Browsing by Subject "infrastructure"

Now showing 1 - 3 of 3
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    Essays on Hospital Infrastructure Investment
    (2023-07) Levin, Zachary
    In this dissertation, I present three essays related to infrastructure investment by acute care hospitals. When hospitals use revenue to invest in their facilities, there is an opportunity cost in terms of staffing, technology, community benefits, and other possible forms of investment. While some level of improvement to facilities may be necessary due to depreciation, infrastructure investment is also a potential way to attract (or maintain) patient demand through signals of high quality and pleasant patient experience. Over $30 billion in construction is invested by hospitals annually in the United States, but little is known on whether this investment impacts demand and/or quality. I provide the first comprehensive look at hospital construction projects, using novel data from California. In Chapter 1, I provide a descriptive overview of significant construction projects. I identify nearly seventy major projects, defined as changing a hospital footprint through either complete rebuilding, additions to general acute care, or service-specific expansions. These projects range in cost from over $2.5 million to add capacity at a small community hospital to nearly $600 million for an urban hospital replacement. Hospitals undertaking these projects are more likely to have above-average volumes of discharges and are less likely to have for-profit ownership structure. They additionally have higher market share than facilities not undergoing a major construction project in my sample period. My results reveal that major infrastructure investment is a non-random occurrence and influenced by hospital and local conditions. I analyze the impact of major construction projects on demand for hospital care in Chapter 2. I perform a difference-in-difference analysis of admissions at the hospital and market level linking data from California’s state discharge dataset. At the hospital level, I find a significant increase in own-hospital admissions after a facility undergoes a major construction project. The impact is especially large among patients with private insurance, which is significant given these insurers typically offer the most generous reimbursement. At the market level, I find strong evidence that admission growth results from market expansion as opposed to purely business-stealing, though I cannot definitively rule out competitive effects. Preliminary evidence suggests market growth occurs particularly among elective procedures. These results suggest certificate-of-need law repeal may not have dramatic anti-competitive effects, but supplier-induced demand remains a concern. Finally, in Chapter 3, I look at the impact of major construction projects on the quality of care received. High quality care is both a policy goal and a potential justification for undergoing construction. I examine quality in terms of both patient experiences, measured using survey data, and clinical outcomes, measured using administrative data. I again employ difference-in-difference analysis for estimation. I find significant improvement across a variety of patient experience measures after a hospital construction project is completed. Among clinical measures, however, there is no significant impact. My results suggest that at least one dimension of quality improves because of construction. This finding raises equity concerns for improving quality at safety net hospitals, given their financial situation makes it more difficult for investment in infrastructure.
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    Fragile Energy: Power, Nature, And The Politics Of Infrastructure In The ‘New Turkey’
    (2016-08) Erensü, Sinan
    This dissertation provides a reading of political power in twenty-first century Turkey through the lens of (energy) infrastructures. By tracing the country’s bourgeoning energy infrastructures along their material, legal and financial dimensions, I examine energy’s ability to do political work and securing societal consent in Turkey, at a time when the idea of development is being privatized and the challenge of climate change encounters the country’s growing energy deficit. Relying on ethnographic and other qualitative methods collected along the path of energy infrastructures—including corridors of the bureaucracy, investment banks, construction sites, ribbon-cutting ceremonies, energy expos, local courthouses as well as electricity grids and hydropower penstocks—I argue that energy has played an under-recognized yet influential role in the establishment and sustenance of an authoritarian neoliberal experience, what is being dubbed by its founders, the ‘new Turkey’. Rather than collapsing the power harnessed from energy resources with political power, I introduce energy as a form of governmental rationality in the new Turkey that seeps into other realms of government from urban governance to counter-terrorism. The prowess of this emergent rationality, which I name as energorationality, stems from energy’s unique qualities in bringing center and periphery, urban and countryside, capital and commons together, from its ability to suture a variety of unlikely actors, policies, and ideas to each other. By examining grassroots mobilizations struggling against energy infrastructures in Turkey’s rural Eastern Black Sea Region (EBSR), I also discuss the fragility of energorationality. Mining disasters, unexpected droughts, unreliable projections, unruly villagers and urban riots, put delicate project cycles into disarray. I illustrate throughout the dissertation how energy infrastructures—small hydropower plants (small hydro, or SHP) in particular—, cause unexpected cracks as well as powerful sociopolitical alliances while converting uncharted rural and environmental settings into energy landscapes.
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    Mutually Reinforcing Relationships Between Bicycling and Infrastructure
    (2017-04) Schoner, Jessica
    Researchers have long sought evidence about whether dedicated bicycling infrastructure induces people to cycle, based on a supply-driven assumption that providing infrastructure causes the behavior change. However, supply inducing demand is only one of four theoretical relationships between bicycling and infrastructure. The aims of this research are twofold: 1. Develop a theoretical framework to identify and evaluate all of the possible relationships between bicycling and infrastructure and describe how these factors reinforce one another to shape diffusion of bicycling and infrastructure in cities; and 2. Develop and execute a research plan to empirically model selected hypotheses within the theoretical framework. The empirical portion of the dissertation tests the hypotheses that (1) bicycling infrastructure supply induces bicycling demand, and (2) bicycling demand induces additional demand. The research uses a series of cross-sectional tests at multiple points in time as well as lagged variable models to add a layer of temporal precedence to our otherwise cross-sectional understanding of associations between bicycling and infrastructure. The findings show persistent associations between infrastructure and bicycling over time, across geographies, and at both the individual and aggregate level. The association between bicycling and additional bicycling holds over time at the individual household level and for bike share membership. However, the tests failed to find evidence of bike share stations and activity affecting general population cycling rates. This dissertation provides a roadmap for future research into feedback loops between bicycling and infrastructure. It additionally provides practitioners with guidance on both the strengths and limitations of both infrastructure provision and socially-focused bicycling initiatives. Like most bicycling research, this dissertation is limited by the quality of data available for both bicycling behavior and infrastructure supply. Neither the data nor the tests performed are rigorous enough to infer causality; instead, the findings add strength and nuance to the existing body of literature.