Health and Health Care
Paper Session
Friday, Jan. 5, 2024 2:30 PM - 4:30 PM (CST)
- Chair: Meghan Skira, University of Georgia
The Effect of Hospital Breastfeeding Policies on Infant Health
Abstract
Breastfeeding is widely considered to be the best method of infant feeding, and both the World Health Organization and the American Academy of Pediatrics recommend breastfeeding through at least one year of age. We study the effects of state hospital breastfeeding support policies, which are intended to increase breastfeeding by requiring certain care standards for new mothers and their babies during their postpartum hospital stay. Leveraging the rollout of these state policies in a difference-in-differences framework, we find that these policies significantly increased breastfeeding initiation by 3.2 percentage points (5 percent) and the probability of breastfeeding at 3 and 6 months postpartum by approximately 7 percent. Using restricted National Vital Statistics System linked infant birth and mortality files and HCUP hospital inpatient discharge data, we then show that these policies significantly reduced infant mortality and improved infant health. Additional analyses suggest these improvements primarily occurred among medically vulnerable infants, consistent with evidence from the medical literature showing that breast milk can support immune development. Evidence also suggests complementary changes in maternal health behaviors.How Much Do Patients Value their Physicians? Evidence on Gender and Racial Disparities
Abstract
Patients may seek demographic concordance and cultural competence in their relationships with physicians and make costly tradeoffs in choosing physicians, such as traveling further or waiting longer for available appointments. This paper studies older U.S. Medicare patients and measures the patients' valuation of their primary care physicians by using willingness to travel through revealed preference. The paper disentangles three mechanisms through which patients could make costly travel choices: patients from certain demographic groups may value relationships with physicians more on average, physicians from certain demographic groups or who offer culturally competent care for certain demographic groups may be valued more by patients on average, and patients may value demographic concordance with or cultural competence among physicians. My empirical strategy leverages exogenous variation in patients' distances to physicians that arises from physician relocations. My results suggest that matches between female patients and female physicians are associated with greater patient valuation of their physicians. Matches between Black patients and physicians with substantial shares of Black patients -- a proxy for offering culturally competent care for Black patients -- are also associated with greater patient valuation of their physicians, though this result is related to value in matches between Medicaid patients and physicians with substantial shares of Medicaid patients. I then investigate whether patients' valuations of their physicians are influenced by having other physician options who would offer the same types of matches. These results have implications for whether increasing diversity in the physician workforce and health plan networks could improve equity in healthcare access and reduce healthcare disparities.Dynamics in Employment and Income Before and After Transgender Transitioning: Evidence from Dutch Administrative Data
Abstract
This paper estimates the changes in labor market and health outcomes before and after legal gender transitioning. Using individual-level administrative panel data from the Netherlands over the period 2014-2022, we identify nearly 6,500 legal gender transitions, defined as the change of gender marker on one's birth certificate. Data on employment and health care utilization are drawn from administrative records.Using an event study approach with a sample of the general population serving as controls, we find changes in economic outcomes after transitioning, and important differences between those transitioning female-to-male (FTM) versus male-to-female (MTF). For both groups, employment and earned income decrease in the years preceding their legal gender transition. They differ, however, in dynamics after transitioning. For those transitioning FTM, there are increases in employment and income 5 or more years after transitioning; in contrast, for those transitioning MTF, employment and income remain significantly lower 3-4 years after transitioning, and are not significantly higher 5 or more years post-transition. The results provide information about dynamics in economic outcomes around legal gender transitions, and demonstrate that there can be meaningful differences for those transitioning FTM versus MTF.
Discussant(s)
Priyanka Anand
,
George Mason University
Marianne Bitler
,
University of California-Davis
Mariana Carrera
,
Montana State University
Christopher (Kitt) Carpenter
,
Vanderbilt University
JEL Classifications
- I0 - General
- I2 - Education and Research Institutions