Essays on the economics of healthcare and health

This thesis consists of three empirical chapters of which two are related to the analysis of hospital performance and one to the determinants of health capital. Health systems implementing policies to boost hospital efficiency might face a trade-off with quality of care. Chapter 1 examines whether hospitals experiencing higher bed occupancy rates are associated with lower quality in the English National Health Service. Using hospital-level data and linear regressions, the results show that bed occupancy is positively associated with overall and surgical mortality, negatively associated with patient-reported health gains but not associated with emergency readmissions nor condition-specific mortality. The associations are explained by patient’s length of stay and variations in bed occupancy across hospitals. Access to public healthcare should not depend on patient’s socioeconomic status. Chapter 2 evaluates socioeconomic inequalities in inpatient waiting times for surgeries in publicly funded hospitals in Catalonia, Spain. It uses patient-level data for six common planned procedures and four cancer surgeries. Compared to patients in the low-income group, patients in the middle-income group wait 2-6 fewer days for hip replacement, cataract surgery, and hysterectomy, and less than a day for breast cancer surgery. Patient and hospital characteristics do not explain waiting times inequalities, which arise within hospitals. Early childhood education policies are thought to improve child human capital development. Chapter 3 explores the effect of a universal preschool programme in Spain, which expanded public preschool places at age three, on long-term health. The chapter exploits the timing and geographical variation of the programme by employing a difference-in-differences strategy and uses survey and registry data. It finds that the policy does not affect long-term health, except for two outcomes. Children aged three post-policy residing in regions exposed to a greater initial implementation intensity of the programme have a lower prevalence of asthma but higher hospitalisation rates.