Health Economics Commons^™

Does Schooling Improve Cognitive Abilities At Older Ages? Causal Evidence From Nonparametric Bounds, Vikesh Amin, Jere R. Behrman, Jason M. Fletcher, Carlos A. Flores, Alfonso Flores-Lagunes, Hans-Peter Kohler

Upjohn Institute Working Papers

We revisit much-investigated relationships between schooling and health, focusing on schooling impacts on cognitive abilities at older ages using the Harmonized Cognition Assessment Protocol in the Health & Retirement Study (HRS) and a bounding approach that requires relatively weak assumptions. Our estimated upper bounds on the population average effects indicate potentially large causal effects of increasing schooling from primary to secondary; yet, these upper bounds are smaller than many estimates from the literature on causal schooling impacts on cognition using compulsory-schooling laws. We also cannot rule out small and null effects at this margin. We do, however, find evidence for …

More Schooling Can Delay The Onset Of Dementia Later In Life, Vikesh Amin, Jere R. Behrman, Jason M. Fletcher, Carlos A. Flores, Alfonso Flores-Lagunes, Iliana Kohler, Hans-Peter Kohler, Shana D. Stites

Upjohn Institute Policy and Research Briefs

No abstract provided.

Causal Effects Of Schooling On Memory At Older Ages In Six Low-And-Middle-Income Countries: Nonparametric Evidence With Harmonized Datasets, Vikesh Amin, Jere R. Behrman, Jason M. Fletcher, Carlos A. Flores, Alfonso Flores-Lagunes, Iliana Kohler, Hans-Peter Kohler, Shana D. Stites

Upjohn Institute Working Papers

Higher schooling attainment is associated with better cognitive function at older ages, but it remains unclear whether the relationship is causal. We estimate causal effects of schooling on performances on the Consortium to Establish a Registry for Alzheimer’s Disease (CERAD) word-recall (memory) test at older ages in China, Ghana, India, Mexico, Russia, and South Africa. We used harmonized data (n=30,896) on older adults (≥50 years) from the World Health Organization Study on Global Ageing and Adult Health. We applied an established nonparametric partialidentification approach that bounds causal effects of increasing schooling attainment at different parts of the schooling distributions under …

Time-Driven Activity-Based Costing For Cervical Myelopathy Surgery: A Step Towards Total Episode Costs, Kavantissa M. Keppetipola, Adam Leibold, Jay Trivedi, Ashmal Sami, Advith Sarikonda, D. Mitchell Self, Emily L. Isch, Steven R. Glener, Srinivas Prasad, Jack Jallo, Joshua E. Pelta-Heller, James Harrop, Alex R. Vaccaro, Ahilan Sivaganesan

Department of Neurosurgery Faculty Papers

INTRODUCTION: Time-driven activity-based costing (TDABC) is a highly accurate method for determining the true cost of delivering a healthcare service. However, TDABC is most often applied to a singular phase of care such as an outpatient visit or a surgical event. Here we broaden the scope by using TDABC to estimate the costs of surgically treating cervical myelopathy - from the moment of surgical scheduling until post-operative hospital discharge.

METHODS: In a single-center retrospective study at a large tertiary academic institution, TDABC was employed to measure pre-operative, intra-operative, and post-operative (inpatient) costs for 63 patients undergoing elective surgery for cervical …

An Exploratory Study Of Household Alcohol Consumption From The Us Bureau Of Labor Statistics Consumer Expenditure Survey With A Focus On Market Conditions And Regulatory Structures, Mayya Makarycheva

Dissertations, Theses, and Capstone Projects

Alcohol consumption and use is not just a harmful behavior or a potential recreational activity, but it also may form a way of self-identification.

Each type of beverage apparently has their own profile of dedicated drinkers. Those drinkers are also apparently loyal to the location of purchase. However, one may also consider whether consumption in one location is a predictor of consumption in the other location. This distinct tendency highlights the intricacy of consumption patterns, as on-premise and off-premise consumption simultaneously serve as complements and substitutes in the long run in terms of both location and type of beverage.

The …

Protecting The Future Of Medical Innovation: Balancing Fiscal Responsibility With The Need For National Institutes Of Health And Federal Health Funding, Irina Petrache, Raed A. Dweik, Michelle Ng Gong, Jesse Roman, M. Patricia Rivera, Karen J. Collishaw

Division of Pulmonary, Allergy, and Critical Care Medicine Faculty Papers

No abstract provided.

Menstrual Math: The Price Of Bleeding, Gabrielle Langston

Dissertations, Theses, and Capstone Projects

This project examines the landscape of menstrual equity in the United States through a data storytelling lens, focusing on state-level policies regarding taxation and access to menstrual products. The analysis explores which states impose sales tax on menstrual products, if state schools provide free menstrual products, and which states ensure access for incarcerated individuals using publicly available datasets from advocacy groups. Additionally, there is an investigation into potential correlations between the gender wage gap and states that tax menstrual products, shedding light on economic and policy disparities.

Through its data visualizations, this project aims to provide a clear, although not …

Federal Health Research Cuts In The Mountain West, 2025, Mia Tschan, Ivan Sun, Sydney Mitchell, Caitlin J. Saladino, William E. Brown Jr.

Health

This fact sheet presents data from the Science & Community Impacts Mapping Project (SCIMaP) report, “Impact of Federal Health Research Cuts,” which predicts economic and job losses resulting from proposed National Institutes of Health (NIH) funding/grants cuts for indirect research costs as of April 9, 2025. This fact sheet focuses on predicted economic and job loss for the Mountain West states of Arizona, Colorado, Nevada, New Mexico, and Utah, and county-level data for the State of Nevada.

Integrating Positive Psychology And Spirituality To Foster Meaning And Well-Being In Older Adults, Crystal Morris

Adultspan Journal

This perspective article explores the integration of positive psychology interventions (PPIs) and spirituality in therapy to foster meaning and well-being in older adults. It highlights exercises such as the positive introduction, positive legacy, character strengths, mindfulness, mindful-based yoga, and a manifestation prayer journaling. The interventions presented are tools to support older adults that may experience depression, difficult life transitions, and the search for renewed meaning. Therapists who integrate PPIs and spirituality into therapy can promote a holistic, non-pathological approach to treatment.

Is Anterior Cervical Discectomy And Fusion More Expensive At Quaternary Care Centers? An Application Of Time-Driven Activity-Based Costing, Jay Trivedi, Advith Sarikonda, Adam Leibold, D. Mitchell Self, Nikolaos Mouchtouris, Steven R. Glener, Ashmal Sami, Kavantissa M. Keppetipola, Emily Isch, Joshua Pelta-Heller, Srinivas Prasad, Ashwini Sharan, James Harrop, Alex R. Vaccaro, Ahilan Sivaganesan

Department of Neurosurgery Faculty Papers

OBJECTIVE: Hospital setting is postulated to be a key driver of cost variation for neurosurgical procedures. Limitations in contemporary costing methodologies have led to the development of time-driven activity-based costing (TDABC). This study applies TDABC to anterior cervical discectomy and fusion (ACDF) to compare intraoperative costs at quaternary care centers versus satellite hospitals affiliated with the same health network.

METHODS: Nine hundred and fifty-eight ACDF cases performed at two quaternary care hospitals (n = 806) and six satellite hospitals (n = 152) were reviewed. Process maps were created to map the intraoperative episode, and TDABC methodology was used to calculate …

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 …

Exploring Anticoagulant Prescription Disparities: A Focus On Hispanic Patient Care, Michael Acevedo, Vanessa Veltre

Rowan-Virtua Research Day

Anticoagulants play a critical role in preventing thromboembolic events, yet disparities persist in their prescription among minority populations. This presentation explores inequities in anticoagulant prescribing patterns, with a specific focus on Hispanic patient care. Using retrospective electronic health record data, we analyzed the prescription rates of warfarin versus direct oral anticoagulants (DOACs) among adults with clinical indications for anticoagulation. Our findings reveal that Hispanic patients are significantly less likely to receive DOACs compared to non-Hispanic White patients, even after adjusting for demographics, comorbidities, and insurance status. Contributing factors include language barriers, lack of insurance, and potential implicit bias in provider …

The Association Between Economic Outcomes And Abortion: A Scoping Review, Larisa Nicole Stephenson

Capstone Experience: Master of Public Health

Background: Abortion access is not just an issue of autonomy, but an economic issue as well. Evidence of the intersectionality of abortion health care and economics has endured due to the financial cascading effects a denial of an abortion, or the inability to access an abortion, has on one’s personal, professional, and economic upward mobility. A change in recent policies impacting access to abortion warrants an updated synthesis examining the relationships between economic outcomes and abortion access for people of reproductive age in the United States (U.S.).

Aim: This scoping review summarizes evidence pertaining to the association …

The Effects Of Income On Infant Health: Evidence From The Coal Boom And Bust, Chu Gek Chew

Dissertations and Theses Collection (Open Access)

An individual’s health at birth is an important component in human capital accumulation, posing significant implications both in the short- and long-run. I investigate how infant health outcomes were impacted during a period of successive positive and negative economic shocks led by the coal industry between the 1970s to 1990s. Using exogenous variation within counties’ pre-existing coal reserves, I instrument for the changes in economic opportunities during the coal boom and bust. I find some limited evidence that an increase in income improves infant health outcomes. The incidence of low birthweight is decreasing in earnings growth, and effects are stronger …

Does Moving From One-Story Building To Multi-Building Affect The Health Status Of The Elderly: Evidence From China’S Par Program, Lu Cao

Dissertations and Theses Collection (Open Access)

This study investigates the causal impact of relocating from single-story to multistory buildings on the health outcomes of elderly residents in China. Using China’s Poverty Alleviation Relocation (PAR) program as an exogenous policy shock, we employ instrumental variable and difference-in-differences approaches to establish causality. Our analysis of data from the China Health and Retirement Longitudinal Study (2011-2018) reveals a nuanced relationship between vertical living and elderly health. While relocation to multi-story buildings is associated with deterioration in self-reported physical health status, it significantly improves mental health conditions and life satisfaction among elderly movers. We identify two key mechanisms driving these …

Strategizing Towards The Future Hospital: A Systems Thinking Approach, Ashish Kumar, Sean Shao Wei Lam, Sze Ling Chan, Yingqi Xu, Yao Ge, Geoffrey Kah Tack Gui, Hiang Khoon Tan

Research Collection School Of Economics

Background: The complex systemic nature of Future Hospital design in the rapidly ageing city-state of Singapore calls for systems thinking. We apply this approach to answer two research questions: (i) What are the variables that drive the present and future dynamics of the Future Hospital system? (ii) How are these driving variables related? Methods: Causal loop diagrams (CLDs) were developed collaboratively by a cross-functional system modelling team through group modelling discussions and reviews, totalling 20 sessions. Network analysis of the resulting CLDs was used to identify dominant variables. Results: Seven interlocking CLDs (national view, cluster view, and study hospital top …

Correlative Assessment Of Demographic Markers And Health Insurance On Self-Reported Health Status, Ismat Ara Sharin Sajnee

All Graduate Reports and Creative Projects, Fall 2023 to Present

This study investigates whether known demographic groups report poorer health status even after adjusting for health insurance. Research analyzes the factors that correlate with poor reported health status and demographic markers associated with inequitable healthcare access. Sealy-Jefferson et al. (2015) explores the rate of health insurance as a primary mechanism to mitigate the financial risk of accessing health care, but significant racial and ethnic health disparities continue to exist among insured populations.

This study uses pooled cross-sectional data from the National Health Interview Survey (NHIS) from 2019 to 2023 and simple linear regression models to examine the relationship between demographic …

Evaluation Of Dentistry Students' Perceptions And Attitudes Towards Artificial Intelligence In Kazakhstan, Yasin Yasa, Kubeisin Altynbekov, Nazgul Onaibekova

Journal of Dentistry Indonesia

Objective: Artificial intelligence’s (AI) potential to analyze medical data and improve patient outcomes is driving its rapid integration into healthcare systems. This study addresses the knowledge gap regarding Kazakhstani dental students’ attitudes toward AI in dentistry. Methods: A survey with 213 participants assessed dental students’ views on AI in dentistry at two Kazakhstani universities. A self-administered questionnaire (22 items) via Google Forms was used to gather data on demographics, baseline knowledge (information sources, understanding of AI principles, and familiarity with dental AI applications), and attitudes/perceptions. Frequency analyses and chi-square tests (p < 0.05) explored the responses. Results: The survey included 213 dental students (mean …

Synthesis And Partial Characterization Of Chitosan Phosphorylation From Marine Cuttlefish Sepia Aculeata (Orbingy, 1848) And Its Antimicrobial Potentials Against Oral Pathogens, Yathin Reddy Putta, Annathai Pitchai, Pasiyappazham Ramasamy

Journal of Dentistry Indonesia

Objectives: This study investigated the synthesis and partial characterization of phosphorylated chitosan extracted from the cuttlebone of Sepia aculeata (Orbingy, 1848) and evaluated its antimicrobial potential against oral pathogens. Methods: The synthesis of phosphorylated chitosan from Sepia aculeata cuttlebone involved several steps: cleaning, deproteinization, demineralization to extract chitin, deacetylation to produce chitosan, and phosphorylation to introduce phosphate groups. Phosphorylation enhances the properties of chitosan, making it a promising candidate for oral health applications. Phosphorylated chitosan was purified and characterized using Fourier Transform Infrared Spectroscopy (FTIR), X-ray diffraction (XRD), and Scanning Electron Microscopy (SEM) to confirm structural changes. This process enhances …

Evaluation Of Mandibular Condyle And Coronoid Process Anomalies Using Cone-Beam Computed Tomography, Rümeysa Şendişçi Gök, Bilay Stevanovic Sancar, Sevcihan Günen Yılmaz

Journal of Dentistry Indonesia

Objective: The aim of this study was to evaluate the prevalence of condylar and coronoid process anomalies, their types, and their relationship to sex. Method: Cone-beam computed tomography (CBCT) images were retrospectively analyzed for the presence and types of abnormalities in the condylar and coronoid processes. Statistical analysis of measurement data was performed using SPSS version 22. Medical histories of the individuals were obtained from their digital dental records. Results: CBCT images of 400 individuals were included in the study. Condylar anomalies were observed in 9.5% of cases, while coronoid anomalies were found in 7.5%. All condylar anomalies were more …

Microstructural And Elemental Characterization Of Hydrated Carbonated Hydroxyapatite As Pulp Capping Agent: An In Vitro Study, S.Swathi Priyadharshini, Chinnasamy Ragavendran, J. Ramana Ramya, Anand Sherwood

Journal of Dentistry Indonesia

Understanding the microstructural and elemental composition of pulp capping materials is crucial for predicting their biocompatibility and effectiveness in promoting pulp healing. Objectives: This study aimed to characterize the microstructural and elemental properties of carbonated hydroxyapatite as a dental pulp-capping material. Methods: Carbonated hydroxyapatite was synthesized using the precipitation method. MTA and Apacal ART were obtained from commercial sources. The materials were prepared into disk-shaped specimens, hydrated in deionized water at 37°C for 14 days, and analyzed using scanning electron microscopy (SEM) and energy-dispersive X-ray spectroscopy (EDX). Results: SEM images revealed that MTA exhibited smooth, plate-like crystalline structures surrounded by …

Does Periodontal Treatment During Pregnancy Reduce The Incidence Of Preterm Birth Rates?: A Meta-Analysis Of Randomized Controlled Trials, Ashraf Elzer, Raga A. Elzahaf, Hameda Asrafel, Khalid Sassi, Mohamed Jedeh

Journal of Dentistry Indonesia

Objective: To find out if scaling and root planing for periodontal disease during pregnancy lowers the incidence of preterm births. Methods: This is a meta-analysis study design; searches were conducted in the PubMed database and on Google Scholar between January 2000 and December 2023. Only randomized controlled trials (RCTs) were considered. The studies will be examined to determine the relationship between non-surgical periodontal treatment and preterm birth rates among pregnant women. Results: Only 14 trials were included out of 194 articles identified. The overall result indicated a statistically significant reduction in preterm birth rate when we use the random …

The Self-Sustainability Of Federally Qualified Health Centers, Javier Vallejo

MUSC Theses and Dissertations

This exploratory data analysis examines the self-sustainability of Federally Qualified Health Centers (FQHCs) using the 2023 Uniform Data Systems (UDS) dataset, focusing on health centers' reliance on government grants as a revenue source. FQHCs provide high-quality healthcare services to medically underserved populations; today, nearly 1 out of every 11 Americans receives some form of care at an FQHC. There is widespread variability in the delivery of care amongst FQHCs. Additionally, funding and reimbursement methodologies vary across states and geographic regions. FQHCs face challenges maintaining operational efficiency amid federal funding shortfalls, shifting reimbursement methodologies, and the lingering impact of the COVID-19 …

The Economic Factors Of Suicide, Hogan C. Fox

Honors College Theses

This study examines how macroeconomic indicators influence state‐level suicide rates in the United States and, critically, how those effects differ by gender. Drawing on annual data from all fifty states over 2010–2020, I merge age‐adjusted suicide rates from CDC WONDER with five key economic indicator: real hourly compensation, labor productivity, employment rate, median income, and logged state GD, from the Bureau of Labor Statistics, Census Bureau, and the Bureau of Economic Analysis. After comparing pooled OLS, random‐effects, first‐difference, and two‐way fixed‐effects specifications, I adopt a two-way, state‐and‐year fixed‐effects model for its superior fit and capacity to control for unobserved heterogeneity. …

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, …

Risk And Outcomes Of Pregnancy-Related Acute Kidney Injury: A Cohort In Bronx, Ny, Erica Marnet, Mayssaa Hoteit, Isbell Crevantes, Sonail Gupta, Ladan Golestaneh

Posters

Pregnancy-related acute kidney injury (PR-AKI) has been increasing in incidence and is associated with worse maternofetal outcomes. The goal of this study is to examine risk and hospitalization outcomes of PR-AKI compared to pregnancy without AKI in a low-income, minoritized population in Bronx, New York

Implementation Of Performance-Based Budgeting For Public Health Care Service Delivery In An Emerging Economy, Isaac O. Randa, Christine A. Adere

Southern African Journal of Policy and Development

This study investigates the determinants and implications of the implementation of performance-based budgeting (PBB) on public health care service delivery at the Ministry of Health and Social Services (MoHSS) in Windhoek, Namibia. Using a cross-sectional survey research design targeting 100 respondents, this study employed a quantitative research approach involving MoHSS's budgeting and health care services departments. Data were analysed using partial least squares structural equation modelling. Communication, bureaucratic structures, and implementers’ disposition significantly influenced PBB implementation alignment, thereby enhancing service delivery. However, resource utilisation showed no significant effect. Additionally, implementation alignment effectively mediated the relationship between latent exogenous variables and …

Strengthening Local Health Systems And Governance For Universal Health Coverage: Experiences And Lessons From The Covid-19 Pandemic Response In Quezon City, Philippines, Esperanza Anita Escano-Arias, Ramona Asuncion D.G. Abarquez, Rolando V. Cruz, Rosalie Espeleta, Madeline Mae Ong, Arianna Maever L. Amit, Veincent Christian Pepito, Vida Gomez, Manuel M. Dayrit

Ateneo School of Medicine and Public Health Publications

The COVID-19 pandemic has disrupted the Philippines's transition toward universal health coverage. However, some local government units in the country made use of the pandemic as a catalyst to strengthen their local health system, scale-up the provision of preventive and primary care services, and improve health governance to make it more prepared to face future pandemics and realize the aims of the country's new Universal Healthcare Act. This paper describes the response of the local government of Quezon City, Philippines, to COVID-19 and how it strengthened local health systems. We also discuss enablers such as partnerships, collaborations, and foresight to …

Opioid Treatment Matters: An Analysis Of District Attorney Non-Prosecution, Samuel A. Maloney

Senior Theses

Drug use and drug overdose have become an overriding concern both for civic order and due to the raw death toll from the opioid epidemic. One reform push in the late 2010s/early 2020s, county-level District Attorneys signalling that they would not prose- cute drug use and related crimes, aimed to reduce overdose by reducing criminalization and stigma as a barrier to opioid treatment. At its peak, the policy covered between twenty and thirty million Americans. Using hand-collected data on District Attorney policies and Augmented Synthetic Control for causal identification, I estimate null ef- fects of non-prosecution policies on an urban …

Inter-Prefectural Migration Of Older Adults In The Tokyo Metropolitan Area, Katsuyoshi Nakazawa, Shinji Komatsu

Japanese Society and Culture

This study uses population migration data from the 2020 National Census to examine the migration of older adults within the Tokyo metropolitan area and between the Tokyo metropolitan area and other areas. The main results are as follows: In the Tokyo metropolitan area, both older adults aged 65–74 and those aged 75 and over move out of Tokyo to the three surrounding prefectures. This tendency was more prevalent in those aged 75 and over than those aged 65–74. Regarding migration between the Tokyo metropolitan area and other areas, the results show the opposite trend, with those aged 65–74 outflowing from …