UC Santa Cruz

This dissertation uses statistical causal inference methods to answer causal questions in the fields of health economics and economics of culture and institutions. The first chapter is an application of examiner designs in health economics. Despite efforts to reduce emergency department (ED) care and transition patients to alternative settings, there is limited evidence on its impact on patient outcomes. This chapter studies patients that call into a nurse advice line that are directed toward ED care in a rater instrumental variables design. Marginal patients are 5.3 percentage points more likely to be admitted as an inpatient within 3 days since triage and 3.7 percentage points more likely to have a second ED visit within 4 to 30 days. This chapter also shows increased outpatient utilization with no differences in short-term mortality, indicating efforts to divert patients to less acute settings are likely justified.

The second chapter examines the origins of the cross-nurse difference in average ED visit rates of similar patients quasi-randomly assigned to telephone triage nurses. Medical practitioners often make substantially different choices for similar patients. This chapter examines how variation in telephone triage practice style across nurses affect downstream patient healthcare utilization. While a triage decision-support tool standardizes the telephone triage process across nurses, the triage nurses can still exercise discretion through two potential margins: (i) overriding triage recommendations and (ii) intensifying verbal communication to ensure patient compliance with triage disposition. I construct two nurse practice measures to quantify each nurse’s average ED recommendation and verbal communication tendencies, exploiting quasi-random assignment of calls to nurses within call centers. My reduced-form estimates suggest that reassigning a call to a nurse with a higher ED recommendation and a longer call duration tendency increases the patient’s probability of seeking in-person medical attention.

The third chapter investigates the causal effects of superstitious beliefs that discriminate against women born in the years of Goat in the Chinese zodiac. Translating the Goat-year superstition into a simple framework of partner search under the zodiac discrimination, I consider two empirical strategies to test for the presence of marriage discrimination: a regression discontinuity (RD) design and a difference-in-differences (DID) method. The RD design identifies the superstition effects if women born just before and after the Goat-new year had, on average, the same unobserved characteristics. However, I find that marriage and other socioeconomic outcomes exhibit persistent seasonal patterns, suggesting that the Goat and adjacent birth cohorts are not comparable without controlling for the unobserved differences. Our DID method controls for the unobserved differences across cohorts around the RD threshold and identifies the causal effects of the Goat-year superstition. Applying the DID method to the 1979 Goat-year women in a 1% sample of the 2000 Chinese Population Census, I find no statistical evidence of the superstition effects on marriage and other outcomes.