Essays on the effect of health care and the environment on health

Sammanfattning: This thesis consists of three self-contained papers studying different topics in health economics. The first chapter studies the substitution effect between in-person physician visits and a new type of doctor visits, direct-to-consumer (DCT) telemedicine, where a person can call a doctor directly via an app. To causally assess to which degree DCT consultations substitute for in-person consultations, we exploit exogenous changes in patient fees in a fuzzy difference-in-discontinuities analysis of young adults in Sweden. We estimate a degree of substitution of 45%, implying an increase in the consultation volume. While the characteristics of the additional demand raise concerns related to healthcare equity and efficiency, the results also suggest that the increase in volume is close to cost neutral and there is no evidence of decreased quality of care. The second chapter studies the importance of patient-to-practice continuity of care for patient outcomes. Exploiting plausibly exogenous timing of closures of primary care practices in a Swedish region, I find that patients who experience a practice discontinuity have an immediate 15% decrease in visits to primary care physicians which lasts for at least two years, with some evidence showing this is partially offset by an increase in visits to nurses and other primary care providers. This effect is stronger for patients with no history of chronic diseases and immigrants. I find that a large share of directly affected patients migrate to neighbouring remaining practices which temporarily crowds out previously established incumbent patients. The third chapter in this thesis studies the effect waterborne disease risk on children's health and learning in Tanzania. Using a difference-in-differences approach, we find that when one-tenth of the local area is covered by simulated disease-prone stagnant water, children are 2.8 percentage points likelier to have diarrhoea, corresponding to an almost 11% increase relative to the baseline incidence. We also find that children have 0.07 standard deviations lower test scores. These results mask important heterogeneities: We find that the most vulnerable children are those who live in urban areas with poor sanitation. Hence, policymakers should consider local environmental risk factor of waterborne diseases when implementing sanitation policies