Guaranteeing the Right to Health: The Role of Supply Chains and Access to Care

Abstract

This dissertation investigates the effects of location of healthcare providers and patients within the healthcare supply chain on the delivery of healthcare. The dissertation consists of three essays that together examine the interplay between location, financing, public health interventions, and policymaking in the healthcare supply chain. Essay 1 investigates the impact of patients’ surrounding home environments on their health outcomes. Specifically, this chapter examines how access to specific forms of infrastructure impacts long term health outcomes. Patients may exhibit signs of a promising recovery while residing in inpatient care; however, when these patients return to their neighborhoods, the surrounding environment might trigger a pattern of behavior that may lead to higher chance of another inpatient stay. The analysis shows that accessibility to grocery stores within a half mile radius reduces the number of annual inpatient stays for heart failure patients. Essay 2 investigates on the impact of policy changes on healthcare supply chain utilization for insurance coverage expansion under the Patient Protection and Affordable Care Act (ACA). The empirical results show that patients make their decisions to access healthcare based on the distance to the nearest care delivery facility, whether it be a primary care clinic or an emergency department, and the hours of operation of the nearest primary care clinic reduces emergency department use. Our results provide a possible alternative explanation to the adage that insurance provision alone increases emergency department utilization. Essay 3 investigates the structural factors that impact the uptake of telehealth services under the expansion of broadband to primary care providers under the Rural Healthcare Program. Specifically, it focuses on physical access and broadband access to primary healthcare services. The empirical analysis shows that broadband coverage directly impacts synchronous telehealth visits in states with payment parity and service parity once the quality of providers broadband is improved through expanded funding under the Rural Healthcare Program (RHP). Notably, the effect of distance to the nearest provider is not impacted by the RHP expansion. With regards to asynchronous telehealth uptake, the analysis shows that the sole predictor of uptake is consumer broadband coverage regardless of a state’s payment parity or service parity laws related to the privately insured population. These papers collectively will contribute to the healthcare operations literature and policymakers by addressing ways to account for geographical location and the structural characteristics of the healthcare supply chain when delivering care to patients.