Evaluating U.S. Health Policy Levers Using Difference-In-Differences: Hospital Acquisitions, Global Budgets, And Income Policies, Kola Adegoke

NYMC Student Theses and Dissertations

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Abstract

Background: U.S. health policy relies on multiple levers to influence system performance, financial stability, and population health. This dissertation uses a three-paper portfolio to evaluate organizational change (hospital acquisitions), payment reform (Maryland all-payer global budgets), and income-related state policies, applying difference-in-differences (DiD) designs with prespecified diagnostics to support causal interpretation.

Methods: Study 1 examined hospital change-of-ownership (CHOW) acquisitions using a national hospital-year panel from RAND HCRIS (2014–2023), linked to CHOW timing data from 2016–2023. Effects on revenue outcomes were estimated using a staggered difference-in-differences design implemented with the Callaway and Sant’Anna estimator, using doubly robust inverse probability weighting, hospital-level …

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Intergenerational Hypertension Transmission Before And After South Africa's Democratic Transition, Winfred A. Avogo

Faculty Publications – Sociology and Anthropology

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Background: Apartheid's structural violence produced profound cardiovascular inequalities among Black South Africans through processes that accelerate biological aging ("weathering") and transmit health disadvantage across successive generations. Whether South Africa's 1994 political transition interrupted this intergenerational transmission remains unknown. This study tests whether parent-to-offspring hypertension transmission weakened among cohorts born after apartheid's end, using the 1994 transition as a natural experiment. Methods: This study analyzed 30,438 parent-offspring dyads from five waves (2008–2017) of South Africa's National Income Dynamics Study, representing 11,655 unique offspring aged 18 years and older. Hypertension was defined as blood pressure ≥140/90mmHg or use of antihypertensive medication. Logistic …

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Cost-Effectiveness Of Blood-Based Fibrosis Screening In High-Risk Metabolic Liver Diseases With Emerging Therapies, Wanyi Chen, Stephanie T. Chang, Ramsey C. Cheung, Donald B. Chalfin, Kinpritma Sangha, Szu-Yu Zoe Kao, Artem T. Boltyenkov

College of Population Health Faculty Papers

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BACKGROUND AND AIMS: Metabolic dysfunction-associated steatotic liver disease (MASLD) remains a global public health threat. With emerging effective pharmacologic therapies, early identification of significant fibrosis in primary care is critical. We evaluated the cost-effectiveness of blood-based noninvasive tests incorporating real-world diagnostic performance in the contemporary MASLD treatment era.

METHODS: We developed a decision-analytic model for MASLD natural history and treatment to compare 6 noninvasive test strategies using Fibrosis-4 (FIB-4) and/or enhanced liver fibrosis (ELF) tests at varying cutoffs. Patients identified with significant fibrosis were referred for hepatology staging (biopsy and/or imaging-based), and eligible individuals were considered for Resmetirom ($47,400/y; mean …

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Awarded Research Grants As A Pathway To Sustainable Development Goals, Maha Inam, Salim S. Virani, Melaine D'Cruze, Veronica Robi, Peter Gatiti, Anil Khamis

Population Health, East Africa

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The United Nations Sustainable Development Goals (SDGs) are a set of global goals that provide an agenda for sustainable growth and development across all sectors and disciplines. However, the contribution of academic institutions from the developing world towards the SDGs has not received adequate attention from the scientific community. A review of all the awarded grants in 2022 and 2023 at an international academic institution was conducted. The objectives outlined in the grant proposals were used to map the SDGs accordingly. A quantitative frequency analysis was conducted to tabulate the results. A total of 293 grants obtained in 2022 and …

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Social, Environmental And Policy Contexts Affecting The Feasibility And Acceptability Of Improving Household Flooring For Better Health In Rural Kenya, Ulrike Fillinger, Victoria Ochwal, Hugo Legge, Sharon Muli, Karisa Kazungu, Carlos Mcharo, Jacinta Mwongeli, Charles Mwandawiro, Katherine Halliday, Doris Njomo

Institute for Human Development, East Africa

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Background Homes with unimproved floors (earth, sand, or clay) are associated with increased risks of soil-transmitted parasites and enteric infections, leading to higher morbidity and reduced quality of life. This study explored the enablers and barriers to adopting improved flooring (sealed, washable, and durable) in three culturally diverse regions of Kenya - Narok, Bungoma, and Kwale - to mitigate disease burdens.

Methods Between August 2021 and July 2022, we conducted 24 focus group discussions with homeowners, stratified by age, gender, and floor type. Additionally, 28 key informant interviews with local government officials, microfinance representatives, and masonry trainers in Kwale and …

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Access Resource Guide For Bay Area Cultural Arts Organizations Developed In Collaboration With People With Intellectual And Developmental Disabilities, Clarissa Junio

Occupational Therapy | OTD Capstone Projects

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Background: Hidden access barriers persist within cultural arts organizations. As a result, people with IDD continue to experience reduced levels of community participation, limiting the associated benefits to health, well-being, and quality of life. Organizational-level occupational therapy (OT) consultation can address barriers and expand organizational capacity to meet the needs of people with IDD.

Purpose: The project aimed to strengthen organizational capacity of Bay Area cultural arts organizations and expand existing accessibility resources by co-developing a resource guide centered on lived experience to maximize community social participation for people with IDD. The guide was disseminated to cultural arts …

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From Fog To Function: An Occupational Therapist's Guide To Evaluating And Treating Cancer-Related Cognitive Impairments, Lauren E. Toner

Entry-Level Occupational Therapy Doctorate - Doctoral Capstone Symposium

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Cancer – related cognitive impairment (CRCI) is a common side effect of cancer treatment that interferes with cancer survivors’ occupational performance, independence, and quality of life. Despite its high prevalence, CRCI remains under recognized and inconsistently addressed within oncology care. About 70% of individuals diagnosed with cancer report cognitive changes during or after treatment, yet many do not receive treatment. Occupational therapists are clinically trained to evaluate and treat functional cognition, activities of daily activities, instrumental activities of daily living, and client centered goals, positioning them as key providers in addressing CRCI. However, limited occupational therapy specific resources have hindered …

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Feeding Missoula: Food Insecurity In Rural Children And Youth, Chani Brammer, Braelee Cheeks, Jordin Holland, Rayne Mccollough, Laurel Palmer, Therese Solomon

Undergraduate Theses, Professional Papers, and Capstone Artifacts

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In Montana, approximately one in seven children live in a food-insecure household, with rural Montanans in particular facing significant barriers. Existing needs-based food assistance programs, such as SNAP and WIC, have structural weaknesses: SNAP benefits are often not sufficient to last through the month, and those eligible for these programs face a confusing application process, shame and stigma, and logistical hurdles, such as limited transportation.

“Feeding Missoula” began with an evaluation of how current food assistance programs met or failed to meet the needs of rural youth. Our methodology integrated a comprehensive review of existing literature and structured interviews with …

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Teaching Equity Early: The Role Of Undergraduate Education In Improving Lgbtqia2s+ Medical Care, Arthur Morris

Honors Capstone Projects

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Due to persistent barriers in the medical system, LGBTQIA2S+ people in America face harmful healthcare disparities. Healthcare providers’ ability to work with LGBTQIA2S+ patients is a critical component of mitigating this harm. While forms of provider education have begun to address the need for culturally compassionate LGBTQIA2S+ medical care, there appears to be an underutilized opportunity to introduce these concepts in undergraduate settings. By providing an early introduction to LGBTQIA2S+ compassionate care, undergraduate institutions can better equip aspiring medical students to serve people with diverse sexualities and gender identities, improving provider competency and contributing to a more equitable healthcare system. …

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The Impact Of Medicaid Policy Limitations On Access To Eating Disorder Treatment: Uncovering The Consequences Of A System Built To Fail, Meghan Frost

DSW Capstone Projects

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Individuals who rely on Medicaid face major barriers when trying to access eating disorder (ED) treatment, reflecting broader patterns of structural disadvantage in publicly funded health care. Research shows delayed diagnosis, limited access to ED specialists, and frequent denials for recommended services. These gaps occur because Medicaid policies do not match the needs of evidence based ED care, resulting in delayed or incomplete care for many individuals with eating disorders.

This issue is highly relevant to social work practice because the policies shaping these barriers are complex and difficult for clients and ED providers to navigate. Social workers across clinics, …

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The Effect Of The Affordable Care Act Medicaid Expansion On The Risk Of Hospital Closure And Adolescent Hpv Immunization In Rural Counties, Juliette Des Rosiers

Scripps Senior Theses

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From 2005 to 2025, over 200 rural hospitals shut their doors, often citing increased operational costs, staffing shortages, low patient volume, regulatory barriers, financial challenges exacerbated by the COVID-19 pandemic, and uncompensated care as common contributors to the closures. Rural patients are often referred by their primary care physician to a hospital for regular immunizations, since smaller clinics have less capacity to provide immunizations due to a shortage of pediatricians and limited vaccine stock. A crucial vaccine that is not required by schools and underutilized in rural areas is that against human papillomavirus (HPV), a virus that infects cutaneous and …

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Systematic Review Of Ketamine Therapy For Treatment Resistant Depression, Amal Abdulkadir

Antioch University Dissertations & Theses

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a systematic literature review the results of 29 published studies from 2020-2025 that met specified inclusion criteria. The review identified costs and benefits of traditional algorithms for treating this problem, as well as the trend in research to include the use of ketamine. Studies have demonstrated a potential association between the use of ketamine therapy and significant clinical improvement in depressive symptoms. However, the current efficacy of ketamine therapy compared to treatment as usual, side effects and contraindications have not been addressed. This dissertation is available in open access at AURA, https://aura.antioch.edu/, and OhioLINK ETD Center, https://etd.ohiolink.edu/

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Exploring The Impact Of Adverse Childhood Experiences On Preventive Healthcare Utilization In Rural Georgia, Ryan R. Traylor

College of Graduate Studies: Theses & Dissertations

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This study examines the relationship between Adverse Childhood Experiences (ACEs) and preventive healthcare use among adults in Georgia, specifically within rural populations facing structural barriers. Using 2023 Georgia Behavioral Risk Factor Surveillance System (BRFSS) data, the research analyzes associations between ACE exposure, rural residence, and preventive care outcomes, including physical exams and flu vaccinations. Guided by an intersectionally adapted version of Andersen’s Behavioral Model of Health Services Use, the study evaluates how predisposing factors, enabling resources, and perceived barriers relate to healthcare engagement. Logistic regression analyses assess the correlation of ACE exposure, cost barriers, provider access, and sociodemographics with preventive …

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Ethical Considerations For Hospice Patients In Inpatient Settings: A Systematic Review And Thematic Analysis, Matthew D. Harry

Honors Theses and Capstones

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Hospice care is intended to prioritize comfort, dignity, symptom management, and quality of life for individuals with life-limiting illness. However, when hospice-eligible patients are managed within inpatient hospital settings, significant ethical challenges frequently emerge due to the tension between comfort-focused care and the curative, intervention-driven structure of acute care medicine. This paper presents a systematic literature review and thematic analysis examining the ethical considerations surrounding hospice patients in inpatient settings, with particular attention to clinical decision-making, communication, prognostic uncertainty, moral distress among nurses, and conflicts involving patient autonomy and family wishes. A structured review of peer-reviewed literature was conducted using …

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The Connection Between Medicaid And Obesity In Northeast Ohio, Emmie Kelley, Sophie Kheder

Williams Honors College, Honors Research Projects

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Obesity is a major public health concern in the United States that is projected to increase exponentially over the next few years. Obesity is commonly associated with a lower socioeconomic status. Lower-income individuals tend to be supported by Medicaid, a federal insurance program for low-income Americans. Prior studies have shown a positive correlation between income status and obesity prevalence. Our goal was to find if there was a correlation between Medicaid patients and obesity in Northeast Ohio, to provide physicians with a set of characteristics to better combat obesity, since preventative and treatment guidelines are tailored to national trends. We …

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Depressive Disorders, Bad Mental Health Days, And Diabetes Management Behaviors Among Non-Hispanic American Indian/Alaska Native Adults: Findings From The Behavioral Risk Factor Surveillance System, Kaipeng Wang, Luohua Jiang, Jie Zhu, Spero M. Manson

Graduate School of Social Work: Faculty Scholarship

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Objective

This study examined the association between diagnosis of depressive disorder, the number of bad mental health days per month, and diabetes management behaviors among American Indian/Alaska Native (AI/AN) adults with diabetes.

Research design and methods

Data were drawn from the Behavioral Risk Factor Surveillance System (2018–2021), including 2,272 self-identified non-Hispanic AI/AN adults diagnosed with non-gestational diabetes. Key variables included a self-reported prior diagnosis of depressive disorder and the number of bad mental health days in the past month. Outcome variables were seven diabetes management behaviors, such as taking a diabetes management class and performing daily foot checks. Statistical analyses …

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Rural Hospital Closure And Medicaid Expansion, Jason White

Theses, Dissertations and Capstones

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Introduction: In the United States, hospitals in rural areas have been under financial pressure and have been closing at an increasing rate.  This reduces access to care for rural citizens.  The Affordable Care Act of 2010 was passed in order to increase access to medical care, partially through an optional expansion of Medicaid coverage to a larger percentage of the population.  As some states adopted the expansion and some states did not, an opportunity was created to examine the policy’s effect on rural hospital stability.

Purpose of the Study:  This study was designed to examine the effect of …

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Exploring The Comparability Between Eq-5d And The Eq Health And Wellbeing In The General Australian Population, Peter Lee, Lidia Engel, Erica I. Lubetkin, Lan Gao

Publications and Research

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Objectives

The EQ Health and Wellbeing (EQ-HWB) is a novel measure that conceptually overlaps with the 5-level EQ-5D (EQ-5D-5L) while capturing broader dimensions of health and well-being. This study aimed to explore the extent to which the EQ-HWB and EQ-5D-5L capture overlapping or complementary constructs and to explore the discriminative ability of the EQ-HWB Short version (EQ-HWB-S) as a multiattribute utility instrument in the Australian setting.

Methods

A secondary analysis of data from a nationally representative cross-sectional survey of 2002 Australian adults was performed. The survey included socioeconomic questions and health characteristics and the EQ-HWB and EQ-5D-5L instruments. Convergent and …

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An Intersectional Approach To Quantifying The Impact Of Geographic Remoteness And Health Disparities On Quality-Adjusted Life Expectancy: Application To Australia, Peter Lee, Steven J. Bowe, Lidia Engel, Erica I. Lubetkin, Nancy Devlin, Lan Gao

Publications and Research

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Objectives

An intersectional multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA) is a novel method for exploring the interaction between sociodemographic characteristics that affect health outcomes. This study explores the interaction between geographic remoteness and socioeconomic status on health outcomes in Australia from an intersectional perspective.

Methods

Data from a cross-sectional survey were matched with data from the Australian Bureau of Statistics and the Australian Institute of Health and Welfare. To explore the effect of health-related quality of life on life expectancy, quality-adjusted life expectancy (QALE) was estimated through applying utility values derived from the EQ-5D-5L to life table …

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Health Inequality Analysis In Europe: Exploring The Potential Of The Eq-5d As Outcome, Inge Spronk, Juanita A. Haagsma, Erica I. Lubetkin, Suzanne Polinder, M F. Janssen, G J. Bonsel

Publications and Research

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Objective: This study explored the additive value of the multi-item EuroQol 5-Dimension 5-Level (EQ-5D-5L) as an outcome measure in health inequality analyses, relative to the single-item EuroQol visual analog scale (EQ VAS).

Methods: A sample comprising the general population from Italy, the Netherlands, and United Kingdom (UK) completed the EQ-5D-5L and the EQ VAS. The level of education was selected as a proxy for socio-economic status (SES). EQ-5D-5L level sum scores (LSS) were compared against EQ VAS scores. Stratified and multivariable analyses were used to study the associations between SES and the LSS/EQ VAS relative to the presence of chronic …

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Examining The Structural Covariates Of Methamphetamine Use: A Social Disorganization Perspective, Justin Smith

Masters Theses

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There have been many anecdotal accounts describing the characteristics of individuals involved in methamphetamine use, trafficking and production. However, prior to the current study there was yet to be a macro-level analysis of methamphetamine use. The extant macro-level literature on drug use has suggested that areas with high levels of social disorganization experience high rates of drug use. It was expected that school-districts with low SES and high rates of ethnic heterogeneity, residential instability and family disruption will experience high rates of methamphetamine use. In addition, it was expected that rural school districts would show higher rates than urban and …

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Experimental Modification Of Attitudes Toward Birth Control, Peggy C. Hunter

Theses, Dissertations and Capstones

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It is apparent in both lay and professional literature that we are living in an age of social crises. Clearly the shortage of resources and the problems of pollution and poverty would be greatly ameliorated if our birth rate were controlled. Despite this, a survey of psychological literature reveals a paucity of articles on birth control. Psychologists largely have their heads in the sand with regard to research to understand factors associated with childbearing. Meanwhile, the birth rate soars on and it is increasingly obvious that something must be done.

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