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The early years of children's lives are crucial to their future health and development. Disparities in health and skills that emerge during children's first few years increase with age. Many factors affect children's health. At an individual level, mother's education is an influential factor. At a societal level, public policies affect children's surrounding environment that influences their health. Therefore it is critical that public policies and other determinants of children's health be studied carefully. As a nation, U.S. has made significant improvements in children's health over the past century. However, there is a significant increase in the number of children in the U.S. today that suffer from conditions and diseases that have emerged in recent years, including asthma and obesity. These conditions are impediments to children's healthy development and have long lasting effects. Investment in children's health yields long term payoffs at the individual as well as societal levels. Healthy children have more opportunities to succeed in schools and more likely to become healthy, productive adults. Benefits extend to society as a whole including reduced dependency and disability, a healthier future workforce, and consequently a stronger economy. Due to these reasons, it is important to understand how health care use and health among children in the U.S. have been affected by some of their key determinants in recent decades. This dissertation is divided into three chapters. The first chapter examines the feasibility of using compulsory schooling policies as instruments for mother's schooling to examine the causal effect of mother's schooling on children's health care use and health. The second chapter examines the causal effect of insurance coverage on children's health care use and health using evidence from the Medicaid and SCHIP expansions. The third chapter examines the causal effect of welfare reform on children's health care use and health. Findings from this dissertation provide informative insights on key factors that shape children's health and wellbeing and highlight important methodological issues involving such empirical research.
This dissertation is comprised of three independent research papers, which broadly focuses on the introduction and outcomes of policies concerning children's health and education. Although the chapters are related in theme, the objective, scope and empirical strategy of each paper differs. The first chapter, "How Did SCHIP Affect the Insurance Coverage of Immigrants Children?" (with Thomas Buchmueller and Anthony Lo Sasso), focuses on the passage of the State Children's Health Insurance Program in the late 1990s, which expanded public insurance eligibility and coverage for children in "working poor families". Despite this success, over 6 million children are eligible for public insurance, but remain uninsured. The study focuses on children born to immigrant parents because of their low rates of insurance coverage and unique enrollment barriers. The results indicate SCHIP was successful in increasing overall insurance take-up and in reducing disparities in access to health insurance coverage. The second chapter, "Looking Beyond Test Score Gains" determines whether the introduction of school accountability programs (prior to the No Child Left Behind Act in 2001) affected individuals' educational attainment and labor market outcomes. The effects are evaluated along two dimensions: differences in the length of program exposure and variation in program quality. The results indicate school accountability had mixed success in increasing outcomes across gender and racial/ethnic groups. They also suggest the heterogeneous treatment effects are consistent with some of the unintended consequences documented in the school accountability literature. The third chapter, "The Role of Education on Health Behaviors, Investments and Outcomes", uses a new combination of instrumental variables to predict individuals' schooling and determine whether there is a causal effect of education on young adults' health behaviors. The instruments rely on changes to state policies, dating back to the 1970s, that dictate when children are permitted to start and stop attending school. The results indicate education not only decreases the likelihood of smoking, heavy drinking and obesity, but affects the frequency of these behaviors and degree of obesity. Education also promotes behaviors that are akin to health investments, such as increasing sunscreen use and the receipt of preventive services.