that used separate programs. We also find evidence that enrollment simplification, continuous eligibility policies, and waiting periods have significant effects on low-income children’s insurance coverage.