Date of Award

Summer 8-2021

Degree Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Department

Economics

First Advisor

James Cox

Second Advisor

James Marton

Third Advisor

Vjolca Sadiraj

Fourth Advisor

Scott Cunningham

Abstract

In recent years, sexual and mental health have become increasingly important in both national discourse and policymaking. These shifting priorities present unique opportunities for economists to study the market contexts, incentives, and trade-offs faced by those making choices about their sexual and mental health. This dissertation’s chapters utilize a mix of experimental and quasi-experimental methods to examine how changes in the health policy landscape affect choices about the treatment and prevention of sexually transmitted illnesses (STIs), and how patterns of discrimination affect access to mental healthcare markets.

Chapter 1 estimates the causal effect of a major eligibility expansion of a major expansion of eligibility for high-quality public health insurance on utilization of medications used to treat and prevent the viral STIs: Human Papilloma Virus, Genital Herpes, and viral Hepatitis. I find a significant increase in uptake of prescriptions used to treat viral STIs, principally driven by uptake in prescriptions to treat genital herpes. These increases appear to be driven primarily by these eligibility expansions, and not by trends of incidence of the illnesses themselves, suggesting pent-up demand for the treatment and prevention of common viral STIs.

Chapter 2 similarly estimates the causal effect of the same public health insurance eligibility expansion on the incidence of HIV and AIDS, mortality, and prescriptions for specialty combination drugs used to treat and prevent these diseases. Using matched data from the Centers for Disease Control and Prevention and the Centers for Medicare and Medicaid Services, I find that while Medicaid expansions had an ambiguous effect on the actual incidence and mortality of HIV and AIDS, it led to a modest uptake in prescriptions for these combination drugs.

Chapter 3 details the results of a field experiment aimed at detecting evidence of discrimination against transgender individuals, racial, and ethnic minorities in access to mental health appointments. Constructing a nationally-representative sample of mental health providers, we conduct an audit study in which fictitious prospective patients request mental health appointments. We find evidence of discrimination against both racial and ethnic minorities and transgender individuals, especially along intersectional lines.

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