Three Essays in Health Economics: Evidence from U.S. Vaccination Policy

Abstract

In this dissertation I empirically examine a range of policies that have been implemented in the United States with the goal of achieving and maintaining high population vaccination rates. In the first chapter I focus on two policies targeted towards infants and young children: simple non-binding recommendations to receive the hepatitis A vaccine and mandates requiring receipt of the vaccine prior to childcare or kindergarten attendance. Using provider-verified immunization data I find that recommendations significantly increased hepatitis A vaccination rates among young children by approximately 20 percentage points, while mandates increased rates by another 8 percentage points. These policies also significantly reduced population hepatitis A incidence. In the second chapter (joint work with Christopher S. Carpenter), we estimate the effects of state laws that mandate receipt of the Tdap vaccine prior to middle school attendance. These mandates significantly increased Tdap vaccine take-up and reduced pertussis (whooping cough) incidence, with the largest reductions in disease occurring for the directly targeted age group (adolescents) and for the age group most vulnerable to pertussis (infants). We also document cross-vaccine spillovers: the mandates significantly increased adolescent vaccination rates for meningococcal disease and human papillomavirus (HPV), with particularly large effects for children from low SES households. Finally, the third chapter examines similar vaccination policies - non-binding recommendations and school entry mandates- but in the context of a population that is relatively less connected to the health care system: high school-aged adolescents. I find that vaccine recommendations and mandates significantly increase immunization rates among 16 and 17 year olds for the targeted vaccine, and I further document important spillovers of the mandates to the receipt of other, non-mandated, preventive care. In particular, I find treated individuals are approximately 7 percentage points more likely to have a check-up at ages 16 or 17. Overall, the results of these analyses suggest a range of policy options for addressing suboptimally low population vaccination rates among infants and adolescents and also demonstrate the importance of considering spillover effects on health and health behaviors when quantifying the effects of these policies.