<p> Since the recognition of diabetes over 200 years ago, key fundamental breakthroughs have improved our understanding of the disease process and shaped the design of interventions for effective management. Unfortunately, the sky-rocketing increases in the number of persons with diabetes have slowed advances made in this field. Experts project that if current trends continue, one of every three U.S. adults will have diabetes by 2050. In the view of many researchers, the implications of this increase, along with a concomitant rise in diabetic complications, are profound. They indicate that this diabetic trend will result in increasing hospitalizations, disabilities and health care costs, as well as reduced quality of life and workforce productivity. </p><p> Understanding the triad of diabetes, hospitalization and work-productivity losses is therefore very important from a health policy perspective. To date, no study has examined the relationship between diabetes, the likelihood of hospitalization and the combined effect on labor force participation. Using a quantitative model and review of literature, this study 1) explores the impact of interventions designed to prevent and treat diabetes, 2) analyzes work-force productivity impacts, such as presenteeism and absenteeism, of diabetes-related acute events and 3) projects the growth of prevalence of diabetes in children 0-17 years. </p><p> The findings from this research are manifold: 1) For persons with diabetes, early enrolment in a chronic disease management intervention&mdash;before the development comorbidities that can aggravate the disease state&mdash;can delay the occurrence of any acute event necessitating hospitalization, emergency room visits and observations. 2) Diabetes results in significant productivity losses. In the cohort assessed, the productivity loss within a one-year period was about $2 million and approximately 20,000 lost workdays. Additional research is needed to elucidate the best approach to reduce presenteeism caused by diabetes. 3) By 2030 the number of children with diabetes will almost double the current children with diabetes population. Minority children will continue to bear a larger burden of the diabetes epidemic. The implications of this overall increase are enormous, especially with regard to more people having and managing diabetes for most of their lives.</p>

<p>An important factor in the rise of health care costs is the structure and performance of health care markets. This is an area in which policy can be particularly effective. Health care markets are characterized by complex interactions between consumers, physicians, insurers, facilities, and government agencies. Physicians, insurers, and facilities operate under a mix of objectives and governance structures. The many varieties of objectives, and governance structures can be broadly categorized as for-profit, not-for-profit, and governmental. </p><p> In the three chapters that follow I construct a theoretical framework to analyze hospital behavior and use a 30 year panel of data on Californian hospitals to assess the validity of the models and to identify the impact of governance structure on behavior. Chapter II addresses firm objectives. I find that firms have a continuum of weighting allocations, with for-profit firms placing greater weight on profit, government firms placing greater weight on social objectives, and not-for-profit firms locating in a middle ground. All three types of governance structures display overlap in their objectives. </p><p> In Chapter III, I identify patterns in hospital entry and exit. Like most manufacturing industries, entering hospitals are significantly smaller than incumbent hospitals and exiting hospitals are significantly smaller than surviving hospitals. The patterns of entry and exit for hospitals vary systematically with both governance structure and geographic diversification. </p><p> In Chapter IV, I develop a model of hospital entry that explains heterogeneous entry size and firm survival. I find entry size to be a relatively important factor in firm survival. In general entering on a larger scale increases the probability of survival. Despite this fact many firms enter relatively small. The model that I develop resolves small entry as a rational choice for uncertain firms. </p>

<p> This dissertation examines the factors that will affect nursing home quality of care using several national data sources on market regulation, county demographic characteristics, market structural and the characteristics of different types of long-term care providers in 2010. </p><p> The first study examines how nine different measures of nursing home care quality respond to the greater levels of local market competition from these alternative providers of long-term care, as well as other nursing homes. Findings reveal that faced with greater competition from assisted living facilities, nursing homes are left to care for more disabled, less healthy patients. Although the nursing home's staff-to-bed ratios rise in response, other measures of care quality decline, such as more process- and outcome-based measures. Competition from home health agencies likewise has mixed effects on nursing home care quality, and competition from other nursing homes in a market tends to decrease care quality. These finding suggest that care quality in nursing homes may continue to erode as the market for alternative, community-based long-term care services expands. </p><p> The second study examines the Medicare regulation effects on nursing home quality controlling for the whole long-term care market competition structure. In many local markets nursing homes now compete with assisted living facilities for residents, yet most previous studies of the effects of Medicaid nursing home reimbursement policies on care quality have analyzed nursing homes in isolation, ignoring the presence of nearby competitor firms, and how state regulation of assisted living facilities might also affect care quality in nursing homes. This study uses a richer model specification that accounts for a much broader range of state long-term care regulations as well as the structure of a nursing home's local market. Findings reveal that a higher Medicaid reimbursement rate leads to significant improvements in nine different aspects of nursing home quality, while state certificate-of-need programs for nursing homes lead to a decline in several (but not all) dimensions of it. A large presence of assisted living beds in a local market also tends to reduce nursing home quality, and state regulations regarding assisted living facilities indirectly affect nursing home care quality by altering the nature of local market competition. Overall, these results suggest that state laws related to all long-term care providers, not just nursing homes, are important determinants of nursing home care quality.</p>

Thesis (Ph.D.)--University of Illinois at Urbana-Champaign, 2007. / Source: Dissertation Abstracts International, Volume: 69-02, Section: A, page: 0704. Adviser: Darren H. Lubotsky. Includes bibliographical references (leaves 116-125) Available on microfilm from Pro Quest Information and Learning.

Thesis (Ph.D.)--Indiana University, Dept. of Economics, 2006. / "Title from dissertation home page (viewed July 16, 2007)." Source: Dissertation Abstracts International, Volume: 67-10, Section: A, page: 3907. Adviser: Pravin Trivedi.

The conversion of publicly owned industries and services into privately owned assets has been one of the most radical and controversial global economic trends of the past three decades. The major underlying rationale for this conversion is that public ownership is inherently economically inefficient. This point of view not only ignores the substantive evidence that disapproves this claim, but it also fails to recognize the merits of public ownership in promoting social welfare and health. Public ownership—in the form of public employment—does the latter in two ways: first, by providing employees with better and more equal benefits and working conditions than does the private sector, and second, by ensuring the smooth delivery of affordable quality social services to the public at large. This study quantitatively evaluates the impact of public employment on health at both the national and the individual level. At the national level, a cross-country sample from the 1980s shows that an increase of public sector employment was associated with a statistically and economically significant increase in life expectancy—a major indicator of population health. The association was even more prominent for middle- and low-income countries and for women. At the individual level, using logistic regression on data from a 2006 Chinese household survey, this study finds that public sector employees were statistically more likely to report good or excellent health than private sector employees. Analysis of the data reveals that much of this health premium is attributable to the fact that the public sector provides more permanent jobs than the private sector. Further, the private sector appears to have steep social class-health gradients, while such health inequality is moderate or even absent within the public sector. As a complement to the quantitative findings, this study also conducts a qualitative survey of China’s institutional and social context. It helps to further explain why the public sector in China remains a better employer after the collapse of the “iron rice bowl” system. Several policy implications emerge from this study. First, public sector employment deserves serious consideration as an instrument to promote health and health equality. Second, job security is essential for health; proposals for a more flexible and less regulated labor market are neither theoretically nor empirically justified. And last but not least, if the public sector continues its recent practice of implementing neoliberal policies, such as privatization and deregulation, its health premium over the private sector may go away.

<p> This thesis is an empirical exploration into a range of issues related to the economics of the utilization of physician services. Physicians play an important role in a health care system as physicians are a patient's primary point of contact with the health care system and physicians are predominantly responsible for directing how patients use other health care resources. In particular, physicians are at the center of Canada's universal public insurance system with first dollar coverage for medically necessary physician and hospital services.</p> <p> The thesis comprises three separate essays. The first essay has a methodological focus on statistically modeling and predicting the use of general practitioners (GPs) when use is measured as the number of GP visits. The essay compared a state-of-the-art parametric latent class negative binomial model to a nonparametric kernel conditional density estimator, and evaluated how well each was able to fit the observed data and predict physician use.</p> <p> The second and third essays look at more substantive policy questions. The second essay investigates how the supply of GPs and specialists affects the mix of physician services received by individuals. A persistent concern in many health care systems is how variations in the supply of physicians will impact the use of physician services. The results suggest concerns about concerns of patient access and receipt of care in the presence of a shortage of specialists may be mitigated, all else equal, if patients are able to substitute GP services for specialist services.</p> <p> The third essay examines income-related inequity in the use of physician services by asthmatics and diabetics, relative to the general population, and the contributions of different factors to income-related inequality using the concentration index approach.</p> / Thesis / Doctor of Philosophy (PhD)

<p>Eating disorders are now considered an epidemic among girls and women throughout the United States. This thesis suggests a study in which the acts and processes of anorexia nervosa and bulimia nervosa are positioned as a form of cultural labor undertaken by some Western women in order to embody the myth of the ideal female body. The researcher uses her own lived experience of anorexia and bulimia and her pursuit of embodying femininity in order to raise and guide the major questions concerning femininity and eating disorders in Western culture. </p><p> Keywords: eating disorders, anorexia nervosa, bulimia nervosa, pro-ana, pro-mia, femininity, western culture, autoethnography </p>

<p> Discrimination against immigrants based on country of origin, gender, or race is known to contribute to wage inequality, lower morale, and decrease worker satisfaction. Healthcare leaders are just beginning to study the impact of gender and race on the wages of internationally educated nurses (IENs). Grounded in Becker's theory of discrimination, this cross-sectional study examined nursing wages for evidence of wage inequality among IENs working in the United States using secondary data collected in the 2008 quadrennial National Sample Survey of Registered Nurses. Ordinary least square regression coupled with the Blinder-Oaxaca wage decomposition was used to analyze the wages of 757 IENs working in the U.S. healthcare system. <i>T</i> tests with effect size were calculated to find the impact of gender, race, and country of education on wage. The study found that white male IENs earned higher wages than all other immigrant groups, followed by nonwhite males and nonwhite females (R² = .143; <i>F</i>(8,748) = 15.60; <i> p</i> =.000;). White female IENs earned the least, at 80%, 88%, and 91% of wages earned by white male, nonwhite male, and nonwhite female IENs, respectively (<i>p</i> &lt; <i>.005</i>). The relationship between hourly wage and being a white female was negative and statistically significant (<i>p</i> = .006) and white females earned 19.6% less per hour than white male IENs. Working in tertiary care contributed 21.60% of wages for white IENs and 10.30% of wages for nonwhite IENs. Inequality in nursing wages was related to an interaction between race and gender for wages of white female IENs but not in wages for nonwhite female IENs. Results of this study promote positive social change by motivating nursing departments to equalize wages and policymakers to strengthen equal pay statutes.</p>

<p> Healthcare spending has risen astronomically over the recent past. Some of the blame has been placed upon an inefficient healthcare system. Whether true or not, we are in the midst of burdensome financial trend in healthcare that cannot continue. Thus, private payers, government payers and taxpayers alike, are looking at ways to reduce such spending. At the same time, healthcare providers wish to remain profitable enough to continue delivering care, well into the future. One proposed answer to the conditions plaguing an inefficient and expensive health system is the new focus on collaborative care models for healthcare delivery. This paper examines collaboration, particularly the joint venture between hospitals and healthcare providers. This paper also assesses the financial viability of such organizations, and recommends areas for further exploration in collaborative design.</p>