Date of Award

5-4-2021

Degree Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Department

Economics

First Advisor

James Marton

Second Advisor

Michael Pesko

Third Advisor

Rusty Tchernis

Fourth Advisor

Ian McCarthy

Abstract

This dissertation consists of three chapters, each of which examines a different topic within the sphere the health economics.

In the first chapter, I use unique, proprietary medical practice data from 2019 to investigate the relationship between physicians, various categories of non-physician clinical staff, and other non-labor inputs in the production of patient office visits. Preliminary results suggest that, for some inputs, their marginal productivity has fallen over time. Cross-input elasticities generally match in terms of their historical classification as either compliments or substitutes, although the magnitudes of the elasticities have also fallen over time. One possible interpretation of these results is that medical practices have already adapted to changes in the economic, regulatory, and technological environment in which they practice and have achieved the easy efficiency gains that were once readily available to them.

In the second chapter, I use 17 years of hospital cost report data and a difference-in-differences identification strategy to examine the financial performance and utilization of safety-net hospitals in Massachusetts following the state’s 2006 reform. The results suggest the largest safety-net hospitals experienced a decline in patient revenue because of the reform and may have responded by transferring operations from inpatient facilities to outpatient centers as a cost-cutting maneuver. Other safety-net hospitals, however, did not experience the same decline in patient revenue. Should states need to reduce their supplemental payments to safety-net hospitals as part of national health care reform, these results suggest they should target their remaining funds to their most financially vulnerable safety-net hospitals.

The final chapter, co-authored with James Marton and Benjamin Ukert, evaluates the impact of the Affordable Care Act Medicaid expansion on health insurance coverage, access to care, and self-reported health for individuals with and without chronic conditions. Using five years of post-reform data (2014–2018) from the Behavioral Risk Factor Surveillance System and a difference-in-differences identification strategy, we find that the reform led to improvements in access to care and self-reported health for both groups. Although these improvements are mostly larger in magnitude for individuals with chronic conditions, the differences in magnitude are not statistically significant.

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