Master of Arts, Miami University, 2020, Economics

The positive relationship between socioeconomic status (SES) and health has been observed and established across many fields. This paper looks to extend the literature by first, documenting a relationship between health and income through child mortality rates in the early 20th century U.S. and second, examining whether the relationship is causal. I construct a dataset that finds mothers in their childhood household and test whether there is omitted variable bias with the mother's childhood household socioeconomic status. I find that a one standard deviation increase in husband's occupational wealth is associated with a decrease in the child mortality rate of 20.7 deaths per 1000 children ever born. The childhood socioeconomic status of both parents also play an independent role in the child mortality rate, as a one standard deviation increase in grandfather's occupational wealth is associated with a decrease in the child mortality rate of 8.6 and 11.4 deaths per 1000 children ever born (respectively for the wife and husband's childhood SES). These findings support the existing literature. My attempt to isolate causality further through a fixed effects strategy does not yield a rigorous answer but provides possible intuition into future results.

Committee: Gregory Niemesh (Advisor); Melissa Thomasson (Committee Member); William Even (Committee Member) Subjects: Economic History; Economics

BA, Oberlin College, 2015, Economics

This paper examines the impact of the State Children's Health Insurance Program (SCHIP) on the educational outcomes of American children as measured by fourth and eighth-grade math and reading standardized test scores from the time of the program's inception up to the year 2013. More specifically, I focus on the effects of the increases in eligibility for children's public health insurance coverage brought about by SCHIP on average test scores across the nation at both the state level for all 51 states and the county level for Florida's 67 counties. On the state level, I am ultimately unable to find evidence of a contemporaneous impact of increases in eligibility on average test scores; however, I discover that in a longer-term sense, cumulative increases in the proportion of life for which the cohorts of students taking the tests have been exposed to SCHIP do appear to lead to statistically significant increases in average fourth and eighth-grade math scores. On the county level, I find that increases in eligibility for SCHIP are associated with significant increases in average fourth and eighth-grade reading and math standardized test scores.

Committee: Barbara Craig (Advisor); Tobias Pfutze (Advisor) Subjects: Economics; Educational Tests and Measurements; Health Care

Bachelor of Arts, Miami University, 2006, College of Arts and Sciences - Chemistry

Despite its reputation as a leader in groundbreaking biomedical technology and innovative life-extending procedures, the United States today finds itself plagued by a national health care system in dire need of reform. With the number of uninsured Americans burgeoning to over 45 million, policymakers are struggling to ensure wide access, low costs, and first-rate care. With its high level of health care expenditures, the U.S. remains one of the few industrialized states without a universal health care system. The first half of this thesis examines the financing and delivery mechanisms in the health systems of Canada, the Netherlands, France, Germany, and the United Kingdom—with a focus on how they have achieved universal health coverage. The second half of this thesis applies these models in an analysis of how the U.S. can achieve universal health care—with an emphasis on the state-led federalist approach over single-payer, population-based expansions, tax credits, and employer and individual mandate reform pathways.

Committee: Douglas Shumavon (Advisor) Subjects: Health Sciences, Public Health

Doctor of Philosophy, Case Western Reserve University, 2010, Bioethics and Medical Humanities

America's legislators have found themselves floundering for an economically tenable solution to the healthcare crisis. Consumer driven health plans (CDHPs) represent a proposed solution based on America's constitutional, liberal roots. The success of the consumer driven health movement relies on the anticipated benefits of better informed healthcare consumer choices and increased associated responsibility. CDHPs—with lower monthly premiums and higher deductibles than traditional plans—should incentivize enrollees to become better-informed, prudent consumers of healthcare by searching the Internet for the cheapest and best providers, insurance plans, and medications. In turn, healthcare costs should decrease and quality of care should increase as providers compete for patients. Potential enrollees' competency to make informed decisions regarding the following five tasks critical to CDHPs were assessed: 1) enrolling in CDHPs, 2) becoming better symptom-based medical decision-makers, 3) learning about preventing and managing common chronic conditions, 4) locating high quality healthcare providers, and 5) curbing spending on medications. Twenty volunteers (10 English-speaking, 10 Spanish-speaking)—all without health insurance, from varying sociodemographic backgrounds—participated in observational usability testing using screen capture software, Morae 2.0. The average Flesch-Kincaid reading level and consistency of information presented on four popular health Infomediaries was also assessed. The results suggest most potential CDHP enrollees don't have the adequate skill sets or online tools to effectively and safely make the informed decisions associated with plan usage. The Infomediaries provided fairly consistent information, but had a mean Flesch-Kincaid grade level of 10.1, well above the recommended sixth to eighth grade level. Most participants used search engines' sponsored links that led to poor quality websites. No participants used the government-produced hea (open full item for complete abstract)

Committee: Patricia Marshall PhD (Committee Chair); Mark Aulisio PhD (Committee Member); Nahida Gordon PhD (Committee Member); Stuart Youngner MD (Committee Member) Subjects: Behaviorial Sciences; Communication; Computer Science; Economic Theory; Economics; Educational Software; Health; Health Care; Health Education; Information Systems; Literacy; Mass Media; Multicultural Education; Political Science; Public Health; Science Education; Social

DNP, Kent State University, 2022, College of Nursing

Biosimilars are pharmaceutical agents approved by the Food and Drug Administration (FDA) as an option to treat multiple medical conditions. In rheumatology, they are used as an option to treat inflammatory diseases such as rheumatoid arthritis (RA) and spondyloarthritis (SpA). The term spondyloarthritis is used to describe a group of disorders, including ankylosing spondylitis (AS), nonradiographic axial spondyloarthritis (nr-axSpA), forms of arthritis associated with psoriasis (PsO), psoriatic arthritis (PsA), and with inflammatory bowel diseases (IBD), among others. The structure and therapeutic effects of biosimilars are similar to previously developed and approved patented biologic pharmaceutical agents. However, they cannot be considered identical, as they are not a product of controlled chemical synthesis but are produced by living cells. The main reason for possible differences is related to patent expiration dates, which typically occur for an active ingredient several years prior to the expiration of patent protection for a manufacturing process. Consequently, competitors may produce the active ingredient, but utilizing a different process, which can often result in variations in impurities and efficacy. With biologic production further complicated by the use of live organisms as production “reactors”, FDA's decision to classify off-patent biologic pharmaceutical agents as “biosimilar” rather than “generic”, as is done for small molecule synthetic pharmaceuticals, underscores the similar rather than identical efficacy of a reference biologic vs. its biosimilar. However, as with small molecule generic pharmaceuticals, biosimilars can be made available at a lower cost making them an economically preferred alternative. Available research data suggests that biosimilars and their reference products have comparable pharmacokinetics, safety, and efficacy. In January of 2019 majority of patients diagnosed with rheumatic diseases managed by the department of rheuma (open full item for complete abstract)

Committee: Lynn Gaddis (Committee Chair); Dana Hensen (Committee Member); Lisa Onesko (Committee Member) Subjects: Nursing

Doctor of Philosophy, The Ohio State University, 2020, Economics

This dissertation presents three studies exploring the impact of immigration and diversity and policies governing the two on a set of productive and behavioral outcomes. Migration is a fundamental aspect of modern economic activity, and as geographic mobility increases and the world continues to become more integrated, challenges associated with the movement of people are likely to arise. These studies contribute to our understanding of the complex consequences of immigration and related policies, focusing particularly on the United States. As high-skilled immigration has accelerated in recent decades, the workforces of developed nations has become more diverse. The first chapter, “Cross-Ethnic Diversity and Innovative Output”, explores the implications of this diversity in the context of scientific and innovative productivity. Beyond the admissions of skilled scientists, immigration policy can of course affect a much wider range of populations. In the second chapter, “Immigration Relief and Insurance Coverage: Evidence from Deferred Action for Childhood Arrivals” (DACA), I turn to studying a subset of undocumented immigrants. This chapter examines the effect of a U.S. executive order protecting undocumented immigrants brought to the U.S. as children on health insurance coverage. Another topical concern in public discourse on immigration is the idea that more immigration is associated with elevated crime. The third chapter, “Does Refugee Inflow Affect Urban Crime? Evidence from Miami and Houston”, seeks to shed light on this concern by studying two large-scale refugee settlement episodes in U.S. cities: the 1978 Vietnamese refugee settlement in Houston, and the 1980 Mariel Boatlift in Miami.

Committee: Bruce Weinberg (Committee Chair); David Blau (Committee Member); Kurt Lavetti (Committee Member) Subjects: Economics; Labor Economics

Doctor of Philosophy, The Ohio State University, 2017, Economics

Given the fast-growing health care spending in public health programs and the mounting controversies on certain recent health policy mandates in US, it is critical to identify the elements in these programs and policies that promote efficiency and efficacy, and those that do not. My dissertation looks into the unintended consequences of privatizing Medicare Part D and the important benefits that the Affordable Care Act dependent coverage provision offers to the college graduates with student loan debt, adding insights and perspectives to the ongoing policy debates. The first chapter examines the effects of the 2010 Affordable Care Act (ACA) provision, which requires insurers to allow dependents to remain on parental health insurance policies until age 26, on a variety of outcomes among college graduates with student loan debt. Using data from the National Longitudinal Survey of Youth 1997, in which the majority of the sample were unable to benefit from the provision due to the age restriction, we find larger student loan debt is associated with a lower probability of having health insurance, and lower utilization of routine checkups as well as doctor visits in time of sickness. Using data from the Panel Survey of Income Dynamics, we find that among college graduates who were eligible for the provision, having more student loan debt increases the likelihood of joining a parental health insurance plan. We also estimate a difference-in-difference model and find that for the average college graduate in the sample, being eligible for the provision increased the likelihood of having health insurance by 9.8 percentage points more after 2010. Finally, we use college-level data from the College Scorecard to estimate the impact of the provision on college graduates' financial outcomes in a fixed effects model identified by changes in the age distributions of students across cohorts which changes the average eligibility rates over time. We find that at the college level, a (open full item for complete abstract)

Committee: Kurt Lavetti (Advisor); Lucia Dunn (Committee Member); Yi Xu (Committee Member) Subjects: Economics

Master of Arts, Miami University, 2015, Economics

Doctors in the United States in the early 20th century had a limited ability to treat their patients. Most treatments and vaccines for diseases were not developed yet. Furthermore, prior to 1910, many medical schools had scant entrance requirements and limited time practicing treating patients. However, as late as the 19th century, the American medical education system underwent revolutionary changes, drastically improving the way doctors were trained. Despite these changes, physicians still did not have the benefit of antibiotics or vaccinations with which to treat and prevent infectious disease. Given these limitations, how much did the availability of doctors matter and how much did good doctors matter? The models suggest the quality matters much more than quantity. The relationship between doctors per capita and infant mortality is actually positive when accounting for overall physician quality, while physician quality has a strong negative relationship with infant mortality rates.

Committee: Melissa Thomasson (Advisor); William Even (Committee Member); Greg Neimesh (Committee Member) Subjects: Economic History; Economics

Master of Science (MS), University of Toledo, 2015, Pharmaceutical Sciences (Health Outcomes and Socioeconomic Sciences)

Background: Individual pharmacy-based interventions have improved outcomes, but have not solved the $290 billion problem of medication non-adherence. Combinations of interventions have a potential to more heavily impact medication adherence, and associated healthcare costs. Objectives: To 1) Describe the implementation, and initial experiences, of a hybrid model of pharmacy care for patients with metabolic syndrome, 2) Study the impact of a hybrid model of pharmacy care on economic outcomes when compared to other community pharmacy models of care in patients with metabolic syndrome. 3) To study the impact of a hybrid model of pharmacy care on adherence to medications targeted by the CMS Five-Star Quality Rating System in patients with metabolic syndrome. Methods: This is an exploratory pilot of a large, prospective, randomized control study. The hybrid model utilizes an appointment based model to provide adherence blister packaging, Medication Therapy Management (MTM) and refill synchronization. A second group receives adherence packaging and refill synchronization, a third group MTM alone, and a control group receives none of the aforementioned services. Contact between the researcher and participant occurs every three months, alternating between face-to-face and telephonic. All four groups are compared for healthcare cost and utilization, as well as adherence to medications identified by the Centers for Medicare and Medicaid Services (CMS) STAR measures. Participants were recruited from a local endocrinology practice within an Integrated Delivery Network (IDN), and included adults within a certain health plan selected from a Diabetes Center. Patients were required to have; diabetes, hypertension and hyperlipidemia, and at least one medication for each disease state. Cost data was obtained via medical and prescription claims. Medication adherence was calculated from the claims data as the proportion of days covered (PDC). Baseline consists of data for (open full item for complete abstract)

Committee: Sharrel Pinto PhD (Advisor); Robert Bechtol (Committee Member); Aliaksandr Amialchuk PhD (Committee Member) Subjects: Economics; Health Care; Health Care Management; Health Sciences; Pharmacy Sciences

Doctor of Philosophy, The Ohio State University, 2014, Agricultural, Environmental and Developmental Economics

This dissertation analyzes health human capital issues in developing countries. The first two essays examine the production of human capital at the household level, and the third essay analyzes supply of health care services. The first essay tests for noncooperative behavior using the Mexican Family Life Survey (MXFLS), a nationally representative longitudinal survey of households that identifies and keeps track of local and international migrants. Migration introduces asymmetries of information that might trigger noncooperative behavior of spouses left behind. I use the MXFLS to study noncooperative behavior in Mexican households and the way this behavior affects children's human capital. I find that migration causes noncooperative behavior in the spouse left behind, namely spouses reduce the time in doing chores and do not change their labor supply. At the same time, boys do more agricultural work and girls have to spend more time in taking care of other members. Migration positively affects school enrollment, but nonlinear effects suggest younger children are bearing most of the negative effect because, as the literature suggests, lower school enrollment at early ages means lower cognitive achievement later on. In the second essay I analyze production of health in Chinese children. Modernization and subsequent changes in lifestyle have caused a dramatic increase in prevalence of obesity in China. Since obesity is one of the main forces driving noncommunicable diseases (NCDs), increases in prevalence of obesity in children lead to higher incidence of NCDs and reduction in health human capital. Intervention in public policy must be based on an understanding of how health is produced in the household. I use the China Health and Nutrition Survey (CHNS) to carry out structural estimation of the health production function for children in China. Results suggest that calorie intake is the most important input in the production of excessive weight with an impact on (open full item for complete abstract)

Committee: Joyce Chen (Advisor); Brian Roe (Committee Member); Alessandra Faggian (Committee Member) Subjects: Economics; Education; Health

Doctor of Philosophy, The Ohio State University, 2008, Family Resource Management

Lack of physical activity has been identified as one of the health issues facing Americans, including the elderly population. While the elderly population tends to have relatively worse health condition, this population has great potential in being actively involved in physical activity since this population is less restricted by familial responsibilities and more likely to be retired. This study examined the demand for physical activity among elderly in the U.S. based on Grossman's health demand model. Six hypotheses related to time spent on physical activity were derived from Grossman's health model and tested using the Health Retirement Survey (HRS) and its supplement survey, the Consumption and Activities Mail Survey (CAMS) 2001 and 2003. In order to better estimate the demand for physical activity based on Grossman's demand for health model, this study improved the usage of four variables: wage rate, asset, health depreciation rate, and price of medical care. Random-effect Tobit model and three-stage least square estimations were used respectively to estimate reduced- and structural-forms of demand for time spent on physical activity. Only one of the six hypotheses, smoking variable, derived from a Grossman-based theoretical model was supported, as tested in the structural-form equation. Wage rate was found to be highly significant but in the opposite direction than predicted. This study exemplifies an approach of studying a public health issue using a health economics model. The operationalization of wage rate as market efficiency allows results of estimations, including those of health stock and medical care, to be generalized to the non-working population. Smokers tend to spend the least amount of time in physical activity, followed by those who never smoked, which indicates that those who are more concerned about health changes (i.e., those who stopped smoking) tend to spend more time in physical activity. The insignificance of wealth implies that people wi (open full item for complete abstract)

Committee: Jinkook Lee (Advisor) Subjects: