Essays on Health and Development

Abstract

This dissertation is comprised of three related essays pertaining to healthcare and its relationship to economic development using data from Costa Rica. In particular, it discusses the economic, educational, and public health implications of a wide-ranging health reform in the context of a country with universal healthcare. In chapter 1, I study whether a coordinated effort by a government to expand access to healthcare through increased expenditure would bring about higher incomes at the household level. Using data from the major healthcare reform that Costa Rica underwent starting in 1994, which greatly increased access to primary healthcare, I explore the effects of getting local clinics (known as EBAIS) in their district as a result of the reform on household and personal income. Based on theoretical work by Strauss and Thomas (1998) and a seminal paper by Grossman (1972), my main hypothesis is that, by producing healthier individuals, having increased access to healthcare incentivizes people to pursue better-paying jobs, thereby increasing their income. I proceed by difference-in-difference, as well as by an event study specification, both of which point to a positive average impact of around 4% of getting a clinic on income. In chapter 2, I explore the effects of the healthcare reform on education. A difference-in-difference analysis points to an increase of 0.07 to 0.11 years of education as a result of getting an EBAIS stemming from the reform. Additionally, using the statistical tool of mediation, I find that as a result of getting an EBAIS, and through the channel of household income, theaverage person increased their level of education by a significant 0.69 years (with people in the study having on average 5.6 years of education). The mediation analysis demonstrates that increases in household income from the reform, shown to exist in Chapter 1, account for a significant 4.3% of the increase in years of education, with the rest attributable to other channels. In chapter 3, I revisit and update the results on mortality from Rosero-Bixby (2004). Using close to a decade's-worth of new data, my goal was update his results and determine if they had persisted since the publication of his study. I find a highly statistically significant 5.62% decrease in general mortality, a 22.75% decrease in under-five infant mortality, both attributable to the healthcare reform that created the EBAIS, and through the channel of reductions in infectious and chronic illnesses. These numbers are higher than Rosero-Bixby's results of a 2% reduction in general mortality and an 8% decrease in infant mortality, thereby showing that the reform has continued to have effects since his initial paper.