Zhang, Zhanji2025-03-212025-03-212024https://hdl.handle.net/11299/270636University of Minnesota Ph.D. dissertation. 2024. Major: Applied Economics. Advisor: Bryan Dowd. 1 computer file (PDF); iv, 83 pages.Chapter 1: Adequate nutrition plays an important role in healthy aging. Although poor diet is a strong predictor of chronic diseases, the causal impacts of diet quality on health care utilization have rarely been explored. This study fills the gap by applying an instrumental variables (IV) approach, instrumenting for diet quality with the number of convenience stores in a county per 1000 residents. Using a nationally representative longitudinal sample of adults ages over 50 from the 2013 Health Care and Nutrition Study (HCNS) survey, I find that eating healthier can bring about a lower probability of healthcare service use. Specifically, a 10-point score increase in the Healthy Eating Index (HEI)-2015 leads to a decrease in the probability of taking prescription medication regularly by around 7 percentage points. Results emphasize the importance of nutrition as a social determinant of health in avoiding unnecessary health care utilization and expenditures. Chapter 2: Public reporting of provider quality in the health care sector improves information and is an important part of health care reform in the United States. In this study, I use a two-way fixed effects model to evaluate the effects of the star ratings on patient market shares for home health agencies (HHAs) serving Medicare beneficiaries. I find significant but modest effects of quality-of-care star ratings on the share of the market. Specifically, a one-star improvement in the quality-of-care star leads to an increase of 0.11 pp. in the market share for an HHA on average. The effects of quality-of-care star ratings are linear except for the 1.0-star category. However, this study does not find significant effects of patient experience ratings on the market share. Results emphasize the evaluation of HHA characteristics. Chapter 3: Public reports of quality measures are designed to help patients select higher-quality providers and incentivize providers to improve care. In this study, I use a conditional logit model to explore the effects of star ratings on home health agency (HHA) selection. Overall, the quality-of-care and patient experience star ratings play an important role in patients’ HHA selection process. On average, a one-star increase in quality-of-care and patient experience stars of an HHA brings about a higher probability of being selected by 2.3 and 2.2 percentage points (pp.), respectively. The effects of quality-of-care star ratings increase over time (from 1.3 pp. in 2016 to 3.2 pp. in 2019), and the effects of patient experience star ratings stay relatively stable over the study period (from 2.4 pp. in 2016 to 2.4 pp. in 2019). In terms of subgroups, I find that the quality-of-care star effects are statistically significant only for White (2.3 pp.) and Black (2.1 pp.) patients, and the patient experience star ratings are significant only for White patients (2.6 pp.). My findings emphasize the importance of public reporting of quality information and the mechanism underlying HHA selection.enDiet qualityHealth care utilizationHome health agenciesHome health careInstrumental variablesThesis or Dissertation