Date of Award

Spring 5-14-2021

Degree Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Department

Economics

First Advisor

Dr. Charles Courtemanche

Second Advisor

Dr. James Marton

Third Advisor

Dr. Carlianne Patrick

Fourth Advisor

Dr. Glenn Landers

Abstract

ABSTRACT ECONOMIC ESSAYS ON HEALTH AND LOCATION By JOSEPH ANTHONY GARUCCIO May, 2021

Committee Chair: Dr. Charles Courtemanche

Major Department: Economics

This dissertation is composed of three chapters that focus on the effect of one’s environment on one’s health and healthcare decisions. Specifically, this work focuses on how various policies and physical environments affect one’s potential access to care, one’s probability of acquiring preventive care, and the spread of the novel coronavirus 2019 (COVID-19). In my first chapter, I examine if Medicaid expansions induced new physicians to locate closer to poor populations. I use precise physician location data and American Community Survey data at the census block group level to identify the extent to which the expansions induced new physicians to locate closer to poor populations. A goal of the Affordable Care Act and Medicaid expansions was to increase healthcare access for low-income adults. I show that new physicians in expansion states located increasingly closer to poor populations after expansion, arguably increasing their healthcare access.

In my second chapter, I estimate the effect increases in urban sprawl in metropolitan statistical areas (MSA) have on the probability individuals acquire timely preventive care. I make use of Behavioral Risk Factor Surveillance System data, an index of urban sprawl at the MSA level, and the 1947 Interstate Highway Construction Plan to estimate the effect of increased sprawl. In an instrumental variable design, I find that a standard deviation increase in sprawl lowers the probability that individuals have various important cancer screenings and are more likely to be obese. Such an increase also increases the probability of individuals obtaining flu shots.

In my third chapter, my coauthors and I estimate the effect social distancing policies had on reducing the growth rate of COVID-19. We make use of daily, county-level confirmed case and intervention data from Johns Hopkins University as well as state-level testing data to estimate the effect of four key social distancing policies. We make use of an event-study design to separately estimate the effect of shelter-in-place orders (SIPOs), bans on large gatherings, public school closures, and restaurant and entertainment venue closures. We find that SIPOs and the closure of restaurant and entertainment venues significantly reduced the growth rate. We found no significant evidence that gathering bans nor school closures had a mitigating effect.

DOI

https://doi.org/10.57709/22685494

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