Author ORCID Identifier
Date of Award
Doctor of Philosophy (PhD)
Thomas A. Mroz
Michael F. Pesko
John D. Gibson
This dissertation examines policy trade-offs and interventions for two different populations: rural mothers and drivers. Each essay uses a different econometric approach, such as simulation or quasi-experimental econometrics design, to identify trade-offs faced by rural mothers or causal impacts of policy interventions on drivers’ behaviors. The first chapter examines the trade-offs US rural mothers face between hospital quality, and distance traveled to deliver their babies. Over 18 million women of reproductive age live in rural areas. They face substantial difficulties in accessing quality medical care. Thirty-five percent of all US counties have no hospital providing obstetric care. The rural hospital closure phenomenon exacerbates the shortage in maternity care provision, with 181 hospitals closed in rural areas since 2005. One in every ten individuals drives over 100 miles for maternity care. Additionally, rural patients complain about the quality of their community hospitals. As such, many bypass their local hospitals and drive longer distance to reach better quality hospitals. In this chapter, I examine the distance-quality trade-offs faced by rural mothers and how it differs by age, race, education, risk level, and types of insurance coverage. I use the Vital Statistics (birth records) and the American Hospital Association annual surveys over the period 2007-2017 for a total of over 113 million hospital-births matched observations. This chapter helps one evaluate who is harmed and benefited from policy interventions to subsidize, open, or close various types of health facilities, including Neonate Intensive Care Unit (NICU), teaching, public, private, critical access, and sole community hospitals.
In the second chapter, Nicholas Wright and I analyze the causal impacts of handheld devices legislation on traffic fatality. Nowadays, people tap, swipe, and click on their mobile phones more than ever before, with an average of 2,617 clicks per day. There is evidence that 56% of individuals make phone calls, more than 28% utilize social media applications, and about 12% read text messages or emails while operating a vehicle. Using a cell phone while driving increases the risk of an accident five-fold and the total cost of distracted driving on society in 2010 alone was estimated at $123 billion. Policymakers are concerned about this public health crisis. More than 20 states passed regulations that prohibit the use of handheld wireless communication devices, texting, dialing, or emailing while operating a vehicle (handheld bans). This chapter examines the effects of this policy on traffic fatality using the Fatality Analysis Reporting System (FARS) data over the period 2000-2015 and several quasi-experimental econometric approaches, such as Regression Discontinuity and Difference-in-Differences. This chapter has value for at least two reasons: 1) distracted driving is one of the leading causes of traffic injuries and fatalities in the United States; 2) while the number of states with handheld bans have tripled over the last decade, empirical studies have yielded mixed results.
Dorilas, Ernest, "Hospital Quality, Patient Distance Traveled, and Traffic Fatality." Dissertation, Georgia State University, 2022.