Health Economics Commons^™

The Impact Of Tobacco-Free School Laws On Student And Staff Smoking Behavior, Rachana Bhatt, Peter Hinrichs

Upjohn Institute Working Papers

A number of U.S. states have enacted bans on tobacco use by students, staff, and visitors anywhere on the grounds of public elementary and secondary schools statewide. These laws are intended to reduce tobacco use, reduce exposure to secondhand smoke, reinforce anti-tobacco curricula taught in schools, and prevent children from viewing their teachers and fellow students using tobacco products. We examine the impact that the laws have on the smoking behavior of students, teachers, and other school staff by using stacked difference-in-differences estimators that exploit the time variation in adoption of the laws across states. The results presented in this …

Did Statewide School Smoking Bans Reduce Smoking Rates?, Rachana Bhatt, Peter Hinrichs

Upjohn Institute Policy and Research Briefs

No abstract provided.

Financial Recovery Capital: Exploring The Role Of Extension Education In Promoting Substance Use Recovery, Alex Elswick, Nichole L Huff, Omolola A. Adedokun, Leslie Workman

Journal of Extension

Substance use is a widespread and complex public health challenge. Financial stress (e.g., unemployment, inadequate housing, transportation access, poor financial literacy) is pervasive among people with substance use disorder (SUD). However, few educational interventions exist to address financial stress for this group. Through the theoretical lens of recovery capital (an asset-based approach that describes the totality of resources that support SUD recovery), we summarize the association between financial stress and substance use, offering implications for Extension educators by highlighting PROFIT, an exemplary program that leverages Extension education as a tool to promote financial recovery capital among people with SUD.

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 …

Clinical Outcomes Of Adjunctive Use Of Oxygen-Releasing Formula In Non-Surgical Treatment Of Periodontal Abscess Associated With Type 2 Diabetes Mellitus, Anil Kumar Kanakamedala, Laxmi Kavya Gangireddy, Gautami S Penmetsa, Sruthima Gottumukkala, Mohan Kumar Pasupuleti, Konathala Santhosh Venkata Ramesh

Journal of Dentistry Indonesia

Background: This study aimed to evaluate the effectiveness of oxygen-releasing formula (ORF) as an adjunct in the non-surgical management of periodontal abscess in patients with type 2 diabetes mellitus.

Methods: This split-mouth clinical trial was conducted on 14 patients with periodontal abscess with type 2 diabetes mellitus (T2DM), who were divided into a control group, nonsurgical periodontal therapy (NSPT) alone, and a test group (NSPT+ORF). Parameters such as Landry's healing index (HI) were evaluated at 1 week, 2 weeks, and 1 month. Probing pocket depth (PPD), clinical attachment level (CAL), and bleeding on probing presence or absence (BOP) …

Adverse Drug Reaction Reporting In Dental Practice And The Importance Of Pharmacovigilance In Dental Education, Radhakrishna Lagishetty, Lakshmi Ramya T, Kvr Barath Raju, Mohan Kumar Pasupuleti

Journal of Dentistry Indonesia

Background: Adverse drug reactions (ADRs) are a critical component of patient safety; however, ADR monitoring remains underutilized in dentistry. This study aimed to assess knowledge, attitudes, and practices regarding ADR reporting among undergraduate and postgraduate students and practicing dentists.

Methods: A cross-sectional observational study was conducted using a structured, validated 19-item questionnaire covering socio-demographics, knowledge (6 items), attitude (4 items), and practice (5 items), which was distributed both in person and online. A total of 258 complete responses were analyzed out of 300 individuals contacted (response rate: 86%). Descriptive statistics and Chi-square tests were applied, with p < 0.05 considered statistically significant.

Results …

Investigation Of Patients' Use Of Non-Pharmacological Substances In Dental Pain Management, Neslihan Yılmaz Çırakoğlu, Özgenur Kaya

Journal of Dentistry Indonesia

Background: Dental pain is a complex condition influenced by biological, biochemical, environmental, and psychological factors. Before seeking professional care, many patients attempt to relieve dental pain using self-administered, non-medical agents. This study aimed to investigate patients’ use of non-pharmacological substances in dental pain management and to identify factors influencing these practices.

Methods: The questionnaire consisted of four sections addressing demographic characteristics, oral hygiene habits, pain characteristics, and pain-relief agents. Categorical variables were analyzed using Pearson’s chi-square test. Categorical data are presented as frequencies and percentages, while continuous data are expressed as mean ± standard deviation and median values. …

Orthodontic Camouflage Treatment Of A Severe Class Iii Skeletal Pattern With Anterior Open Bite: A Case Report, Dikeledi Maureen Letsholo, Mandla Dominic Nyakale, Mosimane Peter Silas Sethusa

Journal of Dentistry Indonesia

Background: Class III malocclusion combined with anterior open bite (AOB) is one of the most challenging occlusal problems to treat. The objective of this article was to report a case of an adult female patient diagnosed with Class III malocclusion combined with an anterior open bite and a hyperdivergent facial pattern.

Case Report: Camouflage orthodontic treatment with the extraction of maxillary and mandibular first premolars was used to treat the patient. Anterior teeth were retracted maximally against the Nance holding arch and fixed lingual arch appliances, and box elastics were used to close AOB. At the end of …

Assessing Healthcare Access Among Overweight And Obese Individuals In Türkiye Using Latent Variable Modeling, Banu Beyaz Sipahi

Makara Journal of Health Research

Background: Overweight and obesity are critical determinants of healthcare access, yet evidence on how the COVID-19 pandemic reshaped these dynamics in Türkiye remains limited. This study investigates whether the early post-pandemic recovery period altered healthcare access patterns for individuals with excess weight.

Methods: Using nationally representative microdata from the 2014, 2016, 2019, and 2022 Turkish Health Surveys, we constructed a latent Healthcare Access Index based on six indicators of unmet care needs. Probit models were estimated to assess associations between BMI categories and healthcare access, controlling for socioeconomic and demographic factors. The 2022 wave serves as the early …

Preventive Interventions Targeting Social Determinants Of Health: Implications For Healthcare Utilization And Cost, Audrey Wrinkle

NEXUS: The Liberty Journal of Interdisciplinary Studies

Preventive interventions targeting social determinants of health could reduce avoidable healthcare utilization and positively impact long-term cost outcomes within healthcare systems. Evidence indicates that financial and social barriers to preventive care lead to delayed treatment and increased use of high-cost healthcare services in the long term. Preventive interventions focusing on upstream social factors, like home-based care and digital health programs, could improve patient outcomes and reduce avoidable service utilization. Also, incorporating social needs data into policy creation could promote better allocation of healthcare resources. This research highlights the role of prevention-focused strategies in promoting cost-effective, sustainable healthcare delivery.

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 …

The Impact Of State Insulin Copayment Caps On Diabetics In The United States, Ryan C. Meyer

All Theses

Insulin is a life-saving medication for people with diabetes that helps regulate blood glucose levels throughout the body. A Type 1 diabetic cannot survive without insulin, and a Type 2 diabetic’s quality of life greatly diminishes without access and use of this drug. Currently, many diabetics skip, ration, or abstain from insulin due to financial barriers. As of June 2026, 29 states have enacted insulin copayment caps for state-regulated commercial health insurance plans to reduce the financial burden of insulin costs. This study examines the impact of these caps on all commercially insured diabetics in the United States, particularly on …

The Effect Of Vaccine Mandates On Disease Spread: Evidence From College Covid-19 Mandates, Riley K. Acton, Wenjia Cao, Emily E. Cook, Scott A. Imberman, Michael F. Lovenheim

Research Collection School Of Economics

Nearly 700 4-year U.S. colleges mandated students receive COVID-19 vaccinations in fall 2021. Using data on college policies and county health, we estimate how mandates affect surrounding communities. Event studies from August to November 2021 show that mandates covering all colleges in a county reduced COVID-19 deaths by 5.6 per 100,000 persons, a 4.6% reduction in the U.S. total during this period. Mandates reduced COVID cases by 504 and ICU admissions by 16.2 per 100,000, though we see no statistically significant impact on hospitalizations. Impacts are larger in counties with larger college populations and low estimated ex-ante student vaccination rates.

Out-Of-Pocket Health Spending And Household Impoverishment In Tanzania Using The 2020/21 National Panel Survey, John Geofrey Massito Dr, Hinju John Gabriel Dr

Tanzanian Economic Review

Out-of-pocket health spending (OOPHS) can convert healthcare needs into financial hardship, particularly where risk-pooling mechanisms are limited. Evidence on its direct contribution to household impoverishment in Tanzania remains limited. This study estimates the impoverishing effect of OOPHS and examines the factors associated with household exposure to healthcare payments. We analysed nationally representative data from the 2020/21 Tanzania National Panel Survey. Household welfare was assessed before and after OOPHS using the Foster–Greer–Thorbecke poverty framework. Changes in the poverty headcount, poverty gap and poverty severinty were used to identify poverty entry and poverty deepening. Determinants of OOPHS were estimated using a two-part …

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 …

The Effects Of Private Equity Ownership Of Acute Care Hospitals On Patient Experience, Abigail M. Huffman

Theses and Dissertations

In 10 years, private-equity firms' share of hospitals has grown from 2-3% to 8%.  Using data from two sources: the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) patient surveys and the Private Equity Stakeholder Project (PESP), I demonstrate a causal effect of private-equity ownership on patient satisfaction using difference-in-difference methods.

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

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 …

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 …

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

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 …

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 …

Essays On Public Policy And Health Outcomes: Unintended Consequences And The Cost Of Influence, Wenhan Yan

Dissertations and Theses Collection (Open Access)

This dissertation investigates the complex behavioral responses to public policy shifts and institutional cues, quantifying their intended and unintended societal impacts. Across two distinct empirical contexts, this research examines how individuals adapt their risk profiles when signals from political or legal authorities change and how these adaptations generate measurable externalities.

The first chapter, "From Punishment to Treatment: Unintended Social Impacts of Changing Drug Policies," shifts the focus to the intersection of health policy and criminal justice. This chapter evaluates the sudden transition from punitive drug enforcement to health-oriented decriminalization, utilizing the 2021 State v. Blake decision in Washington as a …

Exploring Dominican University Nursing Students’ Perceptions Of Economic Barriers To Accessing Essential Women’S Health Products, Annabelle E. Burke

Nursing | Senior Theses

Period poverty is defined as inconsistent or inadequate access to feminine hygiene products, and it has been shown to negatively impact physical and mental health, academic performance, and dignity across diverse populations. Existing research highlights financial strain, social stigma, and insufficient support as key barriers to menstrual equity among individuals experiencing homelessness, adolescents living in low-resource environments, low-income women, and general undergraduate students (Brinkley & Niebuhr, 2023; Dave et al., 2022; Gruer et al., 2021; Lahme et al., 2018; Parkinson et al., 2024; Gilchrist et al., 2024). However, no studies have examined these issues amongst Dominican University nursing students who …

Improving Maternal Health: Investigating The Early Impacts Of Medicaid Coverage Of Doulas In Oregon, Miriam Akhmetshin

Scripps Senior Theses

While the U.S. spends more per-capita than any country on healthcare, we experience the worst maternal health outcomes of high-income nations. In addition to hefty healthcare bills, an overwhelming majority of mothers experience pregnancy-related health issues that decrease productivity and utility. Thus, it is critical to research cost-effective solutions that can improve maternal health and promote equitable outcomes. Doulas are trained non-medical professionals who support mothers and families before, during and after birth. As a growing body of medical literature points to the role of doulas in decreasing costly medical interventions, insurance companies have begun covering their services. In 2014, …

Barriers To Immunity: Understanding Covid-19 Vaccine Uptake In Africa, Emilia Blechschmidt

Honors Theses

This thesis examines the factors influencing COVID-19 vaccine uptake across African countries, with a focus on structural, informational, and behavioral barriers to immunization. Drawing on cross-country data, the study analyzes how access to transportation, reliable information, and healthcare resources shape vaccination rates, alongside the effect of demographics and institutional factors in shaping individual perceptions of risk and vaccine safety.

The findings emphasize that the broader strength and preparedness of national health systems strongly influence vaccine uptake. Countries that demonstrated higher coverage of routine childhood immunizations, such as polio and hepatitis B, also tended to perform better in COVID-19 uptake efficiency …

Differential Impact Of Admission Type And Clinical Complexity On Diabetes Hospitalization Costs Among African American And Hispanic Patients In Southeastern Virginia, Ismail El Moudden, Asra Amidi, Reem Sharaf-Alddin, Michael C. Bittner, Qi Zhang

Department of Obstetrics & Gynecology Faculty Publications

Background

Diabetes mellitus (DM) imposes substantial healthcare costs with documented disparities among African Americans and Hispanic patients. To inform care delivery and resource allocation, this study identified hospitalization cost predictors among African American and Hispanic patients with diabetes in Southeastern Virginia.

Methods

We analyzed 6,011 hospital discharges from the Virginia Health Information database (2016-2020) for adults aged 18-85 with diabetes. Discharges were classified by Medicare Severity Diagnosis-Related Groups: DM with complications/comorbidities (DCC, n = 3,328), DM with major complications/comorbidities (DMCC, n = 1,518), and DM without major complications/comorbidities (DWO, n = 1,165). Because cost distributions were right-skewed (skewness 3.5-8.24), we …

Visit Complexity Differs Between Scarring And Nonscarring Alopecia: A 5-Year Dataderm Analysis, Ian Noel Encarnacion, Noelle Desir, Nicholas Schell, Apoorva Mehta, Temitayo Ogunleye, Susan Taylor

Department of Medicine Faculty Publications

[Introduction] Accurate coding is a critical component of dermatologic practice, influencing reimbursement and documentation of clinical complexity. Although alopecia has significant psychosocial and financial burdens, Current Procedural Terminology (CPT) coding patterns in alopecia management remain largely understudied. Our population-level study using the American Academy of Dermatology's DataDerm clinical registry¹ evaluates alopecia CPT coding trends, pre-2021 and post-2021 evaluation and management (E/M) CPT coding updates,² aiming to inform coding practices and visit complexity, which have significant reimbursement implications.

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 …

Musculoskeletal Disorders In Dentistry: An Insight Into Dental Techniques And Practices, Mehwash Kashif, Aman Ashar, Amna Rehman, Abdul Aleem, Sidra-Tul-Muntaha Hashmi, Muhammad Yousuf Ali

Journal of Dentistry Indonesia

Objective: Musculoskeletal disorders (MSDs) are common workplace hazards in dentistry resulting from poor ergonomics and static postures, which lead to back, neck, and upper limb (shoulder, elbow, wrist, and hand) problems among dentists, resulting in harm to their health, productivity, and career. This study aimed to assess the frequency of MSDs, risk factors related to MSDs, and awareness of ergonomics among clinicians. Methods: Data were collected from 400 dental professionals, including house officers, postgraduate trainees, general dentists, and teachers/consultants, each with at least 12 months of practice. Data were collected using a structured, closed-ended questionnaire. Before data collection, ethical approval …