UC San Diego

This dissertation consists of three chapters that pertain to a core theme in health economics: the role of government policies on individuals, families, and markets. In Chapter 1, we study how employer-sponsored insurance coverage for dependents affects their parents' labor supply decisions. Coverage for dependents is a common feature of employer-sponsored insurance. While prior work shows that employees trade off job mobility for their own coverage, there is less evidence on the intra-family spillovers of dependent coverage onto parental labor supply. We study this using a panel of insurance claims that links dependent insurance enrollment with a proxy for parental job tenure. We develop a regression discontinuity design that exploits variation in coverage eligibility by dependent birth date from the Affordable Care Act, and find that a one percent increase in the dependent enrollment likelihood increases parental job retention by 0.20 percent.

In Chapter 2, I study a reform of the kidney allocation system that involved re-drawing the areas within which donated organs are matched to patients from fixed regions to circles around each donor hospital. To estimate the causal effects of the reform, I exploit the sharp timing of its implementation as well as variation in predicted treatment intensity across transplant centers. I create a novel dataset consisting of detailed administrative information on the universe of donated organs, transplant candidates, and transplant centers using the universe of transplant records in the United States. I find that the reform increased efficiency in organ allocation by reducing the share of donated kidneys that were discarded and mortality among transplant candidates. I document important distributional effects -- kidney recipients after the reform were more likely to have extended dialysis history and reside in counties with higher marginalized populations.

In Chapter 3, I explore the impact of a ``high risk'' designation on organ quality assessment on the efficiency of the organ allocation system. As all kidneys from deceased donors aged 60 or above are classified as expanded criteria donor (ECD) regardless of their health conditions between 2002 and 2014, the dichotomous kidney classification may have increased confusion about the kidney quality of older donors. Combining administrative data on the universe of organ donors and transplant recipients in the U.S., I employ a regression discontinuity design in the donor's age to study the impact of ECD designation on the use of donated kidneys for transplant. I find that the ECD scheme increases the kidney discard rate at the cut-off. Exploiting the timing of the policy change that replaced the ECD scheme with a continuous measure for organ quality in December 2014, I provide evidence that the discard rate decreases for kidneys no longer classified as marginal kidneys under the new scheme compared to those that remain classified in that category.