The Healthcare Impacts of Policies Addressing Inequality
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Author(s)
Wallace, Alexandra E.
Advisor(s)
Hughes, Danny R.
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Abstract
This dissertation is comprised of three essays examining economic disparities in healthcare and the impacts of policies attempting to address healthcare inequalities. The first two essays examine the financial impacts of changes in government regulation intended to expand access to medical care on healthcare markets. The third essay evaluates the potential for environmental health risks to cause disproportionate adverse health outcomes in low-income areas.
The first essay examines the effects of expanding scope of practice laws on the cost and quality of healthcare. It evaluates the effectiveness of state-level laws lifting restrictions on nurse practitioners, allowing them to practice and prescribe medicine to the full extent of their training without physician oversight, by measuring how these laws affect changes in the spending, utilization, and quality of diabetes care for enrollees of a large commercial healthcare insurer. The results suggest that laws allowing nurse practitioners to act to the extent of their training are associated with significant reductions in the cost of delivering diabetic care without an associated decline in quality.
The second essay addresses the impact of legislation affecting health insurance eligibility on the financial decisions made by entities providing healthcare. It studies the impact of state decisions to implement the Patient Protection and Affordable Care Act’s Medicaid expansions on hospital investment in capital. The essay’s results find evidence of a heterogeneous response, where non-profit hospitals invested more on capital following market shifts from the increases in insurance eligibility. Hospitals are also shown to react to state decisions regarding Medicaid expansions by increasing the breadth of capital cost centers before the expansions went into effect, indicating evidence of an anticipatory reaction.
The third essay examines the effect of industrial pollution on cancer rates in low-income populations. It evaluates the potential for a disproportionate impact of arsenic releases from industrial facilities on arsenic-related cancers among nearby residents in areas eligible for federal low-income housing tax credit programs. The findings suggest a disproportionately high increase in lung cancer rates in areas near arsenic-emitting facilities that are also eligible for low-income tax credits.
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Date
2023-04-19
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Text
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Dissertation