Preschool-aged children get sick frequently and spread disease to other family members. Despite the universality of this experience, there is limited causal evidence on the magnitudes and consequences of these externalities, especially for infant siblings with developing immune systems and brains. We use Danish administrative data to document that, before age one, younger siblings have 2-3 times higher hospitalization rates for respiratory conditions than older siblings. We combine birth order and within-municipality variation in respiratory disease prevalence among young children, and find lasting differential impacts of early-life respiratory disease exposure on younger siblings’ earnings, educational attainment, chronic respiratory health and mental health-related outcomes.

We examine child mental health treatment surrounding four school milestones in Taiwan: Primary and middle school entry and high stakes testing for high school and college entry. Given age cutoffs for school entry, we compare August-born to September-born children. August-born reach milestones one year earlier, allowing identification of each milestone’s effect. Entry into primary and middle school increases in mental health prescribing, especially for ADHD and depression. Middle school entry also increases prescribing of anti-anxiety and antipsychotic medications. Use of psychiatric medications falls sharply following high-stakes tests. Effects are stronger in counties where parents and children have higher educational aspirations.

Public-private partnership (PPP) health insurance plans have been viewed as a promising tool to expand coverage while maintaining fiscal sustainability. However, little is known about their impact, particularly whether they increase overall coverage or displace existing private insurance. To examine this, we leverage the staggered introduction of China’s City-Customized Supplemental Medical Insurance (CCSMI) across cities and a novel transaction-level dataset of private health insurance. Results reveal significant spillover effects on both the extensive and intensive margins: CCSMI substantially crowds out private insurance purchases and reduces average coverage amounts. Average premiums paid also decline, with two-thirds of the reduction driven by consumers opting for narrower coverage and the remainder likely due to insurers’ pricing adjustments. A back-of-the-envelope calculation suggests that the decline in private insurance purchases offsets at least 25% of CCSMI enrollment gains. These findings provide important insights for comprehensively evaluating PPP insurance programs.

The older population bears a heavy burden of mental illness. Despite the availability of effective treatments, including services (e.g., psychotherapy) and drugs (e.g., antidepressants, antipsychotics), this paper documents substantial geographic variation in treatment utilization rates among Medicare enrollees. Exploiting patient migration, I show that 45.8% of service utilization variation is attributable to place-specific factors, compared to 15.1% for drug utilization. Further analyses suggest the role of provider accessibility in explaining the different place effects between service and drug use. Regarding health outcomes, I find that higher treatment utilization is associated with lower risks of self-harm-related emergency department visits.

We study Medicare’s competitive bidding program for durable medical equipment. We use Medicare claims data to examine the effect on prices and utilization, focusing on continuous positive airway pressure devices for sleep apnea. We find that spending falls by 47.2% after a highly imperfect bidding mechanism is introduced. This is almost entirely driven by a 44.8% price reduction, though quantities also fall by 4.3%. To disentangle supply and demand, we leverage differential cost sharing across Medicare recipients. We measure a demand elasticity of 0.272 and find that quantity reductions are concentrated among less clinically appropriate groups.

Health systems globally face increasing morbidity and mortality from chronic diseases, yet many - especially in low- and middle-income countries - lack strong chronic disease management in primary health care (PHC). We provide evidence on China’s efforts to promote PHC management using unique five-year panel data in a rural county, including health care utilization from medical claims and health outcomes from biomarkers. Utilizing plausibly exogenous variation in management intensity generated by administrative and geographic boundaries, we compare hypertension/diabetes patients in villages within two kilometers distance but managed by different townships. Results show that, compared to patients in townships with median management intensity, patients in high-intensity townships have 4.8% more PHC visits, 5.2% fewer specialist visits, 11.7% lower likelihood of having an inpatient admission, and 3.6% lower medical spending. They also tend to have better medication adherence and better control of blood pressure. The resource savings from avoided inpatient admissions substantially outweigh the costs of the program.