Three Essays in Health Economics
2015-09
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Three Essays in Health Economics
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2015-09
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This dissertation consists of three essays addressing different topics in health economics. The first essay investigates the impact of the great recession on hospital capital investment and how hospitals respond to offset the recession effect. The great recession may have made it difficult for hospitals to borrow thus reducing capital investments. Hospital capital investment was modeled using the Euler equation with a liquidity constraint. I estimate the model with California hospital data and system generalized method of moments. Estimates were decomposed to show the recession effect in terms of investment dollars. Findings suggest that not for profit and public hospitals were liquidity constrained during the recession. Comparing the changes in hospital capital investment between 2006 and 2009 showed that hospitals used cash flow to increase capital investment by $2.5 million other things equal. The second essay investigates the incremental cost effectiveness of a telecare management intervention for managing pain and depression among patients with cancer. Pain and depression are often undetected and undertreated among patients with cancer. Telecare management has been shown to be effective for managing pain and depression among patients with cancer. Outcomes and cost data from the Indiana Cancer Pain and Depression trial was analyzed to the determine the cost effectiveness of the telecare management intervention. The intervention group was associated with more depression-free days and better quality-adjusted life years than the usual care group. The third essay investigates how out-of-pocket health care spending trends changed before and during the recession. The great recession slowed the growth of health care spending and its impact may have been different for adults and children. Reduction in children's health care spending for may hinder children's access to routine care which could have adverse implications in the long run. Out-of-pocket spending trends of privately insured families with children was examined using the Medical Expenditure Panel Survey data from 2001 to 2009. Out-of-pocket spending for most children was not affected by the recession but spending for children with special needs decreased during the recession.
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University of Minnesota Ph.D. dissertation. September 2015. Major: Health Services Research Policy & Administration. Advisor: Roger Feldman, Jeffrey McCullough. 1 computer file (PDF); viii, 120 pages.
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