Health Economics Commons^™

A Framework For Learning During An Honors Internship: Embold Health Inc., Haley Haldeman

The Eleanor Mann School of Nursing Undergraduate Honors Theses

Embold Health Inc. is a health care analytics start-up company that identifies top performing providers using large data sets and clinically nuanced measurement. A comprehensive assessment of quality, appropriateness, and cost is what Embold Health delivers. Embold allows payers more control in choosing providers within their region. Being able to identify top provider behaviors through rigorous data driven measurement is significant both clinically and commercially; it provides the opportunity to increase value of care, decrease waste, and drive down cost.

Over the past year as an intern, I’ve had a first-hand look into the complexity that surrounds data driven health …

The Effects Of The Affordable Care Act Medicaid Expansion On Breast And Cervical Cancer Screening Rates On Low-Income Childless Women, Michelle Raissa Kobou Wafo

Economics

In 2010, the Obama administration passed the Patient Protection and Affordable Care Act (ACA) commonly known as Obamacare. However, it is in 2014 that several key parts of the ACA went into effect. Among those key parts is the Medicaid expansion program. States that chose to adopt the policy, expanded Medicaid access to everyone under 138 percent of the federal poverty line. This extension had the largest impact on childless adults who previously were not covered by the program. Moreover, ACA made it mandatory for all health plans (private and public) to include the ten essential health benefits in their …

How Can Occupational Licensing Reforms Improve Access To Dental Care?, Jacob M. Caldwell, Brian Isom

Undergraduate Honors Capstone Projects

Occupational licensing laws have a large effect on the American economy and requirements affect all levels of professional work, from hairdressers and plumbers to doctors and lawyers.Those laws vary by state and exist to protect consumers from asymmetric information problems. Yet a growing body of literature finds that occupational licensing raises costs for consumers without necessarily raising the quality of service.

The dental field is one such sector of employment that commonly is licensed. Oral health is an important indicator of overall individual health and general wellbeing. Unfortunately, consumers lack access to dental care in many parts of the United …

Differences In Tsimane Children’S Growth Outcomes And Associated Determinants As Estimated By Who Standards Vs. Within-Population References, Melanie Martin, Aaron Blackwell, Hillard Kaplan, Michael Gurven

Economics Faculty Articles and Research

Anthropometric measures are commonly converted to age stratified z-scores to examine variation in growth outcomes in mixed-age and sex samples. For many study populations, z-scores will differ if calculated from World Health Organization (WHO) growth standards or within-population references. The specific growth reference used may influence statistical estimates of growth outcomes and their determinants, with implications for biological inference. We examined factors associated with growth outcomes in a sample of 152 Tsimane children aged 0–36 months. The Tsimane are a subsistence-scale population in the Bolivian Amazon with high rates of infectious disease and growth faltering. To examine the influence of …

Investigating The Change In The Out-Of-Pocket Cost Of Insulin Over Time, Jared Long

Mahurin Honors College Capstone Experience/Thesis Projects

Insulin is often cited as a classic near perfectly inelastic good; for those living with Type-1 diabetes, antihyperglycemic medicines are the only thing standing between them and possible death, and they must be willing to pay for the medication regardless of the price. When researchers at the University of Toronto released the patent for insulin in 1922, they asked for only $1 so that the medication would be available to as many people as possible; however, as insulin analogs and new biosimilar substitutes have been invented, the price of medications has increased substantially. While the rising cost of insulin has …

Quality Over Quantity: A Comparative Analysis Of The Quality Measures And Performance Between Switzerland And The United States, Lexi Farina

Independent Study Project (ISP) Collection

Even in the best health systems, poor quality of care continues to cause harm to patients and prevent them from receiving the best treatment possible. Thus, it is important to record and report quality of care measures because they can help inform policy changes and improve performance. In this paper, a comparative analysis between the United States and Switzerland is conducted to understand the process for defining and assessing quality indicators in each country as well as compare their quality of care performance results. The methods for this study include a literature review of relevant background information relating to quality …

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 …

Climate Change And Occupational Health: Can We Adapt?, Marcus Dillender

Upjohn Institute Policy and Research Briefs

No abstract provided.

The Three-Year Impact Of The Affordable Care Act On Disparities In Insurance Coverage, Charles J. Courtemanche, James Marton, Benjamin Ukert, Aaron Yelowitz, Daniela Zapata, Ishtiaque Fazlul

Economics Faculty Publications

Objective
To estimate the impact of the major components of the ACA (Medicaid expansion, subsidized Marketplace plans, and insurance market reforms) on disparities in insurance coverage after three years.

Data Source
The 2011-2016 waves of the American Community Survey (ACS), with the sample restricted to nonelderly adults.

Design
We estimate a difference-in-difference-in-differences model to separately identify the effects of the nationwide and Medicaid expansion portions of the ACA using the methodology developed in the recent ACA literature. The differences come from time, state Medicaid expansion status, and local area pre-ACA uninsured rates. In order to focus on access disparities, we …

The Effect Of The Dependent Coverage Provision Of The Affordable Care Act On Opioid Use And Abuse, Christian Carrillo

Theses and Dissertations

The non-medical use of prescription opioids has become the fastest growing drug problem in the United States. This paper examines the effect of the ACA's dependent coverage provision on the prevalence of prescription opioid misuse and abuse along with the mechanism driving the results.

Effects Of Physician-Hospital Integration On Malpractice Claims, Elizabet Shvets

Theses and Dissertations

Recent increases in physician-hospital (i.e., vertical) integration has spurred both opposition on the grounds of anti-trust concerns and support on the basis of lowering transaction costs and improving communication. This paper examines the effects of vertical integration on quality of care as measured by malpractice claims.The study employs four data sets from the state of Florida (FL AHCA Financial Data, AHA Survey Data, FL AHCA Discharge Data, and FL Malpractice Claims from the Office of Insurance Regulation) culminating in an unbalanced panel dataset for the years 1998 to 2013. I utilize a linear model with hospital and year fixed effects …

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.

Climate Change And Occupational Health: Are There Limits To Our Ability To Adapt?, Marcus Dillender

Upjohn Institute Working Papers

This study considers the relationship between temperature and occupational health. The results indicate that both high and low temperatures increase injury rates and that high temperatures have more severe adverse effects in warmer climates, which suggests that avoiding the adverse effects of high temperatures may be easier for workers when hot days are rarer. While research on the effect of temperature on mortality finds substantial capacity for adaption with current technology, the results presented here suggest that outdoor workers face challenges in adapting to high temperatures.

Refusal Bias In Hiv Data From The Demographic And Health Surveys: Evaluation, Critique And Recommendations, Oyelola A. Adegboye, Tomoki Fujii, Denis H. Y. Leung

Research Collection School Of Economics

Non-response is a commonly encountered problem in many population-based surveys. Broadly speaking, non-response can be due to refusal or failure to contact the sample units. Although both types of non-response may lead to bias, there is much evidence to indicate that it is much easier to reduce the proportion of non-contacts than to do the same with refusals. In this article, we use data collected from a nationally-representative survey under the Demographic and Health Surveys program to study non-response due to refusals to HIV testing in Malawi. We review existing estimation methods and propose novel approaches to the estimation of …

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 …

Maintaining Stability In A Changing Climate: A Comparative Analysis Of Public Health Systems And Migration Policies In The U.S. And Canada, Laura Cutlip

Climate and Society

This paper examines the relation between climate change, migration, and public health to better understand how the United States health system is positioned to deal with likely challenges to human health posed by environmental changes. The author reviews probable impacts of climate change on population displacement and disease before considering how the current structure of the health system of the United States will render it unable to adapt to these changes and challenges. The Canadian health care system and refugee policies are then reviewed to provide a counterpoint to this analysis. These findings are then considered in tandem as the …

Short-Run Health Consequences Of Retirement And Pension Benefits: Evidence From China, Plamen Nikolov, Alan Adelman

Justice & Well-Being Studies Faculty Scholarship

This paper examines the impact of the New Rural Pension Scheme (NRPS) in China. Exploiting the staggered implementation of an NRPS policy expansion that began in 2009, we used a difference-in-difference approach to study the effects of the introduction of pension benefits on the health status, health behaviors, and healthcare utilization of rural Chinese adults age 60 and above. The results point to three main conclusions. First, in addition to improvements in self-reported health, older adults with access to the pension program experienced significant improvements in several important measures of health, including mobility, self-care, usual activities, and vision. Second, regarding …

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 …

How Informational Imperfections Lead To Sub-Optimal Solutions In Health Savings Plan And Potential Remedies In A Competitive Marketplace, Jacob Gene Dengg

Electronic Theses and Dissertations

In the growing trend of consumer-driven health insurance, more consumers than ever have access to a high-deductible health plan paired with a health savings account, where consumers can save pre-tax income for healthcare but also face higher out-of-pocket prices, in hopes that consumers will become smarter shoppers. The Health Savings Plan is successful at lowering costs, but at the expense of consumers lowering their adherence to healthcare, raising health risk. Even in a competitive market, HSP plan designs require smart shoppers and more active healthcare self-management, but without dealing with the informational imperfections that need to be overcome to encourage …

It Is Time To Kill The Economic Theory Of Suicide, Gary N. Smith

Pomona Economics

A seminal paper by Hamermesh and Soss modeled suicide as a rational economic decision based on a comparison of the financial costs and benefits of staying alive. Their model is fundamentally flawed and their prediction that suicide rates increase with age is wrong.

The Association Between Neonatal Death And Facility Birth In Regions Of India, Diane Coffey

Journal Articles

BACKGROUND Reducing neonatal mortality in India is critical to achieving the 2030 Sustainable Development Goal of a global neonatal mortality rate (NNM) of no more than 12 per 1,000. Policy efforts to reduce India's NNM, including a large-scale conditional cash transfer program, have focused on promoting birth in health facilities, rather than at home. Between 2005 and 2015, the percentage of facility births doubled, from 40% to 80%. OBJECTIVE We assess evidence for the hypothesis that facility births reduce NNM by using new data from the National Family Health Survey, 2015-2016. METHODS We analyze the association between neonatal death and …

Monthly Spending Dynamics Of The Elderly Following A Health Shock: Evidence From Singapore, Terence C. Cheng, Jing Li, Rhema Vaithianathan

Research Collection School Of Economics

We use novel longitudinal data from 19 monthly waves of the Singapore Life Panel to examine the short-term dynamics of the effects health shocks have on household health and non-health spending and income by the elderly. The health shocks we study are the occurrence of new major conditions such as cancer, heart problems, and minor conditions (e.g. diabetes, and hypertension). Our empirical strategy exploits unanticipated changes in health status through the diagnosis of new health conditions, combined with an individual fixed effect framework. We find that major shocks have large and persistent effects while minor shocks have small and mainly …

Geographic Determinants Of Infant Health: The Impact Of Sports Facility Construction Projects, Brad Humphreys, Jane Ruseski

Economics Faculty Working Papers Series

A large body of research examines determinants of infant health outcomes but little examines geographic variation generated by exogenous economic shocks. Linking birth data from the CDC Natality files to counties building new facilities from 1995-2002, we find that sports facility construction projects generate local negative externalities. Infants born during facility construction periods have lower birth weights than infants born in comparable counties where no new facility opened. Maternal prenatal health visits also fall in the post-facility-opening period. Mechanisms for this impact include local airborne particulate matter and reduced provision of government services affecting prenatal health.

The Health Care Systems Of The United States And Spain: A Comparison, Tasia Harman

Senior Honors Theses

When it comes to understanding and improving the United States health care system, comparison and analysis with the health care system of another country provides valuable insights. In this thesis, the United States’ health care system was compared to that of Spain, as the health care system of Spain is generally ranked well above the United States in terms of quality, function, and cost. In the comparison, information such as the health of the population, the quality of health care received, accessibility, and health care costs indicate the state of the health care systems and their ability to function well …

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 …

The Effect Of Neighborhood Crime Rates On Childhood Obesity In Los Angeles County, Lachlan Montgomery

CMC Senior Theses

This thesis examines the effect of neighborhood crime rates on childhood obesity in Los Angeles County over a five-year period 2012-2016. Using yearly pooled cross-sectional geocoded data from the University of Southern California (USC) Price Center for Social Innovation Neighborhood Data for Social Change (NDSC) interactive platform, I run multiple ordinary least squares regressions using different measures of crime to determine if neighborhoods with higher crime rates influence the unhealthy percentage of 5^th, 7^th, and 9^thgrade public school students. I hypothesize that crime influences obesity, violent crime has a stronger correlation than property crime, …

Essays On Health Economics Using Big Data, Samane Zarebanadkoki

Theses and Dissertations--Agricultural Economics

This dissertation consists of three essays addressing different topics in health economics. In the first essay, we perform a systematic review of peer-reviewed articles examining consumer preference for the main electronic cigarette (e-cigarette) attributes namely flavor, nicotine strength, and type. The search resulted in a pool of 12,933 articles; 66 articles met the inclusion criteria for this review. Current literature suggests consumers preferred flavored e-cigarettes, and such preference varies with age groups and smoking status. Consumer preference for nicotine strength and types depend on smoking status, e-cigarette use history, and gender. Adolescents consider flavor the most important factor trying e-cigarettes …

Essays On Child Well-Being And The Social Safety Net, Cody N. Vaughn

Theses and Dissertations--Economics

This dissertation consists of three essays examining the role of two particular social safety net programs, the Temporary Assistance for Needy Families (TANF) program and the Supplemental Nutrition Assistance Program (SNAP), on the well-being of children from disadvantaged households. While the impact of these programs on the adults and parents of the household have been studied extensively, less is known about their effect on children. This is true for both their immediate impact on child well-being and any long-run impacts on children who grow up under these programs. Given the demonstrated importance of child well-being on later life adult outcomes, …

The Impact Of Medicare Part D On Mortality And Financial Stability, Katherine Toran

Theses and Dissertations--Economics

Using the Health and Retirement Study Panel core files from 1996 to 2014, I analyze how Medicare Part D impacted access to prescription drug coverage by various demographic factors such as race, gender, and income. In Chapter 1, I find the highest take-up rates for those who were white, female, and with higher incomes. However, increases in coverage were high across the board, such that Medicare Part D also improved drug insurance coverage for those who were black, male, and with lower income. Thus, although Medicare Part D did increase prescription drug insurance coverage for seniors across the board, I …

Water And Life. A Cross-Sectional Study On Determinants Of Beverage Consumption And Water Access In One Tribal Community, Christina White

All Master's Theses

Increasingly, poor diet has been shown to be one of the most crucial factors associated with cause of death, even more critical than smoking. Research in the past two decades has consistently linked increased consumption of sugar-sweetened beverages (SSB) to the obesity epidemic contributing to a public health crisis all over the United States. Native Americans, among other minority groups, suffer obesity disproportionately from the rest of the US population, yet they continually fail to be included in research on the subject. Traditional research methods, sparse care coverage on reservations, consolidation of unique tribes into one classification, and failure to …