Health Economics Commons^™

Hospital Concentration And Aca Premiums, Lucas Piselli

Bryant REDay (Research and Engagement Day)

This research examines the relationship between hospital market concentration and health insurance premiums in the Affordable Care Act (ACA) Marketplaces. As hospitals across the United States have increasingly merged or closed, provider markets have become more concentrated, raising questions about whether consolidation improves efficiency or instead increases healthcare costs through greater market power. Using Marketplace premium data, hospital discharge information, and demographic controls from 2014–2017, the study analyzes how hospital concentration, measured by the Herfindahl–Hirschman Index (HHI), affects insurance pricing. The findings show that highly concentrated hospital markets are associated with significantly higher Marketplace premiums, even after controlling for insurer …

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 …

Drowning Prevention In The West: Who Did It Better?, Arran Hedley

University Honors Theses

This paper aims to communicate the differences on how the US, UK and Australia have approached drowning prevention in each of their nations. This paper addresses drowning statistics within each nation, national, state and local policies, access to public facilities, and the preventative strategies, swim lessons and Lifeguarding. These are the criteria each nation is being graded upon, because each criteria is a factor that can help mitigate drowning deaths.

For literature around this subject, there are many papers on each individual nation's approach to drowning but in researching there does not appear to be a comparison of the nations' …

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 …

Expanding Public Health Insurance To Parents: Effect On Parents' And Children’S Well-Being, Michelle Marcus, Xuan Zhang

Research Collection School Of Economics

Expanding public health insurance to parents may not only improve parental outcomes but also have spillover effects on their children. This paper leverages the natural experiment of the Affordable Care Act (ACA) to estimate the causal effects of expanding public health insurance to low-income parents on their well-being and that of their children. Using a difference-in-differences model and data from the 2010–2017 National Health Interview Surveys, we observe significant improvements in health care access, increased health care utilization, reduced financial burdens, and slight improvements in health status among low-income parents. For children in Medicaid expansion states, we find reductions in …

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 …

Military Service During The Vietnam War Hurt Veterans’ Long-Term Health, Xintong Wang, Carlos A. Flores, Alfonso Flores-Lagunes

Employment Research Newsletter

No abstract provided.

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 …

Statute Meets Custom: Explaining Provincial Variation In Child Marriage After Indonesia’S 2019 Reform, I Made Yudisthira, Diahhadi Setyonaluri

Jurnal Ekonomi Kependudukan dan Keluarga

This study investigates whether Indonesia’s 2019 Marriage Law reform, which raised the minimum legal age of marriage to 19, has been associated with lower child marriage prevalence. Using province-level aggregates from the 2022 Indonesian National Socio-Economic Survey (SUSENAS, N = 1,237,946), we distinguish documented and undocumented unions and estimate Ordinary Least Squares models with controls for poverty, education, assets, rural residence, religious composition, and marriage dispensations. Descriptive maps show prevalence is highest in South Kalimantan (18%), East Java (17%), and West Java (17%), with undocumented unions concentrated in West Nusa Tenggara (7%), Banten (5%), Papua (5%), and West Sulawesi (5%). …

Bibliometric Analysis Of Research On Women’S Labor Force Participation And Household Economics, Muhamad Dupi, Inayat Ullah Baloch

Jurnal Ekonomi Kependudukan dan Keluarga

Studies of women labor participation (WLFP) and household economics have grown in size in the last two decades and more research and policy focus are given to gender equality, labor markets and household welfare. Nevertheless, the available literature is still in pieces by region, theme, and institutional settings and a complete bibliometric review of this area of study is yet to be done. The objective of the proposed study is to trace the world-wide literature on the topic of women participation in the labor force and household economics through the analysis of the patterns of publications, networks of cooperations, and …

Bukan Hanya Tugas Istri: Pengaruh Penggunaan Kontrasepsi Suami Terhadap Kesehatan Mental Istri, Aldo Savira Adha Saputra, Elda L. Pardede

Jurnal Ekonomi Kependudukan dan Keluarga

Male participation in contraceptive use in Indonesia remains very low, while women continue to bear a disproportionate reproductive burden, including mental health impacts from contraceptive side effects. This study aims to examine the effect of husbands’ contraceptive use on wives’ mental health. The analysis utilizes data from the fifth wave of the Indonesia Family Life Survey conducted in 2014. Wives’ mental health is measured using the Center for Epidemiologic Studies Depression Scale - 10. The results of the binary logistic regression model indicate that husbands’ contraceptive use lowers the likelihood of wives experiencing depression. Additionally, being aged 25-49, having good …

Military Service During The Vietnam War Hurt Veterans’ Long-Term Health, Xintong Wang, Carlos A. Flores, Alfonso Flores-Lagunes

Upjohn Institute Policy and Research Briefs

No abstract provided.

Retroactive Eligibility Waivers: Innovative Or Ineffective?, Mohamed Kacem Benyamine

Theses and Dissertations

Medicaid’s retroactive eligibility provision covers medical expenses for beneficiaries up to 90 days before the application date. Retroactive eligibility insulates uninsured, low-income households from expensive healthcare emergencies. New Hampshire, Arkansas, and Iowa recently obtained waivers to end retroactive coverage. Using a difference-in-differences design and data from the Behavioral Risk Factor Surveillance System, I evaluate whether changes in retroactive coverage affect enrollment rates and self-reported health. Removing retroactive eligibility has no statistically significant effects on insurance enrollment or self-reported health. However, it does increase rates of access to a doctor by 1.0% overall and by 1.6% for women. Removing retroactive eligibility …

The Effect Of Medical Aid In Dying On Health Outcomes And Risky Behavior Of The Elderly, Jacky Wu

Theses and Dissertations

This study examines the effects of Medical Aid in Dying (MAiD) legalization on health outcomes and behavior among elderly U.S. adults using BRFSS data from 2005-2022. Using staggered difference-in-differences, this paper finds that MAiD increases exercise, lowers BMI, and reduces blood pressure medication use.

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 …

Beyond Bans: A Travel Distance-Based Approach To Estimating The Effects Of Dobbs V. Jackson Women’S Health Organization On Fertility And Labor Supply, Enya Kamadolli

CMC Senior Theses

The Dobbs v. Jackson Women’s Health Organization decision had highly heterogeneous effects on abortion access across U.S. states, variation I exploit to identify causal effects on fertility and labor supply. Rather than a binary “total ban” indicator, I construct a continuous treatment measure based on changes in distance to the nearest legal abortion provider between 2021 and 2023, and apply a difference-in-differences design to state-level panel data. Effects are attenuated and imprecise in the South, consistent with diminishing marginal effects at large distances. In non-Southern states, I find that a 100 km increase in distance raises total births by about …

The American Anomaly: Feasibility Of Universal Healthcare, William Bernstein

Student Research and Publications

No abstract provided.

Economic Inequality And Family Formation In The United States, Elizabeth S. Krause

Theses and Dissertations--Economics

This dissertation evaluates economic inequality and family formation in the United States in three essays. In Essay 1, I estimate the effect of providing subsidized access to immediate postpartum contraceptives on birth spacing and infant health among low-income teen mothers. The intent-to-treat estimates indicate a 20% reduction in the monthly short-interval birth rate among teens 12-14 months after policy enactment. I also find evidence that the policy increased the average interval between births and reduced preterm and low-birth weight births and NICU admission rates. In Essay 2, I provide evidence that single mothers and single women without children are important …

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 …

Dampak Peraturan Daerah Terkait Kesehatan Terhadap Prevalensi Stunting Tingkat Kabupaten/Kota Di Indonesia, Cakra Yudi Putra, Teguh Dartanto

Jurnal Ekonomi dan Pembangunan Indonesia

Stunting remains a major public health challenge in Indonesia with long-term impacts on health, cognition, and productivity. This study examines whether health-related regional regulations (Peraturan Daerah or Perda) reduce stunting prevalence across 338 districts/municipalities in 2007 and 2013. Using Difference-in-Differences (DiD) and DiD with Propensity Score Matching (DiD-PSM) on secondary data from Riskesdas, Statistics Indonesia (BPS), and the Legal Documentation and Information Network (JDIH), we find no statistically significant causal effect of cumulative health Perda on stunting reduction, although OLS shows a negative association. Sanitation significantly reduces stunting in eastern Indonesia. Findings highlight the need for evidence-based, multisectoral, measurable, implementable, …

Policy Snapshot : Health Insurance Trends Among Child Care Educators, Sara Amadon

Straus Institute for Thriving Children & Families

This brief compares the health insurance status of child care educators in 2019 and 2024—spanning the COVID-19 pandemic and preceding 2026H.R.1’s implementation—to highlight shifting coverage patterns and state-level solutions to safeguard this essential workforce.

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 …

Essays On Nursing Home Closures And Disparities In Post-Acute And Long-Term Care, Hyeonwoo Do

Electronic Theses & Dissertations (2024 - present)

This dissertation examines the consequences of nursing home closures for access to care, local economic conditions, and resident health in the United States. As the long-term care system shifts toward home- and community-based services and the nursing home sector contracts, facility closures have become an increasingly important policy concern. Although closures may reflect necessary market restructuring in some settings, they may also reduce access, weaken local economies, and place pressure on surviving facilities. Across three essays, this dissertation shows that the consequences of nursing home contraction are uneven and depend on racial and ethnic composition, rurality, local market concentration, and …

Three Essays In Health Economics, Caroline Andressa Welter

Graduate Theses, Dissertations, and Problem Reports (ETD)

Health outcomes and access to care are shaped by the interaction between public institutions, administrative rules, and responses to health risk. This dissertation investigates how barriers to access, changes in perceived risk, and policy design influence participation in public programs, preventive health behavior, and  treatment continuation. Across three essays in health economics, I examine how individuals respond to disruptions in service delivery, epidemic exposure, and administrative burden, with a focus on vulnerable populations that depend on public systems of care.
The first essay analyzes the impact of Social Security Administration field office closures on participation in federal disability programs during …

Three Essays In Cpi Bias And Health Economics, Auderta Amoako-Nuamah

Graduate Theses, Dissertations, and Problem Reports (ETD)

The first essay estimates bias in the Consumer Price Index (CPI) for elderly individuals in the United States using Engel curve methodology and household-level data from the Panel Study of Income Dynamics (1999–2023). The analysis focuses on how well the CPI reflects changes in the cost of living for older Americans, with particular attention to differences by gender and marital status. Results show that from 1999–2011, the CPI overstated the increase in the cost of living for both elderly and non-elderly households. In contrast, from 1999–2023, the CPI understated cost increases, with the bias generally larger for non-elderly households. Within …