Louis A. Rene Fréget defends his PhD thesis at the Department of Economics

Candidate:

Louis Alexandre Rene Fréget, Department of Economics, University of Copenhagen

Title:

Four Essays in Health Economics – Early Health Inequality, Early Investments and Family Well-being 

Supervisors:

  • Miriam Wüst, Associate Professor, Department of Economics, University of Copenhagen
  • Hans Henrik Sievertsen, Professor MSO, VIVE

Assessment Committee:

  • Torben Heien Nielsen, Professor, Department of Economics, University of Copenhagen
  • Rita Ginja, Professor, Department of Economics, University of Bergen
  • Krzysztof Karbownik, Associate Professor, Department of Economics, Emory University

Summary:

This PhD dissertation documents early health and socioemotional inequalities in Denmark and isolates some of their determinants. It consists of four self-contained chapters. The first two chapters have a descriptive aim.  They reveal new patterns that connect inequalities in birth outcomes, infant health, maternal mental health, parental investments, and children’s socioemotional development. The final two chapters employ quasi-experimental methods to uncover determinants of birth outcomes and postpartum maternal mental health. 

The first chapter of my dissertation is joint work with Jonas Ćuzulan Hirani and Miriam Wüst. Mental health issues are among the most common complications of childbirth. We examine the relationship of maternal postnatal mental health issues and family outcomes in population data from a universal screening program for new parents in Denmark. We present three sets of findings: First, using an event study approach, we document that postnatal mental health issues contribute to the child penalty in labor market outcomes. Second, we explore the relationship of maternal mental health issues with family well-being, parental behaviors and infant socio-emotional development. We document oftentimes non-linear relationships between higher maternal depression risks and worse family outcomes. Zooming in on fathers, we find spillovers of poor maternal mental health on fathers’ hours worked and on their involvement in the family (suggesting compensating behaviors by fathers). Third, examining the timing of health care usage during the first year of the child’s life, we show women’s uptake of low-complexity care increases around the suggested timing of the universal screening. 

The second chapter is joint work with Hans Sievertsen and Miriam Wüst. Both family income around birth and health at birth are positively associated with favorable later life outcomes for children. However, evidence from Sweden and the US shows that children in the upper part of the income distribution have worse health at birth than children further down the income distribution. We confirm this pattern using Danish data and also confirm that the negative income-health-at-birth relationship is driven by two factors: higher maternal age and higher rates of non-singleton births in the upper part of the income distribution. Studying the first year of the child's life, we show that high-income families are able to compensate for the initial worse health status: higher family income is associated with more days of exclusive breastfeeding, fewer emergency GP contacts, fewer nurse visits, higher first-year weight, and faster socioemotional development.

The third chapter is joint work with Maria Koch Gregersen. It uses a quasi-experimental approach to isolate the medical and social impacts of a labor induction guideline in Denmark. Despite routine induction for mothers with a high BMI being frequent in developed countries, there is no consensus on the net benefits of the practice for higher-risk populations such as obese mothers. We study the consequences of earlier routine induction of labor for a growing sub-population of pregnancies: high-BMI women. Using a regression discontinuity design, we exploit Danish obstetric guidelines mandating inductions for mothers with a BMI of at least 35 one week after the due date instead of 10-13 days after. In addition to improving short-term health of both mother and child, early labor induction reduces the number of nurse visits during the first year of life as well as maternal postpartum depression risk (suggestive). The intervention has no statistically significant medium-run effect on maternal supply nor on fertility in the medium-run.  

The chapter which closes the dissertation is solo-authored. I study the effects of general physicians’ practice closures during pregnancy on birth outcomes. Understanding the impact of clinic closures appears to be a crucial stake. The aging of the general physician workforce in developed countries is expected to lead to increased practice closures. Hence, concerns arise regarding the health effects of such closures, particularly for patients facing them during critical life stages such as pregnancy. However, no study exists to date on the health effects of general physicians’ (GP) practice closures during pregnancy. I compare the birth outcomes of mothers experiencing practice closures within nine months post-conception to those facing closures nine months prior to conception. I find a small to medium-sized adverse effect of discontinuity in care on birth outcomes. The negative effect on birth weight is especially pronounced when the closure happens in the last trimester of pregnancy.  Such dip in birth weight for mothers facing a closure in their last pregnancy trimester is pronounced enough to be readily seen in the descriptive data. Consistently, mothers affected by GP practice closures during pregnancy experience small disruptions in healthcare provision at the extensive and at the intensive margin.

An electronic copy of the dissertation can be requested here: lema@econ.ku.dk