| dc.description.abstract | In this dissertation I present three projects related to the topic demand and welfare in health economics by leveraging changes in technology, institutions and policies through quasi-experimental and experimental approaches.
In the first essay "Television, Health, and Happiness", which is joint work with Adrian Chadi, we study the consequences of television consumption. Watching television is the most time-consuming human activity besides work but its role for individual well-being is unclear. Negative consequences portrayed in the literature raise the question whether this popular activity constitutes an economic good or whether it is an economic bad and hence serves as a prime example of irrational behavior reducing individual health and happiness. We are the first to comprehensively address this question by exploiting a large-scale natural experiment in West Germany, where households in a few geographically restricted areas received commercial television via terrestrial frequencies. Rich panel data allow us to determine how signal availability over time changes individual time-use and well-being. Contrary to previous research, we find no health impact when television consumption increases. For life satisfaction, we even find positive effects. Additional data support the notion that television is not an economic bad and that non-experimental evidence seems to be driven by negative selection.
The second essay "Vaccines at Work", which is joint work with Roberto Mosquera and Adrian Chadi, is investigating the causes and consequences of vaccination. Influenza vaccination could be a cost-effective way to reduce costs in terms of human lives and productivity losses, but low take-up rates and vaccination unintentionally causing moral hazard may decrease its benefits. We ran a natural field experiment in cooperation with a bank in Ecuador, where we experimentally manipulated incentives to participate in a health intervention, which allows us to determine the personal consequences of being randomly encouraged to get vaccinated using administrative firm data. In a first stage, we find strong evidence that opportunity costs and peers matter to increase vaccination demand. In the second stage, contrary to the company’s expectation, vaccination did not reduce sickness absence during the flu season. Getting vaccinated was ineffective with no measurable health externalities from coworker vaccination. We rule out meaningful individual health effects when considering several thresholds of expected vaccine effectiveness. Using a dataset of administrative records on medical diagnoses and employee surveys, we find evidence consistent with vaccination causing moral hazard, which could decrease the effectiveness of vaccination.
The third essay studies "The Unintended Consequences of Health Insurance" in a universal health care system. Universal healthcare is associated with desirable health and equity outcomes and often allows individuals to purchase supplementary private health insurance. While the purchase of private health insurance is clearly beneficial in the absence of public insurance, it is more difficult to evaluate individual costs and benefits when baseline coverage exists for everyone. The perceived benefits of insurance and the increase in health costs due to premium payments can lead to hidden costs and unintended consequences of supplementary health insurance. To study those costs, I use a regression kink design in conjunction with a policy implemented in Australia in 2000 to overcome selection. The policy punishes agents for delaying the purchase of private health until later in life. Following the policy-guided instrumentation of insurance purchase, it appears that private health insurance does not cause moral hazard. There is a zero effect on medical expenditures despite evidence of adverse selection. Supplementary insurance does not change mortality or work expenses but it changes the budget. We observe an increase in student debt which is consistent with premium payments crowding out debt repayments. There is a loss of gross income from private health insurance which is consistent with income under-reporting to reduce expenses from premium payments. | en |
