Several reviews have shown that health problems are the single most common adverse event experienced by households in many low- and middle-income countries. There is a great deal of research documenting household health expenditure and its impact on poverty. However, evidence on the costs incurred by households outside of the health care system is at best scattered. The objective of this present study is to document the household response to illness in China using two large-scale panel household surveys and following a 'health shocks' approach. Health shocks are used to address endogeneity concerns associated with the use of alternative traditional health measures. In this manuscript, the impact of health shocks on household socio-economic status and welfare is analysed using a framework encompassing household income, medical expenditure, consumption patterns, coping strategies, and labour force supply. We find that health shocks lead to a significant increase in medical expenditure (significant for all types of shocks), and in the case of a health shock experienced by a household head, to a decrease in income ranging around five per cent of the total household income. This decrease in income is partly explained by a statistically significant reduction in labour force supply (work hours and labour force participation) from individuals who experienced a shock (larger for women and elderly). In addition, for rural-to-urban migrant workers, health shocks are associated with a higher probability of returning. However, spouses also increase their labour force supply in response, which helps avoiding large shortfalls in income. Significant coping strategies include increase in debts and remittances; and in some cases, sale of assets. On consumption, households are mostly able to maintain consumption levels following the occurrence of a health shock (with the exception of food consumption). Nonetheless, we find a significant large negative trailing impact on consumption in subsequent years. This is in line with the literature arguing that households are risk adverse and deploy ineffective coping strategies to avoid immediate shortfalls in consumption, which generate delayed costs in the long run. The results of the analyses carried out in this thesis highlight some of the potential channels of impoverishment due to health shocks, which might be of interest for policy makers, especially in China where a large-scale health system reform is currently taking place.

In Chapter 1 of this thesis we examine two key empirical questions in public economics by exploiting the 2009 Polish tax reforms. First, we estimate the degree of substitution between employment and self-employment tax bases – on the extensive margin. In particular, we quantify the impact of changes in the differential in rates of taxation between the two tax bases on the propensity of taxpayers to declare any positive level of employment or self-employment income. Second, we contribute to the literature on elasticities of taxable income on the intensive margin – the responsiveness of taxable income to changes in marginal tax rates – by providing estimates which are more likely to be robust to changes in year-to-year income dynamics than previous estimates. To identify these effects, we exploit variation in marginal and total tax rates around the 2009 reforms which occurs independently of an individual’s position in the income distribution as a result of joint reporting with a spouse. At the same time, to obtain the extensive-margin responses, we exploit the uniqueness of the 2009 Polish tax reforms, which left the tax schedule un-changed for some types of self-employment while changing the tax schedule for the employed. The baseline estimates of the intensive-margin elasticities are around 0.2-0.3 for the employed and around 0.5-0.7 for the self-employed. The estimates jointly make possible the decomposition of the deadweight losses of the tax reform into intensive and extensive-margin responses, with the contribution of the extensive margin found to be around 7% of the total. In Chapter 2, we examine the optimal non-linear taxation in an environment in which individuals have the option of engaging in either employment or self-employment activity. We build on the estimates from Chapter 1 to calibrate an extension of the classic Mirrleesian model which allows for extensive-margin transitions between employment and self-employment. The results help rationalise the preferential tax treatment of self-employment income versus employment income given in certain tax systems. They also illustrate the ways in which the possibility of extensive-margin transitions between tax bases moderate the incentive to give such preferential treatment. Based on the parameterisation here, the presence of the extensive-margin ap- pears to have a limited impact on the optimal marginal and total tax rates faced by the employed and self-employed. This, together with the earlier decomposition of deadweight losses in Chapter 1 by types of response, points towards a limited role of the extensive margin as a consideration for optimal-tax design, at least as far as the employment and self-employment tax bases are concerned. Chapter 3 turns to a fundamental question in health economics: how do health states change over the life-cycle, and how does the risk of adverse health-shocks change over the life-cycle? Most economic models of individuals’ behaviour over the life-cycle, to the extent to which they incorporate a measure of health risk, assume a simplified unidimensional measure of health. We contribute to this literature by estimating a flexible dynamic factor model of health and health risk over an individual’s life using the rich health data from the Health and Retirement Study (HRS). We find that the many potentially collinear health indicators found in the HRS can broadly be summarized into four underlying factors. Three of these correspond to what may be termed subjective health measures, such as self-reported mobility, while a fourth corresponds to objective measures, including the number of overnight hospital stays, doctor visits and medical spending. The persistence of these underlying factors and the variance of their shocks are estimated as parameters of a vector auto-regressive process. We obtain results about the deterministic evolution of the health factors with age, the level of risk relating to each health measure, as well as heterogeneity by level of education. These are intended as building blocks of an ongoing project concerning the optimal design of disability insurance, given the health risks faced by individuals.

This dissertation consists of two essays examining formal and informal long term health insurance markets. The first essay analyzes heterogeneity of Long-Term Care Insurance policyholders in their lapse decision, and how their ex-ante and ex-post subjective beliefs about the probability of needing Long-Term Care affect their lapse decisions. In this essay, I develop a model of lapse decision in a two-period insurance framework with a Bayesian learning process and implement several empirical specifications of the model using longitudinal data from the Health and Retirement Study. The results show that policyholders' ex- ante point predictions of their probabilities and their uncertainties about them have a persistent but declining impact on lapse decisions. Those who believe that their risk is higher are indeed more likely to remain insured. However, as their uncertainties surrounding their ex-ante point predictions increase, their chances of lapsing increase regardless of their initial perception biases. These results are heterogeneous across cohorts and policyholders and, in particular, show that those in the older group near the average age of Nursing Home entry have a precise prediction of their risk levels compared to the younger cohort. Policy simulations show that a more informed initial purchase decision reduces the chance of lapsing down the road. The second essay examines the extent to which informal risk sharing arrangement provides insurance against health shocks. I develop a comprehensive model of informal risk sharing contract with two-sided limited commitment which extends the standard model to a regime with the following features. Information regarding the nature of realized health shocks is imperfect and individuals' health capital stock serves as a storage technology and is a factor of production. The theoretical results show that, in such a regime, Pareto optimal allocations are history dependent even if participation constraints do not bind. I perform numerical analysis to show that risk sharing against health shock is less likely to be sustainable among non-altruistic individuals with different levels of biological survival rates and health capital productivity. The results also show that optimal allocations vary depending on the set of information available to individuals. Using panel data of households from villages in rural Ethiopia, I test the main predictions of the theoretical model. While there is negative history dependence in transfers among non-altruistic partners, history dependence is positive when risk sharing is along bloodline and kinship. However, neither short-term nor long-term health shocks are insured through informal risk sharing arrangements among non-altruistic individuals.

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Les micro-entreprises domestiques constituent une part importante, si ce n'est dominante, de toutes les économies en développement. C’est aussi le cas au Vietnam où le poids du secteur informel diminue peu malgré une croissance économique rapide. Les quatre chapitres de ce travail posent quatre questions fondamentales pour informer les politiques publiques. Leur originalité est d'adopter le point de vue des entreprises informelles elles-mêmes. Quels bénéfices y a-t-il à rejoindre le secteur formel (chapitre 1)? Quelle est la vulnérabilité de ces unités de production, dont le budget est souvent confondu avec celui du ménages, aux chocs de santé (chapitre 2) ? L’assurance santé permet-elle de réduire efficacement cette vulnérabilité (chapitre 3) ? Enfin, quelle est l’importance du mode de gestion de ces micro-entreprises (chapitre 4) ? Tous les chapitres s’appuient en premier lieu sur des données d’enquêtes quantitatives, de première ou seconde main. L’approche quantitative est complétée par des enquêtes qualitatives. Les résultats dressent le portrait d’un secteur dynamique, dont la persistance ne peut être ignorée, et suggèrent des mécanismes pour améliorer la productivité de ces entreprises qui opèrent dans des conditions largement précaires. / This PhD dissertation is built around four main chapters. Their topic shall sound familiar to policy makers, and to all empirical economists working on microenterprises, as they quesion the common mottos to deal with the informal sector: “formalize them”, “protect them”, and “train them”. Little of these recommendations rely on actual evidence, in particular regarding their effects for the firms themselves. Chapter one starts by questioning the relevance of formalization: what exactly do these production units have to gain from registration? The second chapter investigates the vulnerability of microenterprises to health problems: how much do they suffer from the consequences of health shocks within the household? The third chapter deals with the complementary question of the protection mechanisms, and questions the mitigating potential of health insurance. The fourth chapter finally deals with their managerial capital: do the business skills that are considered standard among larger firms have any meaning for informal micro enterprises?

Esta tesis contribuye a la literatura analizando los efectos causales que el estado de salud tiene sobre la participación laboral en la población en edad de trabajar. De este modo, analiza los efectos que un deterioro en el estado de salud tiene sobre la participación laboral del individuo, así como los efectos de proveer cuidados informales sobre la participación laboral femenina. El primer capítulo utiliza una aproximación empírica homogénea en nueve países europeos, lo que hace posible relacionar las diferencias encontradas con diferencias en el contexto institucional. El segundo capítulo analiza el papel que juega el estado de salud en las transiciones hacia y fuera del empleo. Los resultados muestran que el estado de salud general afecta simétricamente las entradas y salidas del empleo, mientras que cambios en el estado de salud mental sólo influyen el riesgo de abandonar el empleo. El tercer capítulo examina los efectos de varios tipos de cuidados informales en el comportamiento laboral femenino. Los resultados sugieren que los costes de oportunidad laborales aparecen en aquellas mujeres que conviven con la persona dependiente, al mismo tiempo que los efectos negativos surgen cuando se proveen cuidados informales por un período superior al año. / This thesis aims to contribute to the literature with an attempt to identify the causal effects of health on labour market outcomes in the working-age population. I analyse the effects of the onset of a health shock on the individuals' labour market outcomes, and also the effects of caregiving on female labour participation. The first chapter uses a homogeneous empirical framework to estimate the first set of effects on nine European countries, which allows me to relate the empirical estimates to differences in social security arrangements across these countries. The second chapter analyses the role of health in exits out of and entries into employment and the results show that general health affects symmetrically entries into and exits out of employment, but changes in mental health status influence only the hazard of non-employment for the stock sample of workers. The third chapter examines the effects of various types of informal care on female labour behaviour and the results suggest the existence of labour opportunity costs for those women who live with the dependent person they care for, and the negative effects appear when caregiving for more than a year.