Essays in military healthcare

Abstract

This dissertation examines how American foreign policy and Department of Defense policies influence patterns of health and healthcare utilization for active-duty and retired military personnel and their families. Chapter one uses variation in the timing of deployments to study temporary parental absence. Deployment reduces preventative care, as measured by wellness visits and vaccinations. However, it increases emergency room use and mental health care. These effects are concurrent with parental absence, and disappear upon reunion. The response to deployment differs significantly by parental gender; when fathers become sole caregivers all types of utilization fall. Chapter two uses the administratively determined moves of military doctors to investigate the effect of interrupting the doctor-patient relationship. Exploiting variation in the timing of these moves, I find that change of a primary care provider increases outpatient utilization by 23 percent over the following year. While extra primary care drives three-quarters of this increase, specialist care, and labs tests, and images are also elevated. Increased emergency room use and preventable hospitalizations imply a causal link between the doctor-patient relationship and beneficiary health. These effects increase with the length of the relationship. Chapter three leverages on-base hospital closures to estimate differences in utilization between admissions to on- and off-base hospitals. We find that inpatient utilization is one percent higher per admission to private hospital. There is no measurable difference in health outcomes for nondeferrable care. Private prenatal care results in better outcomes for mothers and infants. Nevertheless, utilization remains higher for private birth admissions, including for women who present in healthier condition as indicated by birth weight and prematurity.