Bachelor of Science (BS), Ohio University, 2023, Economics

Many policymakers support universal healthcare to improve the health of the population. Some economists, however, are concerned that universal healthcare policy may negatively impact the general health of the population due to ex-ante moral hazard whereby a higher level of risk is incurred by the insured. In this paper, I analyze ex-ante moral hazard using the Medicaid expansion with the risky behavior of driving under the influence (DUI) on accidents involving drinking, accidents involving drugs, accidents in which the driver is not wearing a seatbelt, and DUI arrests by state. Unique to this study, I compile the data on risky driving behavior from the Federal Bureau of Investigation (FBI) and the National Highway Traffic Safety Administration (NHTSA). Then, I use a difference-in-differences model to identify the effect of the Medicaid expansion on the number of DUI arrests at the state level. I find that there is a no effect at the state level of the Medicaid expansion on passenger vehicle accidents involving drinking, drug impairments, driver not wearing a seatbelt, or DUI arrests. Therefore, I fail to provide evidence of ex-ante moral hazard in this context. This means there is no evidence that any of the mentioned risky driving behaviors increase at the state level as a result of expanding Medicaid.

Committee: Bethany Lemont (Advisor); Daniel Karney (Advisor) Subjects: Economics; Health Care

Doctor of Philosophy, The Ohio State University, 2020, Public Health

The federally-funded health center program aims to deliver high-quality, culturally-competent primary health care services, as well as ancillary health and supportive services, such as care coordination, health education, and oral health care, to all persons regardless of their ability to pay. Federal funding for community health centers (CHCs) has been uncertain for decades. The Affordable Care Act (ACA) Medicaid expansion provided CHCs with new opportunities to expand their patient revenue, broaden their reach, and fulfill their mission. However, relatively little is understood in the scholarly literature about how the ACA Medicaid expansion affected care delivery at CHCs, especially beyond the first few years, post-expansion. In this dissertation, I attempted to examine aspects of health care utilization and quality of care at CHCs following the ACA Medicaid expansion, and in a broader sense, to explore in different ways whether the ACA Medicaid expansion helped facilitate CHCs' pursuit of mission. Chapter 4 examined whether the ACA Medicaid expansion created lasting increases in the percentage of CHC patients covered by Medicaid and lasting decreases in the percentage of uninsured adult CHC patients in expansion-state CHCs, compared to non-expansion-state CHCs. The results of the study showed that, on average, Medicaid expansion increased Medicaid coverage among adult CHC patients in the expansion-state CHCs by 12.0 percentage points and decreased uninsurance among adult CHC patients by 7.7 percentage points by 5-years post-expansion, compared to non-expansion-state CHCs. Moreover, the predicted percentage of expansion-state CHC adults covered by Medicaid increased to a peak at 2-years post-expansion and then slightly decreased and plateaued from 3-to-5-years post-expansion. Expansion-state CHCs retained most expansion-covered patients over time, and greater state-level enrollment efforts were shown to be important for enrolling Medicaid-covered CHC patients. (open full item for complete abstract)

Committee: Eric Seiber PhD (Committee Chair); Thomas Wickizer PhD, MPH (Committee Member); Wendy Xu PhD (Committee Member); Kate Fox Nagel DrPH, MPH (Committee Member) Subjects: Health Care Management; Public Health; Public Policy

Doctor of Philosophy, The Ohio State University, 2018, Public Health

The June 2012 Supreme Court decision concluded that all provisions of the Affordable Care Act were constitutional except for the mandatory Medicaid expansion for adults. Therefore, each state had the option to expand Medicaid. By 2015, thirty-one states had adopted Medicaid expansion. Medicaid expansion is generally supported by Democrats and resisted by Republicans. Given the power governors have in Medicaid policymaking, it would stand to reason that states with Democratic governors would expand while states with Republican governors would not. However, ten states adopted expansion with a Republican governor. In the context of widespread Republican opposition to the ACA, why did some Republican governors support Medicaid expansion? What factors influence Republican governors' decisions regarding Medicaid expansion? The overall goal of this study is to understand the conditions under which Republican governors decided to support Medicaid expansion, given their party's opposition. Using mixed methods, the specific aims of this study are: 1) Identify the factors associated with a Republican governor's decision to support Medicaid expansion. 2) Determine in-depth how these factors and perhaps others, interacted with Republican governors in two states – one expansion state (Arizona) and one non-expansion state (Florida). The results from this study imply that in the case of Medicaid expansion, ideological, economic, political, and racial factors influence the decision-making of Republican governors, with ideological factors being the most dominant. The implications of this study are extensive for stakeholders including policymakers, public health advocates, interest groups, and researchers in states with Republican governors. It offers statistical and qualitative data that can be used to help them identify potential problems and solutions for coverage expansions in the future in seemingly challenging circumstances. Moreover, findings from this s (open full item for complete abstract)

Committee: Sandra Tanenbaum (Committee Chair); Tasleem Padamsee (Committee Member); Deena Chisolm (Committee Member); Thomas Nelson (Committee Member) Subjects: Political Science; Public Health; Public Policy

Doctor of Philosophy, The Ohio State University, 2009, Pharmacy

The pharmaceutical industry serves societal needs by bringing innovative products and therapies to market. However, innovation does not guarantee market longevity. Consequently, some products are evaluated and considered for market discontinuation. Safety, efficacy, and financial concerns are important considerations when evaluating the reasons for market discontinuation of drugs. In this study, market discontinuation of new molecular entities (NMEs) approved by the FDA from 1980 to 2008 were analyzed. The independent variables considered for the analysis were drug characteristics (route of administration, therapeutic class), sponsor characteristics (sponsor country, sponsor with single NME during study period), drug policy (orphan drug status, accelerated review, priority review and Prescription Drug User Fee Act (PDUFA) enactment). Data were derived from the FDA, Micromedex, Medline, Lexis-Nexis and Medicaid Drug Utilization Data. A drug was considered discontinued if it was deleted from the FDA's Orange book. Withdrawals of approval were also included in the study. Descriptive statistics, chi-square tests, logistic regression and survival analysis were performed for the study. A total of 703 NMEs were approved during the study period. In December 31, 2008, 71.8% NMEs remained in the market; 14.4% were discontinued; 5.4% NMEs had the brand discontinued, but the generic was available; 7.0% had changes in route, dosage form or strength; 0.7% were never marketed and 0.9% were over-the-counter drugs. Safety was the primary reason for withdrawal of 29 (27.4%) NMEs; 4 (3.8%) NMEs had Federal Register determination for not being discontinued for safety or efficacy reasons; 5 NMEs were never marketed (4.7%) and 68 (64.2%) had no reasons stated by the FDA. Compared to other classes anti-infectives were more likely (p<0.05) to be discontinued. Analyses of priority review, orphan drug status, and sponsor company's country (US or non-US) with respect to market withdrawal we (open full item for complete abstract)

Committee: Sheryl Szeinbach PhD, RPh (Advisor); Enrique Seoane-Vazquez PhD (Advisor); Kurt Stevenson MD, MPH (Committee Member) Subjects: Biostatistics; Economics; Epidemiology; Finance; Health Care; Pharmaceuticals; Public Health

Doctor of Healthcare Administration (D.H.A.), Franklin University, 2024, Health Programs

The United States pediatric population is unique in that the epidemiological trends differ from those seen in the adult population. When discussing the pediatric emergency department (ED), this is typically a setting with high patient flow which requires swift diagnoses and treatment. Ideally, all patients should have equal opportunity to receive their highest possible level of quality healthcare, regardless of social determinants of health (SDOH) such as patient race/ethnic background, preferred spoken language, socioeconomic status, and insurance status. This is essentially the concept of health equity. The goal is to provide responsible and ethical healthcare to patients. If healthcare delivery is disproportionate, this may result in the overcrowding of EDs, delays in patient care, economic burden on the healthcare system, and increased morbidity and mortality. Some scholars have claimed that both individual and systemic biases have resulted in inequitable healthcare delivery. The following research study investigated health equity in the United States pediatric ED via the following question: What government and organizational policy changes can be made to enhance ED pediatric patient equity by utilizing first-hand information from ED physicians? The selected methodology for this research was qualitative and utilized in-depth semi-structured interviews of 15 pediatric ED physicians via Franklin University's Zoom platform. ATLAS.ti software was used to assist in identifying key themes and sub-themes from the code transcriptions.

Committee: David Meckstroth (Committee Chair); Karen Lankisch (Committee Member); John Suozzi (Committee Member) Subjects: Epidemiology; Ethics; Gender Studies; Health; Health Care; Health Care Management; Language; Literacy; Medical Ethics; Medical Imaging; Medicine; Mental Health; Native American Studies; Public Health; Public Health Education

Doctor of Healthcare Administration (D.H.A.), Franklin University, 2023, Health Programs

Currently, rural hospitals account for thirty percent of all hospitals in the United States (U.S). However more of these facilities have experienced closure in the last decade than any time in U.S. history. Typical reasons for this occurrence are financial distress stemming from shrinking patient volume, physician departure, and reimbursement reductions. Currently the state of Tennessee has experienced several rural hospital closures to date. Finding opportunities to grow in-patient census while expanding substantial revenue generation is paramount to slow the closure trend. Covid-19 has caused a recent rise and demand for telehealth services in the healthcare industry. Is now a time for rural hospitals to improve telehealth resources to capture greater patient volume and potential improvement in revenue reducing financial burdens? A descriptive causal design utilizing secondary data from four rural hospitals in east Tennessee will determine if telehealth has increased in-patient volume over a four-year period of time. Diagnosis related groups (DRG) will be tested with Pearson's Chi-square with year over year group comparisons for improvement before, during, and since the pandemic. As telehealth use has grown during Covid- 19, have rural hospitals leveraged benefits to care for specialty diseases (i.e., neurology, nephrology, pulmonology) that before may have not been an option? Can comparing hospitals to understand if less or greater telehealth is performed in each studied facility influence in-patient volume? Using Medicare payment codes consideration for this research maybe used in other geographic regions to perform similar analysis in the future.

Committee: Cynthia Smoak (Committee Chair); Jennifer Sheinberg (Committee Member); John Suozzi (Committee Member) Subjects: Health Care; Health Care Management

Master of Arts in Economics, Cleveland State University, 2022, College of Liberal Arts and Social Sciences

I examine changes in Medicaid coverage and insurance status surrounding a work requirement policy implemented within the Arkansas Medicaid demonstration waiver. The policy applied to able-bodied, childless adults, aged 30 to 49, not enrolled as students, and was effective from 2018 to 2019. Eligibility was conditional on policy compliance. Taking a sample from the IPUMS American Community Survey database, I use triple-differences modeling to compare Arkansans subject to the policy with unaffected Arkansans and individuals from a set of control states. I find that the policy pilot group in Arkansas was less likely to be insured or have Medicaid coverage in the two years after the work requirement took effect, compared with controls. In 2018 and 2019 respectively, I estimate increases in uninsurance for the pilot group, compared with non-pilot Arkansans, were 7.3 and 10.8 percentage points greater than those experienced by the hypothetical pilot and non-pilot groups from the control states. Similarly, I estimate declines in Medicaid coverage for pilot versus non-pilot-group Arkansans were 6.2 and 10.2 percentage points greater in magnitude, compared with the hypothetical pilot and non-pilot groups from the control states in 2018 and 2019 respectively. In tandem with a series of robustness checks, I outline how asymmetric information, unobservable government intervention, and contemporaneous policies could affect my results.

Committee: Phuong Ngo (Committee Chair); Aycan Grossmann (Committee Member); Bill Kosteas (Committee Member) Subjects: Economic Theory; Economics; Health Care

PHD, Kent State University, 2021, College of Arts and Sciences / Department of Geography

Cancer epidemiology has a long history of applying geographic thinking to address long-standing place-based disparities. This dissertation adds new knowledge to geospatial approaches to social determinants of cancer outcomes. It establishes a framework consisting of three dimensions in evaluating, identifying, and prioritizing spatially heterogeneous risk factors of cancer outcomes. The first dimension is protection. Using a space-time statistic, the first study evaluated whether a non-spatial healthcare policy, Medicaid expansion, has offered protection targeting spatially vulnerable populations against adverse cancer outcomes such as breast cancer late-stage diagnosis. The second dimension is phenotype. Using a classification and regression tree, the study disentangled how risk factors of late-stage breast cancer diagnosis were conceptualized and capsulized as phenotypes that labeled groups of homogenous geographic areas. It provides a novel angle to uncover cancer disparities and to provide insights for cancer surveillance, prevention, and control. The third dimension is priority. Using a geographic random forest along with several validation methods, the study emphasized the importance of the competing effect among risk factors of cancer mortality that are specific to geographic areas. The findings from this study can be used directly for priority settings in addressing the most urgent issues associated with cancer mortality. This dissertation demonstrated that geographic methodologies and frameworks are useful and are imperative to cancer epidemiology.

Committee: Jay Lee (Committee Chair); Jun Li (Committee Member); James Tyner (Committee Member); Xinyue Ye (Committee Member) Subjects: Epidemiology; Geographic Information Science; Geography; Health; Health Care; Health Care Management; Oncology; Public Health; Public Policy; Statistics

Doctor of Philosophy, The Ohio State University, 2021, Agricultural, Environmental and Developmental Economics

There are many determinants of health such as individual dietary and health-related habits, constraints such as money and time, as well as market goods and services such as medical care, access to health insurance, and environmental conditions. In this dissertation, I focus on three key elements of household and individual consumption behaviors that are tied to economics of health and nutrition—policy, preferences, and consumption self-control. In the first essay, I demonstrate how receiving subsidized health care services can lead to new patterns of household consumption, specifically, undertaking fewer preventative health measures by the targeted households. This topic has received less attention in the literature. To do this, I investigate the effects of recent Medicaid expansions on eligible households' quarterly food and non-food expenditures using state and time variation in Medicaid expansion. Using an event-study design, and a triple difference-in-differences framework, I find that the Medicaid eligible households from expansion states spent less on fresh produce per adult and more on over-the-counter medications and remedies while not changing their expenses on frozen fruits and vegetables which have similar nutritional value as fresh fruits and vegetables. The robust reduction in fresh produce expenditures and increase in expenditures on over-the-counter medications and remedies suggest that while expanded public health insurance increases formal healthcare activity, it decreases informal preventative non-healthcare expenditures. These findings may begin to shift the focus in the literature on the unintended consequences of Medicaid expansion from sins of commission, i.e., moral hazard responses such as increased smoking, alcohol use and junk food consumption, to sins of omission, i.e., responses in which preventative health habits erode. In the second essay, I focus on healthy eating in institutions such as schools and colleges, which is promoted in (open full item for complete abstract)

Committee: Brian Roe (Advisor); H Allen Klaiber (Committee Member); Zoë Plakias (Committee Member); Wuyang Hu (Committee Member) Subjects: Agricultural Economics

DNP, Kent State University, 2021, College of Nursing

Advanced Practice Registered Nurses (APRN) are at the forefront of our current patient care systems. The APRN presence has brought questions involving the advanced practice community and their relationship to the medical staff, committees, and administration. Advanced practice registered nurse (APRN) includes the following practitioners: Certified Nurse Midwife (CNM), Certified Nurse Practitioner (CNP), Certified Nurse Specialist (CNS), and Certified Registered Nurse Anesthetist (CRNA). In 2012, the Center for Medicare/Medicaid Services (CMS) expanded the medical staff definition to include non-physician practitioners. This regulation change included advanced practice registered nurses and physician assistants. The Code of Title 42 C.F.R 482.22 allows hospitals and their medical staffs to take advantage of the expertise and skills of all types of practitioners who practice at the hospital when making decisions concerning medical staff privileges and membership. In 2014, Title 42 C.F.R. 482.22 Medicare Conditions of Participation clarified state laws would determine the eligibility for appointments by the governing body. The document does state the membership to the governing body is not a requirement but optional. (CMS, 2012). The DNP project “APRNs and Medical Executive Committee Membership: A Quality Improvement Proposal” highlights an environmental scan and a validation group input. Is there value of the APRN beyond the bedside? Multiple advanced practitioner journals, professional practice organizations, and textbooks direct APRNs toward positions in leadership as part of our professional responsibilities. However, few hospitals have positioned the APRN within the medical executive committee (MEC). The APRN membership on a MEC would reflect the diversity of our healthcare provider climate and is a natural progression of our hospital leadership. The s (open full item for complete abstract)

Committee: Lynn Gaddis Dr (Committee Chair); Kimberly Cleveland Dr (Committee Member); Marilyn Nibling Dr (Committee Member) Subjects: Nursing

Doctor of Philosophy, The Ohio State University, 2020, Political Science

This dissertation presents an exploration of anxiety for politics distinct from previous study in political psychology. Previous studies report on anxiety's potential to mobilize the electorate. Anxiety has been shown to bring political activation, to help sustain the collective action needed for civic and political participation, to increase willingness for compromise, to encourage political learning, and to increase trust in experts. But for many, the political world underlies much of their anxiety. Consider members of marginalized groups, many of whom are chronically taxed by politics, which can rewire neural networks in the brain and which leaves them with less available mental bandwidth to conduct themselves civically and politically. Taken together, I predict members of marginalized groups respond differently to anxiety than members of non-marginalized groups. While non-marginalized persons can muster their cognitive resources to channel anxiety into action, the precarious situations of many marginalized people merits devoting their cognitive resources elsewhere, leaving them demobilized by their anxiety. In Chapter 2 I lay bare this theory and annotate specific hypotheses. In Chapter 3 I launch a preregistered survey experiment to test my theory among a sample of Black subjects, White subjects, and Hispanic subjects, on welfare and off. Findings offer support for a heterogeneous understanding of anxiety's effects. Higher levels of anxiety caused the marginalized to be less likely to express an interest in voting than the non-marginalized. Furthermore, the interactive effect of race and welfare status inhibited participation the most among the intersectionally marginalized. In Chapter 4 I offer robustness tests for my hypotheses, testing for moderated mediation in particular. In Chapter 5 I conclude by discussing the broad implications of my findings, how government and politics can foster anxiety among the masses, but in particular the negative consequences i (open full item for complete abstract)

Committee: Thomas Nelson (Committee Chair); William Minozzi (Committee Member); Thomas Wood (Committee Member); Michael Neblo (Committee Member) Subjects: Behavioral Sciences; Cognitive Psychology; Political Science; Public Policy; Social Psychology; Social Research

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

MS, University of Cincinnati, 2019, Pharmacy: Pharmaceutical Sciences

Objective: Diabetes is one of the most prevalent chronic diseases. This study aimed to examine geographic variation and temporal trends in the utilization of antihyperglycemic therapies among the U.S. Medicaid population compared to diabetes prevalence at state-level using Geographic Information system. Methods: A descriptive, retrospective study design was performed for 2011,2014, and 2016. Study drugs were categorized into biguanides, sulfonylureas-meglitinides, DPP-4 inhibitors, SGLT2-inhibitors, GLP-1 receptor agonists, insulins, and others. The annual number of prescriptions for antihyperglycemic therapies were extracted from the national Medicaid pharmacy database provided by the Centers for Medicare & Medicaid Services. Spatial analysis using ArcMap 10.5.1 was performed to create choropleth maps for diabetes prevalence and point maps for the total number of prescriptions for each antihyperglycemic therapy. The percent change in drug utilization during the study period was calculated per therapeutic class per state. Pearson's correlation test was also performed to evaluate the correlation between diabetes prevalence and antihyperglycemic therapies' usage at state level. Results: Utilization of most antihyperglycemic therapies were increased from 2011 to 2016. States with high utilization trends were NY, CA, PA, NJ, AZ, FL, IL, OH, MA, and TX, ranging from 1-fold to 50-fold overall. The five most prescribed antihyperglycemic therapies in 2016 were biguanides (41.95%), long and intermediate-acting insulins (18.9%), short and rapid-acting insulins (12.87%), sulfonylureas-meglitinides (11.37%), and DPP-4-inhibitors (7.87%). Rapidly increasing utilization trends were for GLP-1-receptor agonists, DPP-4-inhibitors, and SGLT2-inhibitors around all states. SGLT2-inhibitors usage in the northeastern states increased by 4 to 26-fold higher than its use in 2014. Sulfonylureas-meglitinides usage decreased in the southeast part of the US by 20%-58% in 2016. There is (open full item for complete abstract)

Committee: Jianfei (Jeff) Guo Ph.D. (Committee Chair); Diego Cuadros Ph.D. (Committee Member); Nicholas Messinger (Committee Member) Subjects: Pharmaceuticals

Master of Sciences, Case Western Reserve University, 2019, Clinical Research

Many barriers to the most effective forms of postpartum contraception, sterilization and long-acting reversible contraception (LARC), exist. Our goal was to assess fulfillment of sterilization and LARC requests, timing of request completion, and impact of non-fulfillment between those with Medicaid and private insurance while accounting for the complex interplay between insurance, clinical, and social factors. After analyzing a retrospective cohort involving 8,654 women delivered at or beyond 20 weeks of gestation from January 1, 2012 through December 31, 2014 at our urban, tertiary-care teaching hospital, we concluded that differences in fulfillment rates of postpartum sterilization or LARC and time to sterilization or LARC between women with Medicaid versus private insurance are not significant after adjusting for relevant clinical and demographic factors. However, adequacy of prenatal care remains an important factor to fulfillment of postpartum sterilization and LARC, confirming the importance of antenatal contraceptive counseling in reducing disparities in contraceptive care.

Committee: Brian Mercer MD (Committee Chair); Robert Kalayjian MD (Committee Member); James Spilsbury PhD (Committee Member) Subjects: Medicine; Obstetrics; Public Health

Master of Gerontological Studies, Miami University, 2017, Gerontology

Ohio has an older population who are more likely to live alone than other states. Older Ohioans are at higher risk of nursing home admission. Additionally, a recent study shows that nursing homes in Ohio have lower quality compared to the rest of the United States. Hence, improving nursing home quality in Ohio is paramount in the field of aging services. The goal of this current study was to identify factors that affect nursing home quality in Ohio using data from the 2013 Biennial Survey of Long-Term Care Facilities in Ohio for Nursing Facilities and 2013 fourth-quarter archived data from the Centers for Medicare and Medicaid Services Five-Star Rating System. Not-for-profit facilities with a low proportion of Medicaid days were more likely to be high performers in Health Inspection, Staffing, and Overall domains. Small facilities were more likely to be high performers in Staffing and Overall domains. Facilities that had no administrator turnover were more likely to be high performers in Health Inspection. Non-chain affiliated facilities performed better in the Staffing domain. Facilities with low STNA retention rates were at higher risk of receiving one- or two- star ratings in Overall. Implications for consumers, policy makers, and providers are discussed.

Committee: Jennifer Kinney (Committee Chair); Jane Straker (Committee Member); Robert Applebaum (Committee Member) Subjects: Gerontology

Doctor of Education (Educational Leadership), Youngstown State University, 2017, Department of Teacher Education and Leadership Studies

The United States has been dealing with a healthcare crisis of millions of individuals being uninsured. The government's response to this crisis has been the enactment of the Patient Protection and Affordable Care Act 2010 (ACA). The law provides patients healthcare protections, along with annual and preventive healthcare services. This law has also expanded Medicaid insurance eligibility for the first time ever to qualifying males. The current investigation examines the impact of the ACA, 2010, on perception about health care, as well as participation in healthcare services among Caucasian males compared to prior years. A short warm up survey and a Q methodology was utilized to gain quantitative and qualitative results. Quantum analysis identified three main viewpoints. Maintainers have chronic illnesses and participate in both annual and preventive healthcare services. Obligers do not have any type of chronic illness, participate in healthcare services, but are highly concerned with the cost of healthcare. Immortals do not have any health concerns, value good healthcare coverage, but have many reasons not to participate in healthcare services. The general opinion of the participants was that participation in annual checkups and preventive health care was important to their health. They also felt strongly that participating in preventive care will detect medical problems and illnesses earlier. The majority of the participants reported that the ACA has not been a determining factor to visit their doctor for a check-up.

Committee: Karen Larwin Ph.D. (Committee Chair); Tammy King Ph.D. (Committee Member); Sara Michaliszyn Ph.D. (Committee Member); Kenneth Miller Ph.D. (Committee Member) Subjects: Health Care

Master of Gerontological Studies, Miami University, 2015, Gerontology

The purpose of this research was to document the experiences of the PASSPORT home care aides in using What Matters Most: A Guide for my Support and Care (WMM) developed by Scripps Gerontology Center. The WMM Guide, pilot-tested in southern Ohio, provides a formal structure to document a consumer's needs, strengths, goals and service preferences. Data were collected through semi-structured interviews with seven home care aides. Findings revealed that all of the home care aides found value in the information, especially if the WMM Guide is received prior to the start of services. Second, while they were not familiar with person-centered care terminology, they all described an approach to care that is consistent with person-centeredness. Third, provider level buy-in for person-centered care, supported through training and policy change, will be essential to the success of this initiative.

Committee: Suzanne Kunkel (Committee Chair); Joan Fopma-Loy (Committee Member); Jane Straker (Committee Member) Subjects: Aging; Gerontology; Health Care

Doctor of Philosophy, The Ohio State University, 2014, Public Health

The purpose of this dissertation is to investigate the effects of the institution of annual limits on certain community based mental health services for adults on Medicaid in the state of Ohio. The first chapter provides an overview of the relevant literature that is used in the dissertation. The second chapter identifies which populations may be likely to experience care limitations as a result of these benefit limits. This is achieved using a log-binomial analysis of utilization data prior to the implementation of the policy. The third chapter of the dissertation explores quantitatively how care delivery changed after the implementation of the policy. The fourth chapter provides a qualitative analysis of the operational changes made by providers of community based mental health services, as well of the antecedents of these changes. The fifth and final chapter aims to summarize the achievements of the dissertation and to highlight areas where further research is needed.

Committee: Sharon Schweikhart (Advisor); Manus Rungtusanatham (Committee Member); Eric Seiber (Committee Member); Abigail Shoben (Committee Member) Subjects: Health; Health Care; Health Care Management; Mental Health; Public Health

Psy. D., Antioch University, 2014, Antioch New England: Clinical Psychology

In 2009, Gawande published an article in The New Yorker that put the unknown mid-sized South Texas city of McAllen on the map. The article stated that McAllen was one of the most expensive health care markets in the country; it caused such media-frenzy that in a few days President Barack Obama (2009) began citing McAllen in his speeches for health care reform. Gawande concluded that overspending in the area was due to overutilization of medical services. The present study examined whether mental health services are overutilized based on archival data on McAllen's mental health services collected from Medicaid, Tropical Texas Behavioral Health (a McAllen area community mental health center [CMHC]), and The Behavioral Center at Doctors Hospital at Renaissance (a McAllen area private hospital). Findings yielded that diagnostic-related groups significantly impacted the average length of stay, as well as total costs for psychiatric inpatient treatment in McAllen, TX. Schizophrenia spectrum disorders required more days of treatment within the hospital than Bipolar disorders and further more days than Depressive disorders. Correspondingly, inpatient treatment of Schizophrenia spectrum disorders cost an additional $5,554.80 when compared to Bipolar disorders and $9,095.16 more than for Depressive disorders. Additionally, the readmission rate at Doctors Hospital was 26.72%, with nearly 1/4 of patients being readmitted at least once, and nearly 7% had 4 or more psychiatric hospitalizations within a one-year period. This readmission rate was higher than the national average perhaps because of inadequate after-care outpatient treatment in McAllen. Medicaid data showed that Texas consistently failed to contribute any state moneys to mental health spending; and that Massachusetts saw a considerably smaller increase in mental health expenditures over a 10-year period for both inpatient and outpatient services when compared to the United States as a whole (i.e., 26% vs. 260% for (open full item for complete abstract)

Committee: Gargi Roysircar Ph.D. (Committee Chair); David Hamolsky Psy.D. (Committee Member); Carlotta Willis Ph.D. (Committee Member) Subjects: Clinical Psychology