UC San Diego

This dissertation is a collection of three essays in health economics. Chapters 1 and 2 study the effects of public health policy interventions, while chapter 3 studies health outcomes directly.

Chapter 1 examines how vaccination behavior and vaccine-preventable disease outbreaks change in response to two mandatory vaccination policy changes in California. Passed as a response to an increase in parental vaccine refusal, the two policies aim to first limit and then fully eliminate personal belief exemptions (PBEs). I find that PBE rates decrease and up-to-date vaccination rates increase after each law is implemented. Furthermore, after fully eliminating PBEs, I find that medical exemptions increase at a faster rate in schools with historically high personal belief exemptions, potentially keeping clusters of children unvaccinated and at risk. Finally, I do not find evidence that either policy decreases outbreaks of vaccine preventable diseases at the county level over the study period.

Chapter 2 studies the causal effects of bonus payments provided by the Centers for Medi- care and Medicaid Services (CMS) through federally designated Health Professional Shortage Areas (HPSAs) on physician location decisions. We find suggestive evidence that counties des- ignated as HPSAs experience an increase in the number of early-career primary care physicians, many of whom are likely making initial location decisions, driven entirely by physicians who attended ranked medical schools. However, we find no evidence that HPSA designation induces physicians in later career stages to relocate to shortage areas.

Chapter 3 focuses on the recent refugee crisis, which has particularly affected countries in Europe. Specifically, we study how the recent refugee migration into Europe affects the mental health of the host country citizens in Switzerland and Germany, exploiting population-only based asylum seeker allocation rules for placement into cantons and counties, respectively. We utilize both administrative health insurance data and survey data. Despite the concerns and fears that have been sparked by the asylum seeker influx, overall, we find no economically significant effects on mental health in either country.