Health Economics Commons^™

Cost Analysis Of Integrated Genderaffirming And Sexual Health Services For Transgender Women In Thailand: Evidence From The Tangerine Clinic, Braprut Sawatwipachai, Kunncadah Anuwong, Nittaya Phanuphak, Rena Janamnuaysook, Kritima Samitpol, Sujin Nitadpakorn

The Thai Journal of Pharmaceutical Sciences

Background: Transgender women experience a disproportionate burden of human immunodeficiency virus (HIV) globally and in Thailand. Integrating gender-affirming care into sexual health services may improve uptake of HIV and sexually transmitted infections (STIs) testing, treatment, and prevention. Cost data are essential to inform program planning and policy decisions regarding inclusion of such services within Thailand’s Universal Health Coverage (UHC) system.
Objectives: To estimate the full and unit costs of trans-led, integrated gender-affirming and sexual health services along the HIV care cascade.
Methods: Costs of Tangerine Clinic services in 2021 were assessed from the provider perspective, using standard and activity-based costing …

Bridging Fiscal Sustainability And Health Equity: A Policy Analysis Of California’S Healthcare Coverage Safeguards, Guadalupe Castaneda Martinez

Master's Projects and Capstones

Without structural policy intervention, approximately 4.6 million Californians remain at risk of being uninsured by 2030, worsening racial and ethnic health disparities and hospital uncompensated care burdens. This policy analysis advocates for a hybrid universal coverage model combining sliding-scale subsidies (California Senate Bill 78) with full-scope Medi-Cal expansion for all income-eligible residents regardless of legal status (California Assembly Bill 133). The framework relies on existing funding mechanisms, including the Managed Care Organization tax and the Health Care Affordability Reserve Fund. Comparative analysis indicates that market-only subsidies leave severe equity gaps, whereas immediate single-payer transitions pose substantial fiscal and administrative risks. …

Cost-Effectiveness Evaluation Of Artificial Intelligence-Assisted Chest Radiograph Interpretation For Tuberculosis Screening In Rural Health Units In The Philippines, Harold Henrison C. Chiu, Bryan Christopher C. Lao, Gloanne C. Adolor

Graduate School of Business Publications

Background: Tuberculosis remains a major public health burden in the Philippines, where diagnostic delays are amplified by limited radiology capacity in rural health units (RHUs) and geographically isolated and disadvantaged areas (GIDAs). Computer-aided diagnosis (CAD) using artificial intelligence (AI)-assisted chest radiograph interpretation may shorten the screening pathway and reduce reliance on scarce specialist readers. However, its economic value for RHUbased tuberculosis screening has not been fully evaluated.
Methods: We developed a decision-tree cost-effectiveness model in Microsoft Excel 365 to compare AI-assisted chest radiograph interpretation with conventional manual radiologist or teleradiology interpretation among a theoretical annual cohort of 1,000 presumptive tuberculosis …

Determinants Of Corporal Punishment And Severe Physical Punishment In Egypt: A Mixed-Methods Analysis For Child Protection Policy, Marwa Moustafa Nassef

Theses and Dissertations

Corporal punishment (CP) and severe physical punishment (SPP) remain a major public health, child rights, and child protection policy concern. In Egypt, despite legislative reforms, survey-weighted analysis of the 2021 Egypt Family Health Survey (EFHS) 2021 (CAPMAS, 2022) reveals prevalence rates of 60.5% for CP and 27.4% for SPP among children aged 1–14 (author’s calculations using EFHS-2021, n=7623), yet evidence distinguishing the determinants of routine corporal punishment from escalation to severe physical punishment remains limited in low- and middle-income contexts. Guided by Bronfenbrenner’s ecological framework, this mixed-methods study identifies key drivers of CP and its escalation to SPP among Egyptian …

Costs, Demographics, And Causative Agents In Patients Hospitalized For Drug Induced Liver Injury: Trends In A Large Academic Healthcare System, Megan Kozar, Yunisse Gonzalez, Dina Halegoua-De Marzio

Department of Medicine Faculty Papers

PURPOSE: Drug-induced liver injury (DILI) is an uncommon but potentially life-threatening condition. To date, the burden of DILI on a single, large healthcare system has not been investigated, preventing adequate resource allocation. This study aims to quantify DILI-related healthcare utilization within the Jefferson Health System (JHS) and identify case-related factors associated with high resource requirements; such information is crucial to focus efforts toward resource reduction.

PATIENTS AND METHODS: This study characterizes trends of 48 DILI cases within JHS, including demographics, payer status, causative agent, and DILI pattern. These variables were correlated with length of stay (LOS) and cost relating to …

Low-Dose Prophylaxis Versus On-Demand Treatment For Children With Severe Hemophilia A In Indonesia: A Conceptual Model, Levina Chandra Khoe, Nur Atika, Dhia Ticha Pertiwi, Septiara Putri

Kesmas

Hemophilia A is a rare bleeding disorder caused by a deficiency of clotting factor VIII, leading to recurrent bleeds, joint damage, and disability. Low-dose prophylaxis has been shown to achieve better clinical outcomes than on-demand treatment in reducing bleeding frequency. However, in Indonesia, access and affordability remain key challenges. This study aimed to develop a conceptual model for conducting a health economic evaluation of low-dose prophylaxis treatment for children with severe hemophilia A in Indonesia. This study followed the ISPOR-SMDM Modeling guidelines, outlining two-stage processes: conceptualization of the clinical problem and model development. A systematic literature review was conducted to …

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

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 …

Validation Of The Jefferson Health-Related Social Needs Screener, Sara Beachy, Kristin L. Rising, Richard W. Hass, Terry Hyslop, Isabella Muti, Mackenzie Kemp, Rhea E. Powell, Cara Martino, Baligh R. Yehia, Joseph G. Cacchione, Patricia C. Henwood

Jefferson Hospital Staff Papers and Presentations

INTRODUCTION: Screening for health-related social needs (HRSN) is a growing national health priority. While multiple HRSN screening tools currently exist, none to our knowledge have been evaluated using robust statistical analyses. The goal of this work is to provide results from a validation study of the Jefferson HRSN screener conducted across inpatient and outpatient settings.

METHODS: This retrospective cross-sectional psychometric study included HRSN assessments conducted across inpatient and outpatient settings with adult patients from March 2023 to May 2024. The study was conducted across a 17-hospital academic health system serving a diverse community in a 9-county area crossing two states …

Experience Matters: An Application Of The Operative Value Index For Lumbar Fusions, Danyal Quraishi, Advith Sarikonda, D. Mitchell Self, Steven R. Glener, Arbaz A. Momin, Emily L. Isch, Ashmal K. Sami, Matthews Lan, Nicholas Clark, Ashwini Sharan, Srinivas Prasad, Jack Jallo, Joshua Pelta-Heller, Alex R. Vaccaro, James Harrop, Ahilan Sivaganesan

Department of Neurosurgery Faculty Papers

INTRODUCTION: As healthcare systems transition to value-based care models, it is critical to understand factors influencing costs and outcomes in neurosurgery. This study utilizes Time-Driven Activity-Based Costing (TDABC) to assess the impact of surgeon experience and case volume on costs, clinical outcomes, and operative value in lumbar fusions. While TDABC has been applied in various surgical specialties, its use in neurosurgery, particularly in analyzing surgeon-specific factors, remains limited.

METHODS: A retrospective cohort study was conducted at a single center, analyzing lumbar instrumented arthrodesis procedures from 2017 to 2019. Primary variables included surgeon experience (years) and case volume (annual procedures). Confounding …

Behavioral Responses To The Medicare Part D Coverage Gap And Its Closure, Selene Urbatsch

Theses and Dissertations

The author examines how exposure to the Medicare Part D coverage gap affects future prescription drug use and whether the closure of the gap under the Affordable Care Act (ACA) altered beneficiary behavior. Using 2007–2019 MEPS data, the analysis compares Part D enrollees to similarly aged, privately insured individuals, producing first-differences and difference-in-differences estimates. Before the ACA, exposure to the gap was associated with 4.9 fewer prescription fills relative to comparable non-Part D individuals. After the ACA, the effect fell to a reduction of 2.2 generic fills, with no significant decline in branded use. Sudden out-of-pocket cost increases prompted sharp …

Evaluating The Current State Of Quality Measure Reporting In The Merit-Based Incentive Payment System, Kinan Sawar, Geoffrey Potts Md

Medical Student Research Symposium

The Merit-Based Incentive Payment System (MIPS) requires physicians to report quality measures along with other metrics that are used to determine an annual percentage adjustment to physician Medicare Part B payments. Unfortunately, physicians have been forced to choose from an ineffective, limited set of quality measures. This has led to an overreliance on process measures, which fail to stratify physician performance effectively; it has also led to differences in the number of reporting options across specialties, resulting in unequal opportunity for physicians to succeed in MIPS. Using Centers for Medicare and Medicaid Services (CMS) public use file data from 2021-2024, …

Analysis Of Systematic Trade-Offs Between Military And Healthcare Expenditure Alongside Gdp Growth Of Select Asian And Western Exporting Economies In The 21st Century, Rahul Balamurugan, Carlos Gershenson, Preethi Nanjundan, Hiroki Sayama

Northeast Journal of Complex Systems (NEJCS)

This study explores the complexity in the trade-offs between military expenditure, healthcare expenditure, and GDP growth across select Asian nations and major weapon-exporting countries, examining how nations allocate finite resources between national security and human well-being over the past two decades. Using a systems science approach, the research integrates Granger causality testing to analyze temporal and directional relationships among GDP growth, military expenditure, and healthcare expenditure, uncovering their dynamic interdependencies. The methodology includes trend and slope analysis, Granger causality testing, outlier detection, and clustering to identify heterogeneity in resource allocation strategies. Developed, weapon-exporting nations exhibit complementary trends, with strong causality …

Evaluation Of Financial Risk Protection Provided By Private Health Insurance In Malaysia, Ng Rui Jie

Student Works (2020-2029)

Private health insurance (PHI) has emerged as an alternative health financing option to public health financing, with the goal of achieving and maintaining universal health coverage. Despite its growing prominence, there is ongoing debate about the extent to which PHI contributes to financial risk protection. In Malaysia, the prevalence of PHI coverage has increased due to factors such as an expanding affluent demographic, government encouragement, and challenges in public healthcare delivery. However, there have been very limited studies assessing the financial risk protection provided by PHI in Malaysia, making this a critical gap that this research aims to address. To …

An Evaluation Of Nhmrc Funded Dementia And Diabetes Research, Etienne Vignola-Gagné Phd, Dmitrii Malkov, Elisabeth Browning, Jörg Hellwig Phd, Luigi Rocco Phd, Henrique Pinheiro, Alexandre Bédard-Vallée

Public Reports

This report, commissioned by the National Health and Medical Research Council (NHMRC), provides comprehensive insights into the research outputs, outcomes, and impacts of NHMRC-funded health and medical research in the areas of dementia and diabetes to support NHMRC's mission of ‘building a healthy Australia.’

Overcoming Disparities In The Treatment Of Alzheimer’S Disease, Christian Gamboa, Tribhuvan Lanka, Elaine Flowers, Nayarith Lopez

Rowan-Virtua Research Day

Background: Deaths due to Alzheimer’s have been increasing at an exponential rate for the last 24 years, with an astounding 145% increase between the years 2000-2024. Early detection is key to slowing down the rate of decline. Unfortunately, Latino and African American individuals delay seeking care, which predisposes them to worse outcomes. To date, socioeconomic limitations are the main factors leading to delayed care in Latino and African American communities. A service project was developed with the aim of addressing limitations that result in delays to seeking care within Latino and African American communities.

Methods: A systematic review of available …

Reducing Food Scarcity: The Benefits Of Urban Farming, S.A. Claudell, Emilio Mejia

Journal of Nonprofit Innovation

Urban farming can enhance the lives of communities and help reduce food scarcity. This paper presents a conceptual prototype of an efficient urban farming community that can be scaled for a single apartment building or an entire community across all global geoeconomics regions, including densely populated cities and rural, developing towns and communities. When deployed in coordination with smart crop choices, local farm support, and efficient transportation then the result isn’t just sustainability, but also increasing fresh produce accessibility, optimizing nutritional value, eliminating the use of ‘forever chemicals’, reducing transportation costs, and fostering global environmental benefits.

Imagine Doris, who is …

“High Spending, Poor Productivity Gains!” Assessing Public Health System (In)Efficiency And Hospital Performance In The State Of Kuwait: Would More Private Delivery Improve Healthcare?, Aljawhara Alsabah

NYMC Student Theses and Dissertations

The healthcare sector in the State of Kuwait has been nurtured for many decades by the government, where the majority of health services in the country are controlled by the Ministry of Health (MoH). Although healthcare services in public sector hospitals are at highly subsidized rates, causing private sector involvement in healthcare to be considerably low, the growing demands for private delivery of care burgeoned participation of private hospitals in Kuwait, and improving hospital efficiency and productivity is more critical and timelier than ever. This dissertation aims to analyze public health system efficiency and hospital performance in the State of …

Episode Based Payment Models And The Hospital Safety-Net: An Evaluation Of The Center For Medicare And Medicaid Services’ Comprehensive Joint Replacement Bundled Payment Program, John A. Gravina

Dissertations and Theses

Episode Based Payment Models and the Hospital Safety-net: An Evaluation of the Center for Medicare and Medicaid Services’ Comprehensive Joint Replacement Bundled Payment Program

By John Anthony Gravina

Advisor: Alexis Pozen, Ph.D.

Introduction: Payments for Healthcare services are increasingly being tied to clinical quality, patient experience, health outcomes, and efficiency through value-based payment arrangements (VBP). VBP presents a potential opportunity to reduce healthcare expenditures by requiring providers to take on financial risk associated with the cost and quality of care, therefore aligning payment incentives with the goals of providing higher quality and efficient care. As of 2020, 80 percent of …

The Effect Of Covid-19 On Depression In Hispanic Vs. Non-Hispanic Populations In South Jersey, Rana Cheikhali, Daniel Casal

Rowan-Virtua Research Day

The COVID-19 pandemic has been challenging for Americans and the world as a whole. It has especially taken a toll on mental health. Studies show that the incidence of depression in the United States was three times greater during the pandemic compared to pre-pandemic times. One specific community in the United States that has been greatly affected by the pandemic is the Hispanic American community. Many Americans across the country have received federal surveys that aim to determine the social and economic impacts of COVID-19. Results revealed that the Hispanic population had the greatest rise in mental illness, with 40% …

The Relationship Between Collective Nursing Knowledge And Nurse Turnover: An Application Of Nursing Intellectual Capital Theory, Pamela Russman-Chambers

Doctorate of Nursing Science Dissertations

The value of a healthcare organization is vested in the expertise, intellect, and wisdom of employees. Nursing knowledge resides both within the individual nurse and the collective knowledge embedded in organizational structures and practice environments. Healthcare organizations rely on their ability to utilize this knowledge to deliver high-quality care to patients. Hospitals wanting to gain a competitive advantage and achieve financial stability must be adept at acquiring, cultivating, and using the nursing knowledge stocks of the organization. When this knowledge can be utilized to mitigate healthcare issues and improve patients' health, this collective knowledge or intellectual capital is often the …

Health Service Utilization And Expenditure In Cardio-Metabolic Conditions In The United States Adults, Kavita Mosalpuria

Theses & Dissertations

Metabolic syndrome is multicomponent risk factor for cardiovascular diseases (CVD) and type 2 diabetes that reflects the clustering of at least 3 cardiometabolic risk factors, among hypertension, impaired glucose regulations, hypercholesterolemia, and obesity. CVD are the leading cause of death in the U.S. CVD occur at earlier age and is a major cause of death and disability among people with diabetes. As compared to Japan, 13.3% to 44% of the excess CVD mortality in the U.S. can be explained by the metabolic syndrome. The prevalence of metabolic syndrome was 34.3% in 2007 to 2014 and it increases with age. Metabolic …

Assessing The Patient-Perceived Monetary Value Of Patient-Reported Outcome Improvement For Patients With Chronic Knee Conditions, Sarah B. Floyd, Alicia Oostdyk, Melanie Cozad, John M. Brooks, Paul Siffri, Brian Burnikel

Journal of Patient-Centered Research and Reviews

Purpose: The high cost of orthopaedic care has attracted criticism in the current value-based health care environment. The objective of this work was to assess the properties of a willingness to pay (WTP)-based approach to estimate the monetary value that patients place on health improvements in chronic knee conditions following orthopaedic treatment.

Methods: A sample of patients with a chronic knee condition were surveyed between January and May of 2018 at a large orthopaedic practice. Each patient provided their WTP for restoration to ideal knee health and completed the Single Assessment Numerical Evaluation (SANE) to describe their baseline knee state. …

Policies Addressing Barriers To Low-Income Women And Children’S Health Care Utilization In The United States And Kenya: The Role Of Physician Payments And Cash Transfer Programs, Muloongo Simuzingili

Theses and Dissertations

This dissertation examined two policies to improve low-income women and children’s healthcare utilization: physician payments and cash transfer programs. Higher physician payments increase the supply of healthcare services while cash transfers increase individuals’ demand for healthcare services. Cash transfer programs can improve health outcomes, yet the extent to which they are a cost-effective strategy is largely understudied. Therefore, this dissertation examines three overarching research questions:

1. Are Medicaid physician fees associated with access to substance abuse disorder (SUD) treatment among low-income women of reproductive age?
2. Do economic preferences moderate cash transfer program effects on children’s health care utilization? Evidence from a …

Health Outcomes And Utilization Associated With Renal Diseases In Patients With Cancer In The United States, Mitisha Dedhia

Theses and Dissertations

Background: Adverse events and impairments associated with cancer and its treatments causes worse outcomes. Increased incidence of renal diseases among cancer patients is of particular concern. Objective: To determine the risk factors for renal disease in cancer patients and compare healthcare costs, utilization and health-related quality of life (HRQoL) of cancer patients with a renal disease and cancer patients without renal diseases. Methods: Medical Expenditure Panel Survey files from 2009 – 2018 for cancer patients was used for this study. Multiple logistic regression, generalized linear model, Poisson regression and multiple linear regression for analyses after adjusting for demographic, socioeconomic and …

Three Essays On Health Economics And Policy Evaluation, Shishir Shakya

Graduate Theses, Dissertations, and Problem Reports (ETD)

This dissertation consists of three essays on the U.S. Health care policy. Each paragraph below refers to the three abstracts for the three chapters in this dissertation, respectively. I provide quantitative evidence on how much Prescription Drug Monitoring Programs (PDMPs) affects the retail opioid prescribing behaviors. Using the American Community Survey (ACS), I retrieve county-level high dimensional panel data set from 2010 to 2017. I employ three separate identification strategies: difference-in-difference, double selection post-LASSO, and spatial difference-in-difference. I compare how the retail opioid prescribing behaviors of counties, that are mandatory for prescribers to check the PDMP before prescribing controlled substances …

Examining Racial & Ethnic Disparities In The Reach Of The Medicare Shared Savings Program, Lindsey Arneson

Capstone Experience: Master of Public Health

It is important to understand the quality of health care for racial and ethnic minorities covered under the largest U.S. government-run insurance program, Medicare, because the demographics of the U.S. are becoming older and more diverse. A new value-based program under Medicare is the Shared Savings Program (MSSP), which creates incentives to improve care quality and health outcomes for Medicare beneficiaries with a specific focus on increasing the provision of preventive care services. This capstone project aims to understand the representation of racial/ethnic minority Medicare beneficiaries, namely African Americans/Blacks and Hispanics/Latinxs, that receive care from providers or facilities (i.e., Accountable …

Out-Of-Pocket Expenditure For Home And Facility Based Delivery Among Rural Women In Zambia: A Mixed-Methods, Cross-Sectional Study, Jeanette L. Kaiser, Kathleen L. Mcglasson, Peter C. Rockers, Rachel M. Fong, Thandiwe Ngoma, Davidson H. Hamer, Taryn Vian, Godfrey Biemba, Jody R. Lori, Nancy A. Scott

Nursing and Health Professions Faculty Research and Publications

Purpose: Out-of-pocket expenses associated with facility-based delivery are a well-known barrier to health care access. However, there is extremely limited contemporary information on delivery-related household out-of-pocket expenditure in sub-Saharan Africa. We assess the financial burden of delivery for the most remote Zambian women and compare differences between delivery locations (primary health center, hospital, or home).

Methods: We conducted household surveys and in-depth interviews among randomly selected remote Zambian women who delivered a baby within the last 13 months. Women reported expenditures for their most-recent delivery for delivery supplies, transportation, and baby clothes, among others. Expenditures were converted to …

A Framework For Learning During An Honors Internship: Embold Health Inc., Haley Haldeman

The Eleanor Mann School of Nursing Undergraduate Honors Theses

Embold Health Inc. is a health care analytics start-up company that identifies top performing providers using large data sets and clinically nuanced measurement. A comprehensive assessment of quality, appropriateness, and cost is what Embold Health delivers. Embold allows payers more control in choosing providers within their region. Being able to identify top provider behaviors through rigorous data driven measurement is significant both clinically and commercially; it provides the opportunity to increase value of care, decrease waste, and drive down cost.

Over the past year as an intern, I’ve had a first-hand look into the complexity that surrounds data driven health …

Differences In Tsimane Children’S Growth Outcomes And Associated Determinants As Estimated By Who Standards Vs. Within-Population References, Melanie Martin, Aaron Blackwell, Hillard Kaplan, Michael Gurven

Economics Faculty Articles and Research

Anthropometric measures are commonly converted to age stratified z-scores to examine variation in growth outcomes in mixed-age and sex samples. For many study populations, z-scores will differ if calculated from World Health Organization (WHO) growth standards or within-population references. The specific growth reference used may influence statistical estimates of growth outcomes and their determinants, with implications for biological inference. We examined factors associated with growth outcomes in a sample of 152 Tsimane children aged 0–36 months. The Tsimane are a subsistence-scale population in the Bolivian Amazon with high rates of infectious disease and growth faltering. To examine the influence of …

Ecological Determinants Of Respiratory Health: Examining Associations Between Asthma Emergency Department Visits, Diesel Particulate Matter, And Public Parks And Open Space In Los Angeles, California, Jason A. Douglas, Reginald S. Archer, Serena E. Alexander

Health Sciences and Kinesiology Faculty Articles

Los Angeles County (LAC) low-income communities of color experience uneven asthma rates, evidenced by asthma emergency department visits (AEDV). This has partly been attributed to inequitable exposure to diesel particulate matter (DPM). Promisingly, public parks and open space (PPOS) contribute to DPM mitigation. However, low-income communities of color with limited access to PPOS may be deprived of associated public health benefits. Therefore, this novel study investigates the AEDV, DPM, PPOS nexus to address this public health dilemma and inform public policy in at-risk communities. Optimized Hotspot Analysis was used to examine geographic clustering of AEDVs, DPM, and PPOS at the …