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Efficiency and Equity in the U.S. Health Care Safety Net
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| 자료유형 | 학위논문 |
|---|---|
| 서명/저자사항 | Efficiency and Equity in the U.S. Health Care Safety Net. |
| 개인저자 | Schpero, William Lewis. |
| 단체저자명 | Yale University. Public Health. |
| 발행사항 | [S.l.]: Yale University., 2019. |
| 발행사항 | Ann Arbor: ProQuest Dissertations & Theses, 2019. |
| 형태사항 | 120 p. |
| 기본자료 저록 | Dissertations Abstracts International 81-03A. Dissertation Abstract International |
| ISBN | 9781088315859 |
| 학위논문주기 | Thesis (Ph.D.)--Yale University, 2019. |
| 일반주기 |
Source: Dissertations Abstracts International, Volume: 81-03, Section: A.
Advisor: Ndumele, Chima D. |
| 이용제한사항 | This item must not be sold to any third party vendors.This item must not be added to any third party search indexes. |
| 요약 | Millions of Americans rely on a safety net of both public and private actors for access to health care services that is anchored in Medicaid - the U.S. public insurance program primarily for low-income individuals. In this dissertation, I explore the optimal design of the safety net and the tradeoffs inherent in extending access to services while also ensuring high-quality care and sustainable financing.In Paper 1, I describe the concentration of hospital care in Medicaid. Medicaid reimbursement for health care services is generally lower than reimbursement from Medicare and private insurers, which can incentivize hospitals to select against treating Medicaid beneficiaries. Selection by providers, combined with patient preferences based on travel distance, trust, and other factors, may result in the concentration of care for Medicaid beneficiaries within certain hospitals. The implications of this concentration for patient outcomes are unclear. I used data on the universe of hospital admissions for 16 states to describe geographic and temporal variation in the concentration and segregation of hospital care for Medicaid relative to privately insured beneficiaries and to examine what area-level factors are associated with greater segregation. I found that about one-third of Medicaid discharges would have to occur in a different hospital for the distribution of discharges to be uniform. Segregated markets were more likely to include for-profit hospitals, teaching hospitals, and hospitals that were members of a system.Given evidence of segregation in hospital care for Medicaid beneficiaries, in Paper 2 I then determined whether shifting care away from Medicaid-focused hospitals would improve outcomes for Medicaid beneficiaries. I leveraged the closure of safety-net hospitals as a shock to the location of hospital care. Difference-in-differences estimates from this analysis suggested that Medicaid beneficiaries in need of emergency treatment and admitted to hospitals with a greater focus on the Medicaid population following the index hospital closure had significantly lower spending per hospital episode and a lower prevalence of adverse medical events. Papers 1 and 2 are collectively designed to inform the evolution of state and federal Medicaid policy on reimbursement and hospital network adequacy, as well as local, state, and federal regulations regarding hospital non-profit status, tax exemption, and hospital charity care expectations.In Paper 3, I turned to examine the broader fiscal implications of investment in safety-net programs. State and federal policymakers have articulated concerns about the budgetary implications of expansions of Medicaid eligibility, arguing that investments in Medicaid may crowd-out investment in other priority services (e.g., education) and could induce "benefit lock", whereby recipients of Medicaid become dependent on the program and other forms of public assistance in the long-run. In this study, my co-author and I examined the long-run effect of receiving Medicaid as a child on the receipt of means-tested public assistance in adulthood. We conducted a quasi-experimental regression discontinuity analysis, comparing receipt of public assistance by individuals born before and after September 30, 1983 |
| 일반주제명 | Public health. Public policy. Economics. |
| 언어 | 영어 |
| 바로가기 | 
: 이 자료의 원문은 한국교육학술정보원에서 제공합니다. |
