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This dissertation explores health care utilization and provision for the elderly. My research aims to answer questions about the health effects of specific types of care, government and insurance policies, and major life events.The first chapter, entitled "Retirement and Health: Evidence from England," investigates the effects of retirement on individual health. With many governments actively considering incentivizing longer working lives by raising the minimum age for pension programs, I examine the discontinuity at the State Pension Age in order to find the causal effect of retirement on health behaviors, health outcomes, health care utilization, and mortality. I focus on England due to a clearly-defined pension age and lack of confounding government programs, and use a full range of novel datasets, including census records, large nationwide surveys, and mortality records. I find that retirement substantially improves well-being, self-reported health, and decreases the proportion of people reporting long-term illnesses and disabilities. However, there is no evidence of an immediate effect on cognitive ability, health behaviors, or health care utilization. Consistent with this, I further show that there is no effect of retirement on mortality. Finally, I show that individuals' show signs of lower stress, with changes to both health markers and day-to-day activities. My estimates are generally more precise than those found in previous literature, and this paper is the first to examine a full range of health-related outcomes with administrative and survey data in a unified context.The second chapter investigates the effect of skilled nursing facilities. Here, I leverage a Medicare policy that induces a sharp change in the probability of being discharged to a skilled nursing facility (SNF) in order to generate causal estimates of the health effects of this type of care. Despite being a significant source of health care spending and of Medicare's annual budget, SNF care has been understudied, with systematic differences in individuals that enter into a SNF. The identification of this paper uses Medicare's requirement of a three-day stay in order to cover SNF care. Using inpatient and emergency department records, I find that those that narrowly made the cutoff experience a substantial increase in the probability of being discharged to a SNF, and a subsequent decrease in readmission probability.The third chapter explores the long-term effects of month of birth on self-reported health and morality rates. I use data from the Census of England and Wales and death certificates from the Office of National Statistics to examine these effects, focusing on a large sample of individuals born between 1940 and 1960. I find that individuals born in fall and early winter months are less likely to report being in poor health and have better mortality rates, particularly compared to those born in late spring and summer.

AbstractThis paper estimates the medium‐ to long‐run effects of slavery in the United States in a spatial regression discontinuity design. Using the boundary between free and slave states immediately antebellum, we find that legal slavery decreased per capita manufacturing output by as much as 30% in the decades following the Civil War. Perhaps surprisingly, agricultural output and farm values were only briefly depressed in former slave states after the war. Although emancipation ended slavery, political forces kept the institution from being completely disintegrated, and we explore channels through which this was possible. We show that slavery affected the structure of the economy in a given region—specifically through agricultural production decisions—and that these structures persisted long after passage of the 13th Amendment. However, sharecropping played a relatively small role in this region. Our results support mounting evidence in recent literature of the significant and lasting effects of institutions on economic development.

IMPORTANCE: The COVID-19 pandemic has affected every aspect of medical care, including surgical treatment. It is critical to understand the association of government policies and infection burden with surgical access across the United States. OBJECTIVE: To describe the change in surgical procedure volume in the US after the government-suggested shutdown and subsequent peak surge in volume of patients with COVID-19. DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study was conducted using administrative claims from a nationwide health care technology clearinghouse. Claims from pediatric and adult patients undergoing surgical procedures in 49 US states within the Change Healthcare network of health care institutions were used. Surgical procedure volume during the 2020 initial COVID-19–related shutdown and subsequent fall and winter infection surge were compared with volume in 2019. Data were analyzed from November 2020 through July 2021. EXPOSURES: 2020 policies to curtail elective surgical procedures and the incidence rate of patients with COVID-19. MAIN OUTCOMES AND MEASURES: Incidence rate ratios (IRRs) were estimated from a Poisson regression comparing total procedure counts during the initial shutdown (March 15 to May 2, 2020) and subsequent COVID-19 surge (October 22, 2020-January 31, 2021) with corresponding 2019 dates. Surgical procedures were analyzed by 11 major procedure categories, 25 subcategories, and 12 exemplar operative procedures along a spectrum of elective to emergency indications. RESULTS: A total of 13 108 567 surgical procedures were identified from January 1, 2019, through January 30, 2021, based on 3498 Current Procedural Terminology (CPT) codes. This included 6 651 921 procedures in 2019 (3 516 569 procedures among women [52.9%]; 613 192 procedures among children [9.2%]; and 1 987 397 procedures among patients aged ≥65 years [29.9%]) and 5 973 573 procedures in 2020 (3 156 240 procedures among women [52.8%]; 482 637 procedures among children [8.1%]; and 1 806 074 procedures ...