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Full-Text Articles in Health Economics

Peran Organisasi Civil Society Dan Belanja Program Penanggulangan Tb (Tuberkulosis) Di Indonesia: Studi Kasus Pw (Persatuan Wilayah) Aisyiyah Aceh, Hanifah Hasnur, Dharina Baharuddin, Asnawi Abdullah Dec 2020

Peran Organisasi Civil Society Dan Belanja Program Penanggulangan Tb (Tuberkulosis) Di Indonesia: Studi Kasus Pw (Persatuan Wilayah) Aisyiyah Aceh, Hanifah Hasnur, Dharina Baharuddin, Asnawi Abdullah

Jurnal Ekonomi Kesehatan Indonesia

The number of TB cases in Aceh has reached 8471 cases in 2018; 240 (2.8%) cases occurred among children. The real cases in the community were estimated higher than this figure. The success of TB control was influenced by many factors, including the roles of civil society organizations. This research was conducted to analyze the roles of civil society organizations in controlling TB cases in the community. A case study was conducted at PW Aisyiyah Aceh using an economic evaluation methodology for tracking expenditures for TB program activities (2011-2013) compared to the targets. The study showed that PW Aisyiyah has …


Strategi Implementasi Jaminan Kesehatan Nasional Dengan Metode Balanced Scoredcard: Studi Kasus Di Rumah Sakit X Tangerang Tahun 2018, Luh Putu Sinthya Ulandari, Jaslis Ilyas, Putu Ayu Indrayathi Dec 2020

Strategi Implementasi Jaminan Kesehatan Nasional Dengan Metode Balanced Scoredcard: Studi Kasus Di Rumah Sakit X Tangerang Tahun 2018, Luh Putu Sinthya Ulandari, Jaslis Ilyas, Putu Ayu Indrayathi

Jurnal Ekonomi Kesehatan Indonesia

One of the private hospital successful implementation the National Health Insurance with cost efficiency without neglecting the quality of service is X Hospital. This study aimed to finding out the strategy of X Hospital in the implementation of the National Health Insurance with Balanced Scorecard. The research was conducted in May 2018 using qualitative approach. Data was collected through in-depth interview to 7 informants from hospital and 2 informants from BPJS Kesehatan. The subjects were selected purposively and the data was analyzed using thematic analysis. The results show that there are several strategies that have been developed and implemented, including: …


Hubungan Realisasi Alokasi Dana Kesehatan Dan Pemanfaatan Pelayanan Kesehatan Ibu Di Indonesia, Izzun Nafiah Dec 2020

Hubungan Realisasi Alokasi Dana Kesehatan Dan Pemanfaatan Pelayanan Kesehatan Ibu Di Indonesia, Izzun Nafiah

Jurnal Ekonomi Kesehatan Indonesia

Increasing the utilization of maternal health services is an important target for the Indonesian government to increase the achievement of the SDGs targets. Funds budgeted for the health sector are at least 5% of the APBN and 10% of APBD excluding salaries. This is smaller than countries in the low-income category, while WHO shows that an increase in the allocation of health funds has a positive relationship with the degree of public health. Therefore, this study aims to determine whether there is a relationship between the realization of health fund allocation and the utilization of maternal health services in Indonesia. …


Determinan Sosial Ekonomi Terhadap Berat Badan Lebih Dan Obesitas Di Indonesia: Analisis Data Ifls 2014, Fajar Nugraha, Riki Relaksana, Adiatma Y. M. Siregar Dec 2020

Determinan Sosial Ekonomi Terhadap Berat Badan Lebih Dan Obesitas Di Indonesia: Analisis Data Ifls 2014, Fajar Nugraha, Riki Relaksana, Adiatma Y. M. Siregar

Jurnal Ekonomi Kesehatan Indonesia

The phenomenon of overweight and obesity has become a serious problem in various countries, especially in Indonesia. According to WHO in 2016 there were 2.8 million people who died due to the problem of overweight and obesity, while according to the Indonesian Ministry of Health the prevalence of overweight and obesity in Indonesia in 2018 reached 13,6% and 21.8%. One of the factors that cause overweight and obesity is socio-economic status. However, there are often differences regarding the effect of socioeconomic status on obesity in developing and developed countries. This study aims to identify the determinant factors of socioeconomic status …


Analisis Faktor Socioeconomic Status (Ses) Terhadap Kesehatan Mental: Gejala Depresi Di Indonesia, Yustika Dewi, Riki Relaksana, Adiatma Y. M. Siregar Dec 2020

Analisis Faktor Socioeconomic Status (Ses) Terhadap Kesehatan Mental: Gejala Depresi Di Indonesia, Yustika Dewi, Riki Relaksana, Adiatma Y. M. Siregar

Jurnal Ekonomi Kesehatan Indonesia

According to the World Federation of Mental Health, 1 of 5 people in the world experiences a mental disorder. Several studies have mentioned that one of the primary factors that cause mental disorders is the low of socioeconomic status in developing countries. Therefore, this study was conducted to determine the influence of socioeconomic status factors on depressive symptoms as a mental disorder, in one of the developing countries, Indonesia. This study uses a quantitative method based on secondary data taken from the Indonesia Family Life Survey (IFLS) wave 5 using the CESD-R 10 questionnaire for depressive symptom variables. Depression symptom …


Evaluasi Implementasi Jaminan Persalinan (Jampersal) Di Indonesia, Mazda Novi Mukhlisa, Rosa Estetika Dec 2020

Evaluasi Implementasi Jaminan Persalinan (Jampersal) Di Indonesia, Mazda Novi Mukhlisa, Rosa Estetika

Jurnal Ekonomi Kesehatan Indonesia

Jampersal as a transfer fund from central to district government is provided to support maternal and child health services aiming to increase access to health services for pregnant women, childbirth and postpartum mothers, also newborns to competent health facilities. This analysis aimed to evaluate the use of Jampersal in increasing institutional delivery using quantitative and qualitative approaches. For the quantitative approach, this analysis used Riskesdas 2018 and routine data from the Ministry of Health. The data was analyzed using benefit incidence analysis (BIA) and linear regression. The quantitative approach was conducted at two levels, the individual level (80,459 pregnant women) …


Social Determinants Of Health: The Impact On Health Outcomes And Hospital Profitability, Danielle Mcpherson Dec 2020

Social Determinants Of Health: The Impact On Health Outcomes And Hospital Profitability, Danielle Mcpherson

Doctor of Business Administration Dissertations

Hospitals are experiencing decreasing profitability due to increasing healthcare cost. In this paper, I demonstrate that there is financial value to hospitals by addressing social determinants of health (SDOH) as this strategy improves health outcomes and yields cost savings. I estimate the impact of SDOH on the health outcomes using an IV probit regression analysis and estimated the impact of health outcomes on cost using a basic linear regression. I estimate that improving SDOH by one standard deviation will result in hospital cost savings as follows: addressing Violent Crime will decrease hospital cost between 0.16% and 0.21%, addressing Supplemental Nutrition …


Staying Connected: The Importance Of Social Integration On The Well-Being Of Older Adults, Paulin T. Straughan, Vincent Chua, Stephen Hoskins, Frosch Quek Dec 2020

Staying Connected: The Importance Of Social Integration On The Well-Being Of Older Adults, Paulin T. Straughan, Vincent Chua, Stephen Hoskins, Frosch Quek

ROSA Research Briefs

It has been about a year since COVID-19 first emerged and reshaped the daily lives of people around the globe, including Singaporeans. Since moving past the circuit breaker in June, Singapore has gradually re-opened and relaxed its restrictions in different phases. As Singapore prepares for Phase 3- the final and least restrictive phase, it is important to examine how Singaporeans have coped and responded with the circuit breaker (7 April 2020) and its gradual easing of restriction in Phase 1 (2nd June 2020) and Phase 2 (19 June 2020), and identify the groups which have fallen through the gaps in …


The Affordable Care Act And Entrepreneurship Lock: An Updated Examination Of Employer-Based Healthcare’S Effect On Self-Employment By Demographic Group, Sean Ruddy Nov 2020

The Affordable Care Act And Entrepreneurship Lock: An Updated Examination Of Employer-Based Healthcare’S Effect On Self-Employment By Demographic Group, Sean Ruddy

Undergraduate Economic Review

This paper capitalizes on a natural experiment created by differences in Medicaid expansion under The Patient Protection and Affordable Care Act (ACA). A difference and difference model comparing states that did and did not expand Medicaid is conducted to investigate if providing an alternative and low-cost source of health insurance affects self-employment rates overall and across different demographic groups. The results suggest that living in a state that expanded Medicaid was associated with a 1.4 percent increase in the likelihood that an individual will be self-employed and that this effect is heterogeneous across different demographics, being largest among African Americans.


Predictors Of Social Distancing And Mask-Wearing Behavior: Panel Survey In Seven U.S. States, Plamen Nikolov, Andreas Pape, Ozlem Tonguc, Charlotte Williams Aug 2020

Predictors Of Social Distancing And Mask-Wearing Behavior: Panel Survey In Seven U.S. States, Plamen Nikolov, Andreas Pape, Ozlem Tonguc, Charlotte Williams

Economics Faculty Scholarship

This paper presents preliminary summary results from a longitudinal study of participants in seven U.S. states during the COVID-19 pandemic. In addition to standard socio-economic characteristics, we collect data on various economic preference parameters: time, risk, and social preferences, and risk perception biases. We pay special attention to predictors that are both important drivers of social distancing and are potentially malleable and susceptible to policy levers. We note three important findings: (1) demographic characteristics exert the largest influence on social distancing measures and mask-wearing, (2) we show that individual risk perception and cognitive biases exert a critical role in influencing …


Attitudes, Behaviours, And The Well-Being Of Older Singaporeans In The Time Of Covid-19: Perspectives From The Singapore Life Panel, Paulin T. Straughan, William Tov, Seonghoon Kim, Terence Cheng, Stephen Hoskins, Micah Tan Jul 2020

Attitudes, Behaviours, And The Well-Being Of Older Singaporeans In The Time Of Covid-19: Perspectives From The Singapore Life Panel, Paulin T. Straughan, William Tov, Seonghoon Kim, Terence Cheng, Stephen Hoskins, Micah Tan

ROSA Research Briefs

COVID-19 has affected all Singaporeans, regardless of age and socioeconomic status (SES). Many measures have been implemented by the government to control the spread of this disease, including restrictions on social gatherings, restrictions on overseas travel, and making it compulsory to wear a mask. Measures have also included a partial lockdown – known as the ‘circuit breaker’ – which began in April 2020. This forced Singaporeans to quickly adapt to a new normal with some doing better than others. This research brief provides an overview of how COVID-19 and its related measures have affected seniors in Singapore using data from …


Impacts Of Rift Valley Fever Virus: A One Health Approach To Assess Burden And Inform Prevention And Control Options, Catherine Machalaba Jun 2020

Impacts Of Rift Valley Fever Virus: A One Health Approach To Assess Burden And Inform Prevention And Control Options, Catherine Machalaba

Dissertations and Theses

Background: Rift Valley Fever (RVF) is a climate-sensitive emerging zoonotic disease associated with large-scale livestock production losses and human disease burden in Sub-Saharan Africa and the Middle East. While recognized as a key One Health issue based on its transmission dynamics involving human, animal and environmental determinants, there has been poor coordination between sectors to reduce the risk and impact of RVF. Efforts to counter the disease remain largely reactive, presenting an ongoing threat to local and global health security. The intent of this dissertation was to improve understanding of the burden of RVF across society and to identify entry …


Treatments For Cancer Given Orally: Patients' Perceptions Of Distress Due To Financial Toxicity, Ellen Carr Jan 2020

Treatments For Cancer Given Orally: Patients' Perceptions Of Distress Due To Financial Toxicity, Ellen Carr

Dissertations

Purpose/Aims: For adult participants who have received or are receiving treatment for hematologic and solid tumor malignancies given orally, this study describes the relationship between participants’ experience of financial toxicity (FT), the participants’ perception of distress associated with FT, and participants’ self-identified adherence to prescribed treatments in the context of FT.

Background: FT has emerged as an additional source of distress for cancer patients. The costs of treatments given orally can be prohibitively expensive for patients. Therefore, these patients may experience considerable distress and may not adhere to treatments as prescribed.

Method: Descriptive cross-sectional correlational design study of a sample …


Poverty In The United States: An Analysis Of Its Measurement And The Long-Term Social And Economic Costs, Abby Magnus Jan 2020

Poverty In The United States: An Analysis Of Its Measurement And The Long-Term Social And Economic Costs, Abby Magnus

Electronic Theses and Dissertations

This thesis examines the role of poverty in the United States and how it has impacted social and economic systems. It explores how U.S. poverty measurements developed in the 1960s may not be accurately measuring poverty now, and the ways in which these measures could be improved upon. This work also reviews literature on health and educational inequities stemming from socioeconomic class, and the role these play in long-term economic mobility. Finally, it analyzes how larger social institutions like mass incarceration and capitalism have developed around poverty, and the role they play in maintaining its prevalence today. This thesis finds …


Evidence-Based Approach To Drug Crisis, Jiebing Wen Jan 2020

Evidence-Based Approach To Drug Crisis, Jiebing Wen

Theses and Dissertations--Public Policy and Administration

I am devoted to health policy research, especially tackling the opioid crisis, and evaluating marijuana laws and newly emerging issues associated with legal recreational drugs. Opioid overdose in the United States continues to jeopardize public health. Meanwhile, the majority of states have legalized medical marijuana and one third of them further liberalized recreational marijuana. Marijuana liberalization, although originally independent of the growing opioid crisis, may be a harm reduction approach to the crisis because marijuana may be a substitute for opioids in pain management at a relatively lower risk. However, marijuana liberalization may also lead to marijuana-related harms, such as …


Examining The Effects Of Public Policies And Addiction On Purchase Of Tobacco Products With Causal Inference And Machine Learning Methods, Xueting Deng Jan 2020

Examining The Effects Of Public Policies And Addiction On Purchase Of Tobacco Products With Causal Inference And Machine Learning Methods, Xueting Deng

Theses and Dissertations--Agricultural Economics

My three essays explore the effects of tobacco policies and addiction on the consumption of e-cigarettes and other tobacco products. Recently, jurisdictions imposed taxes and other regulations on e-cigarettes, with the hope to raise tax revenues and address health concerns regarding e-cigarette use, especially youth addiction. My first essay in Chapter 1 focuses on the effects of e-cigarette taxes on sales of e-cigarettes. It compares the two types of tax policies on sales of e-cigarettes, cigarettes, and smoking-cessation products. This comparison provides information for lawmakers on decisions of taxes regarding the perspectives of revenue generation and tobacco control. Second, after …


A Comparative Analysis Of The Price Of Insulin In Canada And The United States, Kimia Z. Badakhshan Jan 2020

A Comparative Analysis Of The Price Of Insulin In Canada And The United States, Kimia Z. Badakhshan

Honors Undergraduate Theses

There's frequent discourse regarding the rising cost of insulin in the US. Insulin is a drug that over 7 million people rely on for survival, and it has tripled in cost over the last decade. The pricing regulation of the drug is dependent on multiple stakeholders, including wholesalers, pharmacy benefit managers, and manufacturing companies. Due to the lack of governmental intervention in the process of pharmaceutical cost regulation in the US, data on the price negotiations and the rebate system between these entities is unavailable in public records, making it difficult to determine a primary cause as the root of …


Three Essays On Health Economics And Policy Evaluation, Shishir Shakya Jan 2020

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 Dec 2019

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 …


The Effect Of Citi Bike Introduction On Injury Rates In New York City, Masakazu Hiruma Aug 2019

The Effect Of Citi Bike Introduction On Injury Rates In New York City, Masakazu Hiruma

Theses and Dissertations

This paper tests the hypothesis that the introduction of Citi Bike influences bicycle injuries by observing the gradual expansion of the bike share system in NYC. Data is analyzed from 2012-2018 New York Police Department (NYPD) Motor Vehicle Collisions and Citi Bike Station Feeds (NYC Open Data).


Comparative Spending Of Medicaid Dollars On Child Participants Of Kentucky’S Sobriety Treatment And Recovery Teams Program Versus A Matched Comparison Group., Matthew Thomas Walton Aug 2019

Comparative Spending Of Medicaid Dollars On Child Participants Of Kentucky’S Sobriety Treatment And Recovery Teams Program Versus A Matched Comparison Group., Matthew Thomas Walton

Electronic Theses and Dissertations

Child protective services agencies have long observed the complicating role that parental substance use and addiction plays in cases of child maltreatment. Families who struggle with these problems present unique challenges for child welfare professionals. These families are typically more difficult to engage, more likely to have children removed from the home, and have poorer outcomes when compared to other families. These poorer outcomes often include health problems. Addiction has well-known effects on health, and the specific manifestations of these problems for parents have been documented for years in child protection casework. However, what has been less investigated are the …


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 Mar 2019

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 …


The Impact Of Legalization Of Marijuana On Opioid Overdose Deaths, Radhika N. Bharadwaj Feb 2019

The Impact Of Legalization Of Marijuana On Opioid Overdose Deaths, Radhika N. Bharadwaj

Theses and Dissertations

This masters’ thesis aims to examine the impact of the legalization of marijuana for recreational use on the death toll from opioid misuse in the state of Colorado. This investigation was done using the Synthetic Controls Method via data collected primarily from the CDC and IPUMS databases. The results indicate that the 2012 legalization policy in Colorado appears to reduce the number of deaths due to opioid overdoses.


Empty Discarded Pack Data And The Prevalence Of Illicit Trade In Cigarettes In California, James Prieger Jan 2019

Empty Discarded Pack Data And The Prevalence Of Illicit Trade In Cigarettes In California, James Prieger

School of Public Policy Working Papers

Illicit trade in tobacco products (ITTP) creates many harms including reduced tax revenues; damages to the economic interests of legitimate actors; funding for organized-crime and terrorist groups; negative effects of participation in illicit markets, such as violence and incarceration; and reduced effectiveness of smoking-reduction policies, leading to increased damage to health. To study the prevalence of tax avoidance and ITTP, we analyze a large, novel set of data from empty discarded pack (EDP) studies. In EDP studies, teams of researchers collect all cigarette packs discarded in publicly accessible spaces of selected neighborhoods. Packs are examined for the absence of local …


A Study Of The Effects Of Certificate Of Need Law On Inpatient Occupancy Rates, Jomon Aliyas Paul, Huan Ni, Aniruddha Bagchi Jan 2019

A Study Of The Effects Of Certificate Of Need Law On Inpatient Occupancy Rates, Jomon Aliyas Paul, Huan Ni, Aniruddha Bagchi

Faculty Articles

Increasing healthcare costs and the deterioration of healthcare quality have always been major concerns to policy makers in the United States, and Certificate of Need (CON) Law has been implemented as one way to curb wasteful healthcare resource use. Theoretically, CON can lead to a reduction in the number of beds as well as in the number of inpatient days (possibly by shortening the length of patient stay). However, these two effects impact inpatient occupancy rate in opposite directions. We test empirically to find out which of these two effects dominate. In this study, we investigate the impact of CON …


Does Medicaid Increase Emergency Room Use: Evidence From Oregon Health Program?, Md Fourkan Jan 2019

Does Medicaid Increase Emergency Room Use: Evidence From Oregon Health Program?, Md Fourkan

Electronic Theses and Dissertations

This thesis paper strives to identify the relationship between Medicaid expansion and Emergency Department use. I use a Monte Carlo simulation for demonstrating the endogeneity problem and a copula model using the Oregon Health Program (OHP) data to show the previous literature has exaggerated the causal relation between Medicaid expansion and Emergency Department use. This paper can be divided into two parts. First, it tries to focus on the under-identification of multiple endogenous variables problem in typical econometrics papers, where researchers correct for a single endogenous variable but intentionally or unintentionally ignore the endogeneity of one or more other independent …


Patient-Centered Medical Homes And Hospital Value-Based Purchasing: Investigating Provider Responses To Incentives, Lauryn Walker Jan 2019

Patient-Centered Medical Homes And Hospital Value-Based Purchasing: Investigating Provider Responses To Incentives, Lauryn Walker

Theses and Dissertations

Provider incentives are a commonly used policy tool to mold provider behaviors.1 However, while we frequently measure the change in patient outcomes, failure to consistently produce changes in outcomes does not mean that providers are not changing their behavior. This paper focuses on two programs with null or inconsistent quality outcomes to try to identify why such inconsistency occurs. The two programs, both ratified in the Affordable Care Act, are 1) patient-centered medical homes (PCMHs), and 2) the Medicare Hospital Value-Based Purchasing (HVBP) program.

Chapter 1: Using data from the Medical Expenditure Panel survey (MEPS), I match provider characteristic …


The Critical Need For Mental Health Education To Be Mandated In New Mexico's Public Schools, Bonnie L. Murphy Nov 2018

The Critical Need For Mental Health Education To Be Mandated In New Mexico's Public Schools, Bonnie L. Murphy

Shared Knowledge Conference

Based on a review of research and best practices in mental health awareness and skills, this inquiry project argues for state legislative policies that would require mental health awareness and skills in the K-12 curriculum. Mental health affects individual accomplishments in every stage of people’s lives beginning in early childhood and throughout the life cycle. Prevention and treatment of mental illness plays a key role in the ability of an individual to cope with loss and develop resiliency and perseverance in challenging times and to make better decisions that improve the individual’s life and the lives of those around them. …


Determinants Of Usaid Spending, Austin J. Moser Oct 2018

Determinants Of Usaid Spending, Austin J. Moser

Student Research – Stevenson Center

This paper examines the determinants of USAID’s foreign aid disbursements from 2002-2016. Three noteworthy findings emerge. First, USAID foreign aid is based more on political considerations rather than the policies of recipient countries. Second, foreign aid is determined by location and political history. Third, this pattern emerges across all categories of USAID disbursements.


Kisumu County Hospital Patient Demographic Analysis: Looking Toward Universal Health Coverage, Lauren Scheffey Oct 2018

Kisumu County Hospital Patient Demographic Analysis: Looking Toward Universal Health Coverage, Lauren Scheffey

Independent Study Project (ISP) Collection

Universal health coverage is priority sought after by developed and developing nations alike, and Kenya sits on the list of countries seeking to achieve this goal in the coming years. The definition of “coverage” can vary by country, but three criteria are commonly found in the discussion of UHC globally: access, affordability, and quality. Affordability is determined by the state’s healthcare financing system; quality refers to the services provided by health facilities; and access, at least in part, concerns the geographic placement of health services providers in relation to the population they intend to serve. This geographic element is the …