Master of Arts in Medical Ethics and Humanities, Northeast Ohio Medical University, 2023, College of Graduate Studies

Disparities in medical care are present disproportionally in those of low socioeconomic status. The barriers of decreased health literacy and issues with accessibility, implicated by the situations of low socioeconomic status populations. Delving into these problems, analyzing them with an ethical lens, reveals a need for solutions. The presence of these barriers within the current research, and the issues met within the ethical framework of John Rawls's theory of justice and Norman Daniels's matrix principles, calls for solutions to be proposed and an analysis of what these solutions should entail. This was done through the analysis of certain patient case studies who encountered specific health barriers. Three cases were analyzed, viewing the barriers of health literacy, of medical illness, medical insurance, and accessibility. The analysis of each case, in both a clinical and ethical framework, allowed for the formation of recommendations to health systems, physicians, and patients. However, addressing these issues requires the need for further research.

Committee: Julie Aultman (Advisor); Marcus Julius (Advisor); Brian Harrell (Advisor) Subjects: Ethics; Medicine

BA, Oberlin College, 2020, Economics

I add to literature investigating the effects of the Affordable Care Act's (ACA) dependent coverage mandate (DCM). I examine how the mandate, which increased health insurance coverage for 19 to 25 year-olds, impacted short-run mortality rates for the affected age group. Unlike previous research, I examine if and how young adult mortality was affected differentially by race. I use data from the CDC's “WONDER” database to conduct difference-in-difference analysis to assess the effects of the policy change on mortality. I find that the DCM had a significant negative impact on mortality rates for the affected age group as a whole, but that African Americans and Asians and Pacific Islanders missed out on the effect. I then briefly investigate what might have driven these racially disparate impacts, but do not produce a conclusive explanation. During that investigation, I also offer a causally-identified estimate of the magnitude of the DCM's effect on health coverage.

Committee: Barbara J. Craig (Advisor); Paul A. Brehm (Advisor); Martin Saavedra (Advisor) Subjects: Economics; Health Care; Public Health; Public Policy

Master of Arts, Miami University, 2020, Economics

Medicaid is a joint federal-state health insurance program targeting the low-income population. The program covers nearly 20% of Americans and accounted for $592 billion in 2017. Medicaid was originally introduced in 1965 as an optional program without mandatory financial eligibility minimums. By 1982, all 50 states had established a program but at vastly different levels of eligibility. In this paper, I analyze the factors that impacted a state's adoption of Medicaid and the factors affecting eligibility generosity for pregnant women, infants, children, and other adults. I find that politics and health environment factors were insignificant in explaining the adoption of Medicaid. However, with respect to eligibility, these same health environment and political factors become significant in explaining differential levels of eligibility generosity. In both models, demographic factors provide conflicting evidence to support the basic ideas of the Median Voter Theorem. Regression findings for adoption and eligibility generosity are generally robust across models. Finally, future work might examine eligibility generosity for other populations benefiting from Medicaid or apply the models to a variety of optional benefits.

Committee: Melissa Thomasson (Advisor); Gregory Niemesh (Committee Member); Austin Smith (Committee Member) Subjects: Economic History; Economics; Health Care; Political Science; Public Policy

Master of Arts, Miami University, 2019, Economics

Medicare and Medicaid are U.S. Federal health insurance programs established in 1965 as an amendment to the Social Security Act of 1935. They provide coverage to the aged population (65+), low-income individuals, and to other subsets of the U.S. population. After reviewing the foundations of Medicare/Medicaid, I analyze the political economy of Members of Congress vote choices on the original 1965 Medicare/Medicaid law. I find evidence that the number of doctors per 100,000 individuals in a state is a strong predictor of vote choice and there is statistically significant interaction between percentage of Black Americans and the South. Moreover, there is evidence to suggest that party alignment of constituencies and geographic region played roles in persuading Republicans in party-contested states to defect. The behavior of these defectors is dependent on their party alignment and the party alignment of the majority in Congress. To assess the strength of the model across time and legislation, I run a fully interacted, pooled OLS regression on both the 1965 legislation, and the Medicare Modernization Act of 2003. I find the effects of hospitals do not hold across time. However, I find evidence target populations remain insignificant in both datasets, suggesting they are not strong influencers of vote choice.

Committee: Melissa Thomasson (Advisor); Gregory Niemesh (Committee Member); Deborah Fletcher (Committee Member) Subjects: Economic History; Economics; Health Care; Political Science; Public Policy

Master of Science in Pharmaceutical Science (MSP), University of Toledo, 2018, Pharmaceutical Sciences (Health Outcomes and Socioeconomic Sciences)

Objective: To investigate the effects of High Deductible Health Plans paired with a Health Savings Account on the healthcare expenditure and health services utilization. Methods: Data from the 2014 and 2015 Medical Expenditure Panel Survey was analyzed. Subjects enrolled in a Consumer Directed Health Plan (CDHP) were compared with subjects enrolled in non-CDHP after matching. A Chi-square analysis was conducted to assess frequency distribution of subjects in the treatment group as compared to the control. The control group was weighted using propensity score weights to match treatment group. The difference in the healthcare expenditures between the two groups was estimated using a Wilcoxon sign rank test and independent sample t-test. The effect of CDHP enrollment on health services utilization was estimated using a regression model. Results: The total sample population was 2132. The CDHP group was found to have a higher proportion of White, Non-Hispanics with high level of education and high family income as compared to the control group. A significant difference was found between the out-of-pocket costs (OOP) (p=0.0004) and the overall healthcare expenditure (p=0.0119) with the CDHP group having higher costs. There was no significant association between low or high use of health services. Conclusion: The findings suggest that CDHPs might not be fulfilling their required goal of reducing healthcare expenditure as well use of unnecessary care.

Committee: Varun Vaidya Ph.D (Committee Chair); Anthony Pattin Pharm D. (Committee Member); Cindy Puffer R.Ph (Committee Member) Subjects: Pharmacy Sciences

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

Doctor of Philosophy, University of Toledo, 2010, Health Education

The purpose of this study was to survey public school district superintendents'perceptions of the impact of health insurance status on students' academic success; the role schools should play in assisting students in enrolling in health insurance; and benefits and barriers to assisting students in obtaining public health insurance. Superintendents' basic knowledge of state-funded health insurance, the link between health and learning; and specific school system practices for assisting students in obtaining health insurance were also examined. A total of 800 surveys were sent out to a national stratified random sample of superintendents from public school systems using a four-wave mailing procedure, yielding a response rate of 50.5%. Only 19% of schools systematically assessed the health insurance status of students. Using Stages of Change theory, 49% of superintendents identified their school districts in the precontemplation stage, and 36% in the action or maintenance stages for helping students obtain health insurance. Current practices identified were making state funded health insurance applications/materials available to parents (53%) and school nurses helped parents enroll their children (24%). Three-quarters of superintendents indicated overwhelmingly positive beliefs regarding the effects of health insurance status on students' health and academic outcomes. The majority of superintendents believed that schools should play a role in helping students obtain health insurance but their specific role was unclear. Superintendents who believed schools should have a role identified more perceived benefits, fewer perceived barriers; and were more likely to have knowledge scores greater than seven (out of eight), be from a rural school, and be in the action or maintenance stages of helping students obtain health insurance. The perceived benefits identified by more than 80% of superintendents were: to keep students healthier, reduce the number of students with untre (open full item for complete abstract)

Committee: James H. Price PhD, MPH (Committee Chair); Susan K. Telljohann HSD, CHES (Committee Member); Joseph A. Dake PhD, MPH (Committee Member); Brian N. Fink PhD, MPH, CHES (Committee Member) Subjects: Health; Health Care; Health Education; Public Health; School Administration

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

Doctor of Philosophy, The Ohio State University, 2013, Public Health

The policy making and implementation process is poorly understood by many quantitative health services researchers leading to potential threats to the validity of some studies. There is an extensive qualitative literature on the policy making process and a distinction arises between those that decide on a policy (policy makers) and those that implement a policy (policy actors). As multiple actors implement a policy there are multiple concerns raised including heterogeneity of effect among actors, evolving policies as different policy actors interact amongst themselves, variable implementation times among actors and spillover effects as actors engage with other, non-intended groups. When measuring health policies, each of these factors needs to be considered when designing studies and drawing conclusions to properly inform policy makers of policy effects. Crowd-out in health insurance occurs when individuals would have private insurance but for the existence of a public insurance program. Policy makers concerned with crowd-out will put barriers to enrollment in public plans which may discourage the neediest people, who the programs are intended to help, from enrolling. Past estimates of children's crowd-out during expansions in eligibility to Medicaid and the Children's Health Insurance Program have varied widely and are national in scope. I estimate state-specific levels of crowd-out using a regression discontinuity analysis to estimate crowd-out independent of an expansion for children near the eligibility threshold. I find that among states with similar eligibility levels, there is significant variability among crowd-out levels. To evaluate how crowd-out levels may change over time, I estimate crowd-out in Ohio from 2004-2012. I find that crowd-out levels were not constant over time and decreased during these years. Caps on noneconomic damages are viewed by some as a means of lowering the cost of healthcare. A potential unintended effect of these caps i (open full item for complete abstract)

Committee: Thomas Wickizer PhD (Advisor); Eric Seiber PhD (Committee Member); Abigail Shoben PhD (Committee Member) Subjects: Health Care; Public Health; Public Policy

Master of Arts, The Ohio State University, 1960, Graduate School

Committee: Not Provided (Other) Subjects:

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

Master of Science in Criminal Justice, Youngstown State University, 2017, Department of Criminal Justice and Consumer Sciences

To gain a better perspective of contributing factors to substance abuse this thesis will examine the relationship between substance abuse, mental illness, previous mental health treatment and health insurance coverage. It is estimated that about 4 million of the 17.5 million people diagnosed with a mental illness also suffer from substance abuse (Important Statistics on Dual Diagnosis, n.d.). This study is a secondary analysis on the results from the 2013 National Survey of Drug Use and Health. The results from this survey is provided by random households in the United States from individuals aged 12 years and older. I test the following research questions: Is there a correlation between a person's mental health and their likeliness to abuse illegal drugs? Does previous mental health treatment decrease the likelihood that an individual will abuse drugs? Lastly, does not having health insurance increase the likelihood of drug abuse? The findings indicate that the presence of a mental illness, especially a severe mental illness, is correlated with a higher substance abuse rate than individuals without a mental illness or who are suffering from a less severe mental illness. It was also found that persons who had received mental health treatment were more likely to abuse substances than someone who had not received treatment. Lastly, the results showed that individuals without health insurance were more likely to abuse substances than someone with health insurance.

Committee: John Hazy PhD (Advisor); Richard Rogers PhD (Committee Member); Christopher Bellas PhD (Committee Member) Subjects: Criminology; Mental Health; Psychology; Statistics

Master of Science, University of Toledo, 2017, Engineering (Computer Science)

In this thesis, health exchange data has been used to analyze and predict insurance premium for individual plans. The exchange data became public since 2014. Four regression models viz, Multiple Linear Regression, Decision tree Regression, AdaBoost Regression, and Gradient Boosting Decision tree Regression have been used to compare and contrast the performance of these algorithms. To test and verify the model, the data from 2014, 2015 and 2016 were used as inputs for training the models and the predicted premiums were compared with the actual 2017 data to compare the accuracies of the models. It was found that AdaBoost regression and gradient boosting algorithms performed better than the linear regression and decision tree. It was found that AdaBoost regression is the winner, although its performance is comparable to gradient boosting, but it takes much less computational time to achieve the same performance metrics.

Committee: Devinder Kaur Dr (Advisor); Ahmad Javaid Dr (Committee Member); Salari Ezzatollah Dr (Committee Member) Subjects: Computer Science

Doctor of Philosophy, The Ohio State University, 2017, Agricultural, Environmental and Developmental Economics

In recent years the `farm to table' trend, the idea of understanding linkages between agricultural supply, food systems, and the food that is consumed, has been growing in popularity. This dissertation takes this idea a step further and examines topics on the progression from `farm to health outcomes.' It is important to recognize not only that food systems impact the way consumers eat, but that those food choices impact health outcomes and the way that medical care is consumed. The three essays of this dissertation examine three separate points along this continuum to improve the understanding of how food systems, food choice, health outcomes, and healthcare consumption interact. The first essay evaluates factors associated with school districts' decisions to participate in farm to school (FTS) programs. I leverage the USDA's Farm to School Census to analyze factors associated with FTS participation, the types of FTS activities implemented, and the challenges faced by participating school districts. I use spatially articulate data to estimate the spatial spillover effects of FTS participation. The results demonstrate that both school characteristics and local farm production factors are associated with FTS participation. The estimated spatial spillover effect is positive, suggesting that areas with a high penetration of FTS activities have lower barriers associated with implementing FTS programs. In my second essay, I shift to evaluating how parent-child pairs make the daily school lunch decision. Meals served in the National School Lunch Program (NSLP) are on average more healthful than alternatives, implying that increasing participation in the NSLP can improve nutrition for a large number of children. However, there is little understanding of the household decision process that determines participation in the NSLP. This study uses a parent-child choice experiment to assess the impact of both parent and child on NSLP participation. The results show that b (open full item for complete abstract)

Committee: Brian Roe (Advisor); Allen Klaiber (Committee Member); Ani Katchova (Committee Member); Jill Clark (Committee Member) Subjects: Agricultural Economics; Behavioral Sciences; Economics

Doctor of Philosophy, The Ohio State University, 1987, Graduate School

Committee: Not Provided (Other) Subjects: Home Economics

Doctor of Philosophy, The Ohio State University, 1958, Graduate School

Committee: Not Provided (Other) Subjects: Economics

Ph.D., Antioch University, 2014, Leadership and Change

In 2010, an estimated population of the 311,212,863 Americans generated approximately 1,014,688,290 physician office encounters (Moore, 2010). The frequency and number of professional interactions between caregivers and patients/family members in medical office settings equated to a staggering 1,931 visits per minute. Based on the massive volume of interactions that occurred between patients of different races, ethnicities, genders, sexual orientations, and socioeconomic standings that generated an average household income of $49,445 in 2010 (United States Census Bureau, 2010a) with a physician workforce that the Association of American Medical Colleges (2010) captured as being 75% White that earned (primary care specialties) in excess of $190,000 per year in personal income (Hyden, 2011), a paradigm for potential discrimination is created through heterogeneous customers seeking health care services from a mostly affluent homogeneous workforce. What are the experiences of the underinsured in attempting to obtain routine and emergent medical care in the United States? Based on the identified void in the current body of scholarship that leaves silent the voices of millions of underserved and socioeconomically disadvantaged patients, this dissertation will extend the muted voices and, thus, create a platform to learn through the patients' personal contexts and unique health stories. The electronic version of this Dissertation is at OhioLink ETD Center, www.ohiolink.edu/etd.

Committee: Carolyn Kenny PhD (Committee Chair); Alan Guskin PhD (Committee Member); Laura Morgan Roberts PhD (Committee Member); Christine Phillips M.B.B.S. (Other) Subjects: Health Care; Health Care Management

PhD, University of Cincinnati, 2006, Nursing : Nursing, Doctoral Program

Each year increasing numbers of Americans report the use of some form of complementary and alternative medicine (CAM). The purpose of this descriptive study was to examine the implementation of a health benefits package including CAM therapies for employees of a small, self-insured manufacturing company. A secondary analysis guided by a decision-making theoretical framework was performed using data from the primary study, which examined the cost impact of adding two CAM therapies (Healing Touch and guided imagery) to the health care coverage for some employees of the company. The primary hypothesis of the study was that the insurance expenditures of employees who did not participate in CAM therapies would be significantly higher than participating employees one year after the intervention. Other hypotheses included a cost comparison of insurance expenditures over six years, employee satisfaction, and a decision to continue to receive CAM therapy following completion of the study. Data files included insurance expenditure payouts for all employees from 1995 to 2000 following termination of the study intervention and surveys completed by the study participants (N = 41) during the year of intervention. Overall statistical analysis did not support two research hypotheses that addressed the insurance expenditures in the four years prior to the study and in the year following the study. Mean expenditures for the non-participant group of employees continued to be significantly higher than for the study participants. An examination of employee satisfaction for the study participants revealed statistically significant support for the use of Healing Touch and guided imagery. Significant decreases in pain, stress and increase in emotional well-being (decreased anxiety and depression) were reported by the study participants following therapy. Findings in this study did not support the addition of CAM therapies to a health benefits package. However, the conclusions drawn do not (open full item for complete abstract)

Committee: Dr. Marilyn Sommers (Advisor) Subjects: Health Sciences, Nursing

MA, University of Cincinnati, 2006, Arts and Sciences : Psychology

Many young adults face multiple barriers to accessing health care (Morreale et al., 2004). Improving understanding of young adults' perceptions of their access to health care and knowledge of their existing services may provide information for insurance companies and health care providers. College students' perceptions of health care may be related to gender and ethnic group differences. For example, studies have shown that males engage in risky behaviors at higher rates than females, but access and utilize health care at lower rates than females (David & Kaplan, 1995). Of further concern, individuals who are in minority ethnic groups may be more likely to miss or delay accessing needed health care services (Shi & Stevens, 2005). The current study adds to the literature by providing information about how gender and ethnic group differences influence college students' perceived access to health care, knowledge of health insurance, perceived health status, and level of interest in a national insurance plan. One hundred ninety-two females and 122 males (n = 314) completed a survey. MANOVA and discriminant analyses were used to analyze the data. Study results indicated that females were less likely than males to avoid accessing health care services because costs were too high, and they were less likely than males to ignore symptoms. Males were more likely to agree that appointments were available from their medical provider as compared to females. Students from minority ethnic groups (i.e., those who were not white) reported having greater knowledge of their health care plan and were more interested in a national insurance plan compared to those who were white. Interestingly, students who were white endorsed better levels of overall health status and were more likely to ignore symptoms compared to students who were in minority groups. Implications for promoting access to health care services for college students and future directions are discussed.

Committee: Laura Nabors (Advisor) Subjects: Psychology, Clinical

Master of Social Work, The Ohio State University, 2010, Social Work

Health insurance is an increasingly necessary condition for adequate healthcare in the United States. Whether having health insurance is a sufficient condition, however, remains in question. The complexities of health insurance, need, utilization and access have been frequently studied in relationship to consumer satisfaction as a measure indicating effective access to care. The research, however, fails to address graduate students. Further, graduate students' options for health insurance vary in both cost and comprehensiveness, but little to no research has examined students' plans or experiences. To fill the gap in knowledge and establish a framework by which to broaden the public discussion of current healthcare conditions, this thesis addresses access to healthcare in the graduate population. The three main research goals were: to explore the components and characteristics of graduate students' health insurance, to identify any relationships between graduate students' healthcare experiences and their evaluations of specific insurance plan characteristics, and to determine the factors that predict graduate students' satisfaction with their health insurance plans. The study utilized an online survey to collect primary data at one point in time from a sample of 253 graduate students at The Ohio State University. First, descriptive data was used to establish the components and characteristics of graduate student health insurance. Next, chi-square tests of relationship between healthcare experiences and evaluations of specific insurance plan characteristics were conducted. The final and central analysis conducted linear regression with hierarchical entry of variables, modifying the Andersen Behavioral Framework to predict satisfaction. Results indicate that most graduate students have the university-sponsored student health insurance plan, have basic coverage, and pay between $50 and $250 per month in premiums. Results also indicate, however, that insurance plan kn (open full item for complete abstract)

Committee: Shantha Balaswamy PhD (Advisor); Cynthia Fontanella PhD (Committee Member) Subjects: Health Care; Public Health; Social Work