Author ORCID Identifier

https://orcid.org/0000-0002-8218-2607

Date of Award

Spring 5-2024

Degree Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Department

Economics

First Advisor

James H. Marton

Abstract

In chapter 1 of this work, I estimate the causal impact of Section 3008 of the Affordable Care Act (ACA) on its targeted infection outcomes. This policy, implemented in October 2014, imposes a 1% reduction in the Medicare reimbursements of hospitals that perform poorly based on a hospital-acquired infection (HAI) measure. A limited body of literature evaluates the impact of this policy in a primarily descriptive manner. Using patient discharge data from the National Inpatient Sample (NIS), Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality and a difference-in-differences identification strategy, I contribute to the literature by estimating the causal effects this ACA provision had on the incidence of HAIs. Results suggest that the policy reduced the likelihood of acquiring an infection, with effects varying by HAI type. In addition, I find a general reduction in the likelihood of a HAI for whites, while the effects by gender or age vary on HAI type.

In chapter 2, I look at the causal effects of expanding prescription drug coverage on hospital admissions due to antimicrobial resistance. Antimicrobial resistance has been growing rapidly in the United States in recent years despite government efforts to control its outbreak. Both under and overutilization of prescribed medications can lead to an increase in antimicrobial resistance. The introduction of Medicare Part D in 2006 led to an increase in prescription drug coverage, including antimicrobials, for the elderly. If cost barriers had led to underutilization of prescriptions among those without previous prescription coverage, then Medicare Part D may reduce antimicrobial resistance. On the other hand, if Medicare Part D encourages over- utilization of prescriptions, then an unintended consequence may be an increase in antimicrobial resistance. Using data from the Nationwide Inpatient Sample (NIS), Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality for years 2004 to 2011 and a difference-in-differences identification strategy, I estimate the net effect of Medicare Part D on the incidence of inpatient discharges due to antimicrobial resistance among the Medicare- eligible population. Results show that the incidence of antimicrobial resistance among the elderly as measured by inpatient discharges decreased after Medicare Part D implementation.

Finally in chapter 3, I estimate the causal effects of expanding prescription drug coverage on opioid use disorder-related hospital admissions. Opioid misuse is an ongoing public health concern in the United States. Each year, an increasing number of individuals continue to suffer from opioid use disorders (OUD) and fatalities despite government efforts to control the epidemic. Medicare Part D went into effect in January 2006, mandating Medicare plans to cover prescription drugs, including those intended for medication-assisted treatment (MAT) of OUD. To date, there is no estimate available in the literature regarding the causal effects the policy had on the incidence of OUD among its beneficiaries, especially on associated hospital admissions. To help fill this gap, I use a nationally representative sample of hospital discharges from the Nationwide Inpatient Sample (NIS), Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality together with a difference-in-differences strategy comparing OUD-related discharges between the Medicare-eligible adults aged 65 to 69 and ineligible adults age 60 to 64. I find that after the policy went into effect, the incidence of OUD-related hospital discharges decreased among the Medicare-eligible population.

DOI

https://doi.org/10.57709/36919501

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