Document Type



Doctor of Philosophy



First Adviser

Meyerhoefer, Chad D.


This dissertation consists of three essays. The first essay examines how the change in training requirements for certified nursing assistants influences the staffing hours and quality of care in nursing homes. In particular, I use the 2000-2016 Nursing Home Compare data on staffing information and quality of care in nursing homes and seek to evaluate certification requirements on certified nurse assistants (CNA). The impact of CNA training is identified by exploiting state-level variation in required total training hours and the ratio of clinical to total training hour requirements across states. Results show that a higher ratio of clinical to total training hours is associated with an increase in staffing hours of nurse assistants and a decrease in licensed practical nurse hours, as well as improvement in quality of care. These effects are more pronounced among large nursing homes and nonprofit nursing homes.The second essay investigates the effects of dental hygienist scope of practice regulations and autonomy levels on dental care access, utilization, and expenditure. I measure the strength of these laws by extending the Dental Hygiene Professional Practice Index to the years 2001 to 2014. Data on dental care utilization for this analysis come from the 2001-2014 Medical Expenditure Panel Survey. Using a difference-in-difference approach that exploits variation within states over time in the scope of practice laws for identification, I find evidence that increasing the autonomy level of dental hygienists modestly increases dental care utilization, on average. However, increases in use are more pronounced in areas with a shortage of dental care providers.In the third essay, I estimate the short-term effects of paid sick leave on worker absenteeism and health care utilization in the U.S. using data from the 2000-2013 Medical Expenditure Panel Survey. In order to account for nonrandom selection into jobs that offer paid sick leave benefits, I use a difference-in-difference matching specification and estimate the treatment effect of paid sick leave separately for workers who gained paid sick leave and workers who lost paid sick leave. I find that losing paid sick leave benefits decreases the probability of taking sickness absence days among both male and female workers, but that gaining benefits increases absenteeism only among female workers. I also find that the probability of having an outpatient medical visit is higher among women who gain paid sick leave, suggesting that expanding paid sick leave to more women could be welfare improving.

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