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Articles 481 - 510 of 1333
Full-Text Articles in Economics
(Wp 2026-02) Behavioral Macroeconomics, Kaleckian Post-Keynesian Economics, And Stratification Economics: Incorporating Social Identity, John B. Davis
(Wp 2026-02) Behavioral Macroeconomics, Kaleckian Post-Keynesian Economics, And Stratification Economics: Incorporating Social Identity, John B. Davis
Economics Working Papers
Behavioral Macroeconomics draws on cognitive psychology’s errors and biases approach to argue that psychological factors acting on individual choice affect how the economy functions. Keynes drew on psychology in his ‘beauty contest’ account of convention to explain individual investor expectations in terms of the average expectation of all investors. This assumes individual investors identify with the group of all investors, anticipating social psychology social identity analysis. Kaleckian Post-Keynesian Economics focuses on distributional conflict between capital and labor. This also assumes individual capitalists and laborers identify with groups of capitalists and laborers. Stratification Economics makes social group identity the basis on …
On The Trail, In The Towns: Visitor Use And Community Perspectives Along Montana’S Continental Divide Trail, Ava Worbets, Kika Bradford, Melissa Weddell
On The Trail, In The Towns: Visitor Use And Community Perspectives Along Montana’S Continental Divide Trail, Ava Worbets, Kika Bradford, Melissa Weddell
Institute for Tourism and Recreation Research Publications
As outdoor recreation participation has steadily increased nationwide over the past decade, reaching record levels in 2024 amid long‑term growth trends (OIA, 2025), the Continental Divide Trail (CDT) is drawing rising numbers of hikers traveling through Montana’s gateway communities. Yet little is known about who these hikers are or how their presence affects the towns that support them. This report examines CDT hikers and their relationships with Montana gateway communities from two complementary perspectives. First, understanding hikers’ demographics, spending patterns, and trail behaviors using data from 507 respondents who completed Montana’s CDT sections between 2022 and 2024. Second, exploring how …
Geography, Income, And The Incidence Of A Massachusetts Carbon Tax, Susan Stratton Sayre
Geography, Income, And The Incidence Of A Massachusetts Carbon Tax, Susan Stratton Sayre
Economics: Faculty Publications
I use spatial microsimulation to estimate the geographic incidence of the consumer-facing portion of various revenue-neutral carbon tax designs in Massachusetts. I identify a substantial urban-rural disparity in impacts that is reduced, but not eliminated, by proposed revenue-targeting mechanisms. I further demonstrate that seemingly small variations in the definition of rural households can have substantial impacts on urban-rural equity and the distribution of gains and losses. Proposed policies are highly progressive in the aggregate with most low-income households receiving more in rebates than they pay in taxes, but notable numbers of low-income households are likely to experience significant losses. Methodologically, …
Housing Markets In The American West: A Dynamic Time Warping Analysis Of Inter-City Relationships, Daniel Johnson
Housing Markets In The American West: A Dynamic Time Warping Analysis Of Inter-City Relationships, Daniel Johnson
All Graduate Theses and Dissertations, Fall 2023 to Present
Housing markets revolve around perhaps the most consequential good to the average person, yet the relationships between local housing markets remain understudied. While major American cities appear to follow similar patterns, the nature of these connections is not fully understood. This project looks at housing markets across the western United States, using Dynamic Time Warping (DTW) to identify which cities tend to lead or lag others in price movements, and look at the overall similarity of their market movements. We also explore whether geographic distance, population growth, and income growth help explain why some markets are more similar than others. …
Supply Constraints And Domestic Migration As Drivers Of U.S. Housing Price Appreciation, Vasu Patel
Supply Constraints And Domestic Migration As Drivers Of U.S. Housing Price Appreciation, Vasu Patel
Economics
When the Federal Reserve raised rates from near zero to 525 basis points between 2022 and 2023, standard theory predicted a broad correction in U.S. housing market. In most metropolitan areas, that correction did not arrive. This paper examines why housing price appreciation persisted across cities with fundamentally different structural characteristics, and which factors best explain the cross-city variation in appreciation rates observed across the nation. Using a panel of 83 Metropolitan Statistical Areas across four symmetric 24-month periods from December 2017 through December 2025, each aligned with a distinct Federal Reserve rate period, the study estimates OLS models with …
Rationalizable Incentives: Interim Rationalizable Implementation Of Correspondences, Takashi Kunimoto, Rene Saran, Roberto Serrano
Rationalizable Incentives: Interim Rationalizable Implementation Of Correspondences, Takashi Kunimoto, Rene Saran, Roberto Serrano
Research Collection School Of Economics
Are there ways to enforce incentives free of equilibrium considerations? When the normative goals for a set of agents can be summarized in a set-valued rule and agents take actions that are rationalizable, a new theory of incentives emerges in which standard Bayesian incentive compatibility (BIC) is relaxed significantly. The paper studies the interim rationalizable implementation of social choice sets with a Cartesian product structure, a leading example thereof being ex-post efficiency. Setwise incentive compatibility (setwise IC), much weaker than BIC, is shown to be necessary for implementation. Setwise IC enforces incentives flexibly within the entire correspondence, instead of the …
Using Satellite-Observed Geospatial Inundation Data To Identify The Impacts Of Floods On Firm-Level Performance: The Case Of China During 2000–2009, Pao-Li Chang, Fan Zheng
Using Satellite-Observed Geospatial Inundation Data To Identify The Impacts Of Floods On Firm-Level Performance: The Case Of China During 2000–2009, Pao-Li Chang, Fan Zheng
Research Collection School Of Economics
This paper compiles high-resolution geospatial inundation areas of China for the period 2000–2009 based on satellite imagery repositories filtered by the Global Flood Database (GFD). In parallel, we geocode a comprehensive firm-level dataset of China and combine these two sets of geospatial data to identify the set of inundated firms in each year of flood events, as well as the distances of all non-inundated firms from the inundated areas. Given the high-resolution inundation data, we adopt a generalized dynamic-panel specification to estimate dynamic and spatial spillover effects of floods on firm-level production activities (including outputs, capital and labor inputs, and …
Improving Estimation Efficiency Via Regression-Adjustment In Covariate-Adaptive Randomizations With Imperfect Compliance, Liang Jiang, Oliver B. Linton, Haihan Tang, Yichong Zhang
Improving Estimation Efficiency Via Regression-Adjustment In Covariate-Adaptive Randomizations With Imperfect Compliance, Liang Jiang, Oliver B. Linton, Haihan Tang, Yichong Zhang
Research Collection School Of Economics
We study how to improve efficiency via regression adjustments with additional covariates under covariate-adaptive randomizations (CARs) when subject compliance is imperfect. We first establish the semiparametric efficiency bound for the local average treatment effect (LATE) under CARs. Second, we develop a general regression-adjusted LATE estimator which allows for parametric, nonparametric, and regularized adjustments. Even when the adjustments are misspecified, our proposed estimator is still consistent and asymptotically normal, and their inference method still achieves the exact asymptotic size under the null. When the adjustments are correctly specified, our estimator achieves the semiparametric efficiency bound. Third, we derive the optimal linear …
Gme As A Healthcare And Economic Driver In Southern Nevada, Tripp Umbach
Gme As A Healthcare And Economic Driver In Southern Nevada, Tripp Umbach
Policy Briefs and Reports
In early 2025, the Nevada Health and Bioscience Corporation (NHBC) commissioned Tripp Umbach to conduct a comprehensive study examining the current state and future expansion of physician training and retention in Southern Nevada. The approach recommended in this report is rooted in strategic partnerships among medical institutions, proven funding approaches, and needed policy changes. Tripp Umbach, a nationally renowned private consultancy specializing in medical education expansion strategies, reviewed data, conducted interviews, and developed recommendations to expand GME, highlighting its profound economic impact in Southern Nevada.
Exploring Self-Sufficiency And Economic Behavior In Economic Education Students, Rizza Megasari, Sheerad Sahid
Exploring Self-Sufficiency And Economic Behavior In Economic Education Students, Rizza Megasari, Sheerad Sahid
International Conference on Business and Management Research (ICBMR)
This study investigates the self-sufficiency and economic behaviors of economics education students, focusing on how independent living shapes their financial management, consumption habits, and overall approach to life. Data was collected through in-depth interviews, using a question list informed by literature on 21st-century skills, sustainable development, and self-sufficiency. The interview explored the student's understanding and practice of self-sufficiency, examining their experiences with financial management (budgeting, saving, spending), living arrangements (boarding house choices, facilities, and habits), consumption patterns (food, clothing, transportation), and engagement in self-reliant activities (cooking, minor repairs). The study highlights the interplay between economic knowledge, personal values, and practical …
Tourism, Institutions, And The Paradox Of Inclusion: How Institutional Quality Moderates Tourism’S Impact On Inclusive Growth In High-Income European Countries, Saqib Munir, Abdul Ghaffar, Mushab Rashid
Tourism, Institutions, And The Paradox Of Inclusion: How Institutional Quality Moderates Tourism’S Impact On Inclusive Growth In High-Income European Countries, Saqib Munir, Abdul Ghaffar, Mushab Rashid
Arab Economic and Business Journal
Inclusive economic growth in high-income European economies remains contested despite strong institutions and advanced tourism sectors, with limited understanding of how institutional quality and gender-inclusive governance condition the tourism–inclusivity nexus. This study examines the independent and interactive effects of tourism development, institutional quality, gender-inclusive governance, digital infrastructure, environmental sustainability, and income inequality on inclusive economic growth across 15 European countries over 2000–2024. Using World Bank and WGI data, a panel ARDL framework, supported by FMOLS robustness checks is applied to capture dynamic long- and short-run relationships among mixed-order integrated variables. Results indicate that tourism development (β = 5.351, p < 0.001) and institutional quality (β = 8.029, p < 0.001) decisively enhance inclusive growth, yet their interaction exerts a significant negative effect (β = –5.271, p < 0.001), suggesting over-regulation may dampen tourism’s inclusivity potential. Environmental sustainability also contributes positively (β = 0.164, p < 0.001), while income inequality shows a counterintuitive long-run positive association (β = 0.026, p < 0.001). Gender-inclusive governance has a small but significant positive effect (β = 0.005, p = 0.004), whereas digital infrastructure is statistically insignificant. These findings extend institutional economics and endogenous growth theory by revealing governance flexibility as critical to unlocking inclusive tourism benefits, and they inform SDG 8 and 10 policies by advocating balanced regulatory frameworks, renewable energy investment, and targeted redistributive mechanisms in advanced economies.
Understanding Statutory Corporate Tax Rates And Corporate Tax Revenue: Evidence From Oecd Countries, 2015–2023, Carter Johnson
Understanding Statutory Corporate Tax Rates And Corporate Tax Revenue: Evidence From Oecd Countries, 2015–2023, Carter Johnson
Celebrating Scholarship and Creativity Day (2018-)
This paper analyzes the relationship between statutory corporate tax rates and corporate tax revenues among the OECD countries from 2015-2023. Since the 1980’s, statutory corporate tax rates have been gradually declining, however, the relationship between rate and revenue remains unclear. The Laffer Curve helps motivate the relationship between rate and revenue within the theoretical model. Foreign Direct Investment (FDI) and Real GDP are included as control variables, along with incorporating inflation and per capita measurements. The fixed effects panel regression findings conclude there is no direct relationship between corporate tax rate and revenue. However, FDI and Real GDP were found …
In Silico Model Of Musa Acuminata Stem As An Anticancer On Oral Squamous Cell Carcinoma Against Egfr, Nevrila Dewi Rachmayani, Amy Nindia Carabelly, I Wayan Arya Krishnawan Firdaus, Maharani Laillyza Apriasari, Juliyatin Putri Utami
In Silico Model Of Musa Acuminata Stem As An Anticancer On Oral Squamous Cell Carcinoma Against Egfr, Nevrila Dewi Rachmayani, Amy Nindia Carabelly, I Wayan Arya Krishnawan Firdaus, Maharani Laillyza Apriasari, Juliyatin Putri Utami
Journal of Dentistry Indonesia
Background: Oral squamous cell carcinoma (OSCC) is characterized by overexpression of the epidermal growth factor receptor (EGFR). Citral, eucalyptol, and caffeic acid phenethyl ester (CAPE), which are derived from Musa acuminata, have shown anticancer activity. This study evaluated the potential of citral, eucalyptol, and CAPE from Musa acuminata as anticancer agents for OSCC by targeting EGFR using an in silico approach.
Methods: Potential biological activity was predicted using Prediction of Activity Spectra for Substances (PASS) Online. Molecular docking was conducted with AutoDock Vina, and BIOVIA Discovery Studio was used to analyze binding affinity, interaction types, and bond …
Micro-Ct Evaluation Of Root Canal Transportation And Centering Ability In Mesial Canals Of Mandibular First Molars, Selen Ince Yusufoglu, Esma Saricam, Mert Ocak, Ferhat Geneci, Burak Bilecenoğlu
Micro-Ct Evaluation Of Root Canal Transportation And Centering Ability In Mesial Canals Of Mandibular First Molars, Selen Ince Yusufoglu, Esma Saricam, Mert Ocak, Ferhat Geneci, Burak Bilecenoğlu
Journal of Dentistry Indonesia
Background: This study aimed to evaluate canal transportation, centering ability, structure model index (SMI), surface area, and root canal volume changes in the mesial canals of mandibular first molars using micro-CT.
Methods: Twenty-four mandibular first molars with two separate mesial canals and moderate curvature were included. Teeth were scanned using micro-CT before instrumentation and randomly divided into three groups (N = 8). Root canals were prepared using OneShape, OneCurve, and Rotate file systems, followed by post-instrumentation micro-CT scanning (10µm/pixel resolution). Changes in canal volume, surface area, transportation, centering ability, and SMI were analyzed at the apical, middle, and …
State-Level Analysis Of Minimum Wage And Teen Employment Across The U.S. In 2024, Owen Siegel
State-Level Analysis Of Minimum Wage And Teen Employment Across The U.S. In 2024, Owen Siegel
Celebrating Scholarship and Creativity Day (2018-)
This study examines whether differences in state minimum wage levels are associated with variation in teen employment across U.S. states in 2024. Using a cross-sectional regression framework, the analysis estimates the relationship between minimum wage policy and the employment rate of individuals aged 16–19 while controlling for educational attainment, demographic composition, income, and regional differences. The results indicate that higher minimum wages are associated with lower teen employment rates. Specifically, a one-dollar increase in the minimum wage is associated with an estimated 0.87 percentage-point decrease in teen employment, holding other factors constant. This result is statistically significant and economically meaningful, …
The Economic Impact Of Grand Forks Airbase On North Dakota Using Input – Output Analysis & Va Mortgage Loan Evaluation, Jack S. Weikum
The Economic Impact Of Grand Forks Airbase On North Dakota Using Input – Output Analysis & Va Mortgage Loan Evaluation, Jack S. Weikum
Undergraduate Theses and Senior Projects
In this paper, I examine the economic contributions of the Grand Forks Air Force Base to our community. This paper and research seek to find out what the total economic impact of the base truly is compared to its public reports. The base’s own impact statements do not consider the indirect effects associated with its operations. To fully examine its true economic impact, we must consider two important aspects that affect the local economy and other industry sectors. Specifically, I will first examine the economic impact that base operations directly have on expenditures, employment, and labor income. This information will …
From The Ground To The Stars: How Research And Development In Aerospace Plays A Massive Role, Bryan Sohan
From The Ground To The Stars: How Research And Development In Aerospace Plays A Massive Role, Bryan Sohan
Honors College Theses
Aerospace technology is a long-standing field of innovation, yet it has experienced renewed momentum in recent years due to increased public and private investment. This study analyzes how changes in budget allocations to aerospace-related firms and government organizations influence the pace and scope of technological development within the aerospace sector. By examining historical trends in aerospace innovation alongside recent funding initiatives and policy decisions, this research evaluates the relationship between financial investment and technological advancement. This analysis focuses on Hypothesis 1 (H1): that higher aerospace R&D expenditure is positively correlated with innovation output. Using a two-period state-level panel (FY2021 and …
Credential Shortages In Higher Education Programs In Mountain West Metro Areas, 2024, Isabelle G. Graham, Kristian Thymianos, Olivia K. Cheche, William E. Brown Jr.
Credential Shortages In Higher Education Programs In Mountain West Metro Areas, 2024, Isabelle G. Graham, Kristian Thymianos, Olivia K. Cheche, William E. Brown Jr.
Economic Development & Workforce
This fact sheet reports data on workforce demand for middle-skills jobs across five high-paying occupational categories: healthcare, management, blue-collar, protective services, and STEM. The Georgetown University Center on Education and the Workforce report, “Missed Opportunities: Credential Shortages in Programs Aligned with High-Paying Middle-Skills Jobs in 55 US Metro Areas,” includes metro-level data on 55 metro areas in the United States in 2024.2 This fact sheet focuses on data for five Mountain West metro areas, including Denver-Aurora-Lakewood, CO; Las-Vegas-Henderson-Paradise, NV; Phoenix-Mesa-Chandler, AZ; Salt Lake City, UT; and Tucson, AZ.
China-Canada Resource Diplomacy: New Era Of Land Grabbing, Valdrin Dragusha
China-Canada Resource Diplomacy: New Era Of Land Grabbing, Valdrin Dragusha
Bridges: An Undergraduate Journal of Contemporary Connections
This paper examines the evolving economic relationship between China and Canada, particularly in the context of China's transition from a strictly social economy to an authoritarian socialist market economy. It highlights the implications of China's Going Out Policy initiated in 2000, aimed at securing vital natural resources amidst growing domestic demands driven by rapid economic expansion. The paper analyzes China's significant demand for resources, its sustainable development policies, and the changing dynamics of land acquisitions, particularly in relation to Canada, which is perceived as a strategic investment destination due to its abundant natural resources and technological advancements in clean energy. …
Treaty Database Project, Elisabeth Smith
Treaty Database Project, Elisabeth Smith
Honors Capstones
International environmental governance is shaped by a complex network of treaties addressing issues such as water, agriculture, air and atmosphere, energy, wild species and ecosystems, mineral resources, and waste and hazardous substances, among many others.. However, information about these agreements is often fragmented across multiple sources, making it difficult for researchers, policymakers, and the public to understand how different treaties relate to one another. This project develops a structured database of environmental treaties that captures key attributes such as thematic focus, geographic scope, participating countries, and implementation mechanisms.
Building on this database, the project also provides an intuitive front-end interface …
Money And State Politics: State Legislature Partisan Dynamics And Ideology Outcomes Following Citizens United V. Fec, Jillian E. Pastore
Money And State Politics: State Legislature Partisan Dynamics And Ideology Outcomes Following Citizens United V. Fec, Jillian E. Pastore
Bates College Journal of Political Studies
What effect has Citizens United v. FEC had on state-level partisanship and the policy outcomes that follow from it? Scholarship on the influence of corporate and union spending in political campaigns has largely centered on federal elections. In this paper, I extend the analysis to the state level, leveraging the fact that Citizens United created a natural experiment across the states. Prior to the Supreme Court ruling, roughly half of the states prohibited corporate and union independent expenditures in state elections (including for governor, state senate, state house, and state supreme court races). The Citizens United decision effectively nullified these …
Luja Volume 6: Issue 1 (Full Volume)
Luja Volume 6: Issue 1 (Full Volume)
Laurier Undergraduate Journal of the Arts
No abstract provided.
Supporting Those Who Serve: The Impact Of Peer Support On Law Enforcement Suicide, Emily N. Warren
Supporting Those Who Serve: The Impact Of Peer Support On Law Enforcement Suicide, Emily N. Warren
Honors College Theses
Individuals working in law enforcement face daily stressors that far exceed those experienced by the general population. This elevated exposure to stress has been associated with increased rates of mental health disorders and suicide among law enforcement officers. In response, peer support programs have gained recent attention, with new state and federal legislation promoting peer support as a strategy to address the mental health crisis within law enforcement. This paper examines the impact of statewide peer support programs on law enforcement suicide rates through statistical analysis. A difference-in-differences analysis is used to compare state-level law enforcement suicide rates before and …
Expectations And Realities In Primary Care Appointment Access In The United States: A National Study, Brigham Walker, Ethan Tsai, Alexandra Shimanovsky, Edel Doherty, Sarah E. Tinkler, Rajiv Sharma
Expectations And Realities In Primary Care Appointment Access In The United States: A National Study, Brigham Walker, Ethan Tsai, Alexandra Shimanovsky, Edel Doherty, Sarah E. Tinkler, Rajiv Sharma
Economics Faculty Publications and Presentations
Objective: While patients expect timely appointments, little is known about how accurately patient expectations reflect the realities of access to a primary care physician.
Methods: We deployed a national survey (N = 6119, conducted in 2021) to measure patient expectations and a separate national field experiment (N = 11,016, conducted between 2013 and 2016) where trained research assistants called physician offices seeking an appointment to measure physician availability.
Results: Using multivariate regression analyses, we find that patients expected to call 1.9 physicians to secure an appointment, consistent with an appointment offer rate of 49%. However, expectations of 5.4 days wait …
Quantifying Overconsumption In The United States: A Multiple Linear Regression Analysis, Morgan Davis
Quantifying Overconsumption In The United States: A Multiple Linear Regression Analysis, Morgan Davis
Honors Projects
This study examines overconsumption in the United States by analyzing how socioeconomic factors influence household spending relative to income. Overconsumption is defined as elevated discretionary spending relative to income, with a focus on categories such as apparel, entertainment, and food away from home. Using 2024 Consumer Expenditure Survey (CEX) data, three multiple linear regression models were created to evaluate predictors of overall consumption, discretionary consumption, and apparel spending as proportions of income.
Results show that income is the most significant predictor across all models, with higher-income households consistently spending a smaller share of their income. Age and household size also …
Caregiving For Older Adults: How The Child And Dependent Care Credit Could Help, Gabrielle Pepin, Yulya Truskinovsky
Caregiving For Older Adults: How The Child And Dependent Care Credit Could Help, Gabrielle Pepin, Yulya Truskinovsky
Upjohn Institute Policy and Research Briefs
No abstract provided.
Performance-Based Budgeting Implementation Strategies For Improving Financial Performance, Waleed Ibrahim Alsyaegh
Performance-Based Budgeting Implementation Strategies For Improving Financial Performance, Waleed Ibrahim Alsyaegh
Walden Dissertations and Doctoral Studies
The lack of effective strategies for allocating organizational financial resources can lead to adverse business outcomes. Business managers are concerned about the ineffective allocation of financial resources, as it can impede financial performance and sustainability.Grounded in stakeholder theory, the purpose of this qualitative single-case study was to explore the performance-based budgeting strategies that business managers use to sustain financial profitability. The participants were 10 business managers who oversee subsidiaries that successfully implemented performance-based budgeting.Data were collected through semistructured interviews and the review of organization documents. Through thematic analysis, four themes were identified: (a) traditional versus contemporary budgeting; (b) importance of …
People Who Moved In The Mountain West, 2024, Anthony Arroyo, Sydney Mitchell, Maisoon Faris, Olivia K. Cheche, Caitlin J. Saladino, William E. Brown Jr.
People Who Moved In The Mountain West, 2024, Anthony Arroyo, Sydney Mitchell, Maisoon Faris, Olivia K. Cheche, Caitlin J. Saladino, William E. Brown Jr.
Cities & Metros
This fact sheet presents 2024 data on state and city-level mobility rates across the Mountain West states of Arizona, Colorado, Nevada, New Mexico, and Utah. Point2Homes’ “Mobility Rates Reach Record Low: In 2024, Americans Moved Less Than Ever” report provides data on mobility rates within states, as well as the rate of new residents moving into states and cities across the U.S. This fact sheet highlights mobility rates within Mountain West states, the rate of new residents moving into Mountain West states, and the rate of new residents moving into 63 Mountain West cities. This fact sheet also includes national …
Scientific Research In Cuba: A General Analysis With A Special Focus On Energy, Agriculture And Technology, Henri Dou, Pierre Fournie
Scientific Research In Cuba: A General Analysis With A Special Focus On Energy, Agriculture And Technology, Henri Dou, Pierre Fournie
International Journal of Islands Research
An analysis of science in Cuba is carried out using data from the OpenAlex database. Examples are developed: agriculture, rice, technology in relation to the current situation: national food supply, energy and medicine. The predominance of research in biology and medicine and the low commitment in the fields of agriculture, energy, medicinal plants and technology are highlighted. Various development schemes are proposed. The conclusion is that research must be directed towards strategic areas: food and energy, must be less dispersed and that technology must be better taken into account. Three proposals are made: the development of a chemical analysis platform …
Out-Of-Pocket Costs And Antihypertensive Medication Use Among Veterans: A Natural Experiment, Alexander R. Zheutlin, Alexander Chaitoff, Daniel Addo, Joshua A. Jacobs, Catherine G. Derington, Eric L. Stulberg, Peter A. Glynn, Bernardo Modenesi, Jordana B. Cohen, Adam P. Bress
Out-Of-Pocket Costs And Antihypertensive Medication Use Among Veterans: A Natural Experiment, Alexander R. Zheutlin, Alexander Chaitoff, Daniel Addo, Joshua A. Jacobs, Catherine G. Derington, Eric L. Stulberg, Peter A. Glynn, Bernardo Modenesi, Jordana B. Cohen, Adam P. Bress
Department of Neurology Faculty Papers
BACKGROUND: Blood pressure (BP) control remains suboptimal in the United States despite available low-cost antihypertensive medications. Even small out-of-pocket medication costs may contribute to adherence. We determined whether $0 versus >$0 out-of-pocket costs for antihypertensive medications is associated with differences in adherence, discontinuation, BP control, and cardiovascular outcomes.
METHODS: We included veterans with newly diagnosed hypertension who initiated antihypertensive medication in the Veterans Health Administration from 2004 to 2022. A fuzzy regression discontinuity design with 2-stage residual inclusion leveraged differences in medication copay policy at a 50% service-connected disability threshold (≥50% service-connected disability: $0 out-of-pocket cost versus < 50%: $8 monthly cost). Outcomes included 1-year medication nonadherence (proportion of days covered < 80%), 1-year medication discontinuation (no medication in the final 90 days of the study year), 1-year BP control (systolic BP/diastolic BP < 140/90 mm Hg and < 130/80 mm Hg) and cardiovascular disease events (myocardial infarction, coronary revascularization, peripheral artery disease, or stroke).
RESULTS: Among 417 …