Health Economics Commons^™

The Effect Of Prenatal Substance Use Policies On Women's Well-Being, Zukruf Alam

Theses and Dissertations

This paper examines the effects of punitive and priority treatment policies relating to the use of illicit substances during pregnancy on women's health and health-related behavior. Punitive interventions criminalize substance use during pregnancy, which can even lead to termination of parental rights. In contrast, priority treatment policies support pregnant women and grant them priority access to substance use disorder treatment programs. I use staggered difference-in-differences methods and data from the Behavioral Risk Factor Surveillance System data from 2004 to 2018 to estimate the impact of prenatal substance use policies on women's mental health, physical health, self-reported poor health, and cigarette …

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, …

Do Anterior-Posterior Lumbar Fusions Provide More Short-Term Value Than Posterior-Only? An Application Of The Operative Value Index, Steven R. Glener, Advith Sarikonda, D. Mitchell Self, Ashmal Sami, Danyal Quraishi, Emily Isch, Arbaz A. Momin, Cheritesh R. Amaravadi, Jack Jallo, Joshua Heller, Ashwini Sharan, Alex R. Vaccaro, Srinivas K. Prasad, James Harrop, Nicholas J. Clark, Ahilan Sivaganesan

Department of Neurosurgery Faculty Papers

BACKGROUND: Lumbar fusion is a common treatment for degenerative spine changes. Although both anterior-posterior (AP) and posterior-only approaches are used, their cost-effectiveness remains uncertain. This study aims to compare the costs and short-term "value" (outcomes per dollar spent) of AP and posterior-only lumbar fusions using time-driven activity-based costing and patient-reported outcomes.

METHODS: A retrospective review of AP and posterior lumbar fusions from 2017 to 2022 was conducted. Time-driven activity-based costing was used to assign intraoperative costs based on resource utilization, and the Oswestry Disability Index (ODI) was collected preoperatively and 3 months postoperatively. The Operative Value Index (OVI) was defined …

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 …

Does Body Mass Index Influence Intraoperative Costs And Operative Times For Open Transforaminal Lumbar Interbody Fusion? A Time-Driven Activity-Based Costing Analysis, Danyal A. Quraishi, Advith Sarikonda, Dwight M. Self, Emily Isch, Steven R. Glener, Arbaz A. Momin, Ashmal Sami, Nicholas Clark, Joshua Pelta-Heller, Srinivas Prasad, Ashwini Sharan, Jack Jallo, James Harrop, Alex R. Vaccaro, Ahilan Sivaganesan

Department of Neuroscience Faculty Papers

BACKGROUND: The increasing prevalence of obesity has raised concerns about its impact on surgical outcomes and healthcare costs. This study evaluates the influence of Body Mass Index (BMI) on intraoperative costs and operative times during open Transforaminal Lumbar Interbody Fusion (TLIF) procedures using a Time-Driven Activity-Based Costing (TDABC) approach.

METHODS: A retrospective analysis was conducted on 279 patients who underwent TLIF between 2019 and 2022. Patients were categorized into 5 BMI cohorts: healthy weight (BMI 18.5-24.99), overweight (BMI 25.0-29.99), Class I obese (BMI 30.0-34.99), Class II obese (BMI 35.0-39.99), and Class III obese (BMI >40). Intraoperative costs were calculated using …

The Economics Of Substance Use: Treatment, Intervention, And Regulation, Christine Bretschneider-Fries

Graduate Theses, Dissertations, and Problem Reports (ETD)

Substance use in the United States has remained an area of concern with rates of overdose deaths increasing steadily over the years. Historically, the United States has relied on abstinence based treatment options for individuals with substance use disorder. Economists have long been interested in the affects of various supply and demand side policy interventions to help reduce the instance of substance use disorder, especially following the prescription opioid crisis of the 1990s and early 2000s. Supply side policies are most commonly enacted as a way to reduce the supply of illicit substances that enter the market. However, these supply …

Essays In Applied Microeconomics, Ege Aksu

Dissertations, Theses, and Capstone Projects

This dissertation consists of two chapters that investigate the effect of public health policies on health outcomes.

The first chapter evaluates the impact of the extensive health care reforms enacted between 2003–2013 under the Health Transformation Program (HTP) in Turkey on maternal and infant health outcomes for the poor. By focusing on a specific insurance program (Green Card) expansion that was a part of HTP, I explore changes in infant survival, fertility, and children’s vaccination status. Before 2004, all public health insurance beneficiaries (the control group) were covered for outpatient services, including prenatal and postnatal doctor visits, gestational diabetes screenings, …

Essays In Health Economics, Chuxin Liu

Dissertations, Theses, and Capstone Projects

In Chapter 1, I investigate the effect of a financial incentive from the Centers for Medicare and Medicaid Services (CMS) on new medical procedure technology diffusion. I examine how the incentive affects diffusion among Medicare patients, for whom hospitals receive the incentives, and non-Medicare patients for whom there are no incentives. I answer these two questions by studying the New Technology Add-on Payment (NTAP) program offered by Medicare (Part A). It is unknown whether its incentive is enough to encourage diffusion under the prospective payment system and it also remains unknown whether it spills over to non-Medicare patients or crowds …

Association Of Diabetes Prevalence With Labor Force Participation Rates In Kentucky Counties, Ryan Montgomery

MPA/MPP/MPFM Capstone Projects

Compared to other states in the USA, Kentucky has one of the highest rates of diagnosed diabetes and one of the lowest levels of labor force participation. This project employs a multivariable linear regression model to estimate the correlation between county-level diabetes prevalence and county-level labor force participation rates in Kentucky counties from 2015-2019, using publicly available data from the Centers for Disease Control’s Behavioral Risk Factor Surveillance System (BRFSS) and the U.S. Census Bureau’s American Community Survey (ACS). Labor force participation rates serve as the dependent variable and diabetes prevalence rates serve as the primary independent variable, alongside nine …

Indie Illness: An Evaluation Of The Orphan Drug Act, Nicholas Castellanos

Honors Theses

The purpose of this study is to evaluate the Orphan Drug Act of 1983 by subtracting the cost of incentives for drug development from the estimated value created by each drug in the form of quality-adjusted life-year gains. Data regarding costs of incentives is retrieved from the FDA as well as a report released by the National Organization for Rare Disorders. Data regarding value created by each drug is retrieved from a Freedom of Information Act request to the FDA, the CEA registry, and a report released by the US Department of Health and Human Sciences. Sufficient data was available …

The Impact Of Afghan Opium Cultivation On The U.S. Opioid Epidemic, Zachary Wahab Cheek

UNL Student Research Days Posters, Undergraduate

I argue here that increases in Afghan opium cultivation, the most prolific in the world, has depressed American prescription opioid and heroin prices, thereby increasing abuse risk in U.S. addict populations and increasing death rates. Utilizing a two-stage regression model with a sparse dataset from several national and international sources, I find evidence that a one percent increase in Afghan opium production is associated with a 0.122 percent increase in prescription opioid overdose deaths, and a 0.367 percent increase in heroin overdose deaths. Assessing the 2001-2002 Taliban opium ban with an identification strategy, I find that in this timeframe prescription …

Cost Estimation Alongside A Multi-Regional, Multi-Country Randomized Trial Of Antenatal Ultrasound In Five Low-And-Middle-Income Countries, B W. Bresnahan, E Vodicka, J B. Babigumira, Ashar Muhammad Malik, F Yego, A Lokangaka, B M. Chitah, Z Bauer, H Chavez, Sarah Saleem

Community Health Sciences

Background: Improving maternal health has been a primary goal of international health agencies for many years, with the aim of reducing maternal and child deaths and improving access to antenatal care (ANC) services, particularly in low-and-middle-income countries (LMICs). Health interventions with these aims have received more attention from a clinical effectiveness perspective than for cost impact and economic efficiency.
Methods: We collected data on resource use and costs as part of a large, multi-country study assessing the use of routine antenatal screening ultrasound (US) with the aim of considering the implications for economic efficiency. We assessed typical antenatal outpatient and …

The Effect Of The Fresh Program On Fruit And Vegetable Consumption In Nyc, Haido Andrianos

Theses and Dissertations

This study examines whether the NYCEDC's FRESH Program has had an effect on the fruit and vegetable consumption of NYC residents. Using data collected by the NYC DOHMH, a difference-in-difference regression with fixed effects was run. Stratifications for race and sex were also performed.

Economic And Cost-Effectiveness Analysis Of The Community-Level Interventions For Pre-Eclampsia (Clip) Trials In India, Pakistan And Mozambique, Jeffrey N. Bone, Asif R. Khowaja, Marianne Vidler, Beth A. Payne, Mrutyunjaya B. Bellad, Shivaprasad S. Goudar, Ashalata A. Mallapur, Khatia Munguambe, Rahat Qureshi, Zulfiqar Ahmed Bhutta

Woman and Child Health

Background: The Community-Level Interventions for Pre-eclampsia (CLIP) trials (NCT01911494) in India, Pakistan and Mozambique (February 2014-2017) involved community engagement and task sharing with community health workers for triage and initial treatment of pregnancy hypertension. Maternal and perinatal mortality was less frequent among women who received ≥8 CLIP contacts. The aim of this analysis was to assess the incremental costs and cost-effectiveness of the CLIP intervention overall in comparison to standard of care, and by PIERS (Pre-eclampsia Integrated Estimate of RiSk) On the Move (POM) mobile health application visit frequency.
Methods: Included were all women enrolled in the three …

Exploring Equity In Health And Poverty Impacts Of Control Measures For Sars-Cov-2 In Six Countries, Sedona Sweeney, Theo Prudencio Juhani Capeding, Rosalind Eggo, Maryam Huda, Mark Jit, Don Mudzengi, Nichola R. Naylor, Simon Procter, Matthew Quaife, Lela Serebryakova

Community Health Sciences

Background: Policy makers need to be rapidly informed about the potential equity consequences of different COVID-19 strategies, alongside their broader health and economic impacts. While there are complex models to inform both potential health and macro-economic impact, there are few tools available to rapidly assess potential equity impacts of interventions.
Methods: We created an economic model to simulate the impact of lockdown measures in Pakistan, Georgia, Chile, UK, the Philippines and South Africa. We consider impact of lockdown in terms of ability to socially distance, and income loss during lockdown, and tested the impact of assumptions on social protection coverage …

Government Management Capacities And The Containment Of Covid-19: A Repeated Cross-Sectional Study Across Chinese Cities, Wenchao Li, Jing Li, Junjian Yi

Research Collection School Of Economics

Objectives: Better understanding of the dynamics of the COVID-19 (2019 novel coronavirus disease) pandemic to curb its spread is now a global imperative. While travel restrictions and control measures have been shown to limit the spread of the disease, the effectiveness of the enforcement of those measures should depend on the strength of the government. Whether, and how, the government plays a role in fighting the disease, however, has not been investigated. Here, we show that government management capacities are critical to the containment of the disease. Setting: We conducted a statistical analysis based on cross-city comparisons within China. China …

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

Theses and Dissertations

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

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

Market Structure And Quality Of Service: Investigating Oligopolies And The Quality Of Nursing Home Care In California During The Covid-19 Pandemic, Tessa Ireton

Senior Independent Study Theses

Quality-of-service outcomes in nursing homes are of great social and human importance. However, especially during the COVID-19 pandemic, consistently maintaining markets with high quality care has been a pervading issue in the American nursing home industry. Furthermore, the industry is strongly characterized by oligopolies, a market structure that literature indicates may be less compatible with quality service than competitive markets. With this paper, I aim to investigate the possible intersection of oligopolist market structures and the quality of nursing home care during the COVID-19 pandemic. I start by describing quality of care in nursing homes, particularly during the COVID-19 pandemic, …

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 …

The Effect Of Good Samaritan Laws (Gsl) On Opioid Overdose Mortality, Tarun Ramesh

Undergraduate Economic Review

This paper investigates the effects of Good Samaritan Laws on opioid overdose mortality rates in the United States. Evaluating policy interventions in response to upticks in opioid mortality is crucial to enact federal legislation that protects communities. However, concerns about moral hazard implications could have profound impacts on current efforts to combat the epidemic. This paper will look at various policies proposed and evaluate the effects of such policies on overall mortality rates, elucidating the moral hazard effects of Good Samaritan Laws.

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 …

Three Essays In Applied Econometrics, Collin Dean Hodges

Graduate Theses, Dissertations, and Problem Reports (ETD)

The body of work presented here consists of a collection of research projects developed during my time as a graduate student at West Virginia University. As will soon become apparent, this collection of research topics is quite eclectic. This is, in part, due to the to the nature of the research process itself--where one often begins by asking one question and ends by answering a completely different one--but also due to the fact that my time at West Virginia University has provided me the opportunity to gain insight into a wide variety of economic fields as well as work on …

Impacts Of Antepartum Health Status And Health Insurance Coverage, Anjelica Gangaram

Theses and Dissertations

This paper examines how a woman's antepartum health and health insurance status affect her likelihood of experiencing postpartum maternal morbidity complications.

Essays On Health Economics: The Impact Of Public Policy On Health And Labor Market Outcomes, Grace Ellis Arnold

LSU Doctoral Dissertations

In this dissertation, I present three essays in health economics that can be read independently from one another. Chapter 2 examines the long-run impact of teenage access to family planning services on young women's health and non-health outcomes. Using the state-level variation in Medicaid family planning expansions, I find that expanding access to family planning services negatively impacts teen births and has positive spillover effects with regards to education and labor outcomes. A back of the envelope calculation suggests that the benefits outweigh the costs of providing these services to teenagers. In Chapter 3, I exploit the state-time variation in …

The Effect Of Fast Food Restaurants On Type 2 Diabetes Rates, Grace Bailey

CMC Senior Theses

This paper conducts an analysis of county level data to determine the effect of fast food restaurants on type 2 diabetes rates. Due to endogeneity concerns with respect to the location of fast food restaurants, this paper follows the work of Dunn (2010) and uses the number of interstate exits in a given county to serve as an instrument for fast food restaurants. The strength of the instrument, which is theoretically and empirically tested in this paper, imposes some restraints on the interpretation of the findings. Using the Two-Stage Least Squares estimation method, I find that the presence of fast …

A Critique Of Neoclassical Theory Of Health Care Consumption, Xiao Jiang

Electronic Theses and Dissertations

The purpose of this thesis is to display an internal critique of the neoclassical theory of health care consumption with the intention of understanding its true merits and limitations. To avoid arbitrariness, instead of criticizing it directly, this thesis first explores the existing scholarly critiques, as well as the developments of this theory in response to these criticisms. What is interestingly observed is that the neoclassical responses tend to systematically fall into two problematic categories – the trade-off between reality and theoretical determinacy, and free-market behavior resolution. Such observation suggests that there is something fundamentally problematic with this theory, which …