Thesis (Ph.D.)--Indiana University, Dept. of Economics, 2009. / Title from PDF t.p. (viewed on Jul 15, 2010). Source: Dissertation Abstracts International, Volume: 70-12, Section: A, page: 4783. Adviser: Pravin K. Trivedi.

In the face of escalating health care expenditure, OECD countries are turning to a variety of cost-containment strategies. This thesis analyses three such mechanisms. In Part I, I consider the use of coinsurance to limit the demand for health care. Because coinsurance reduces the elasticity of demand with respect to the price of health care, consumers facing low coinsurance rates may be charged a higher price by doctors. Such discriminatory pricing enables the doctor to extract surplus created in the insurance market, and therefore reduces the effectiveness of coinsurance. I show that in equilibrium, some consumers remain uninsured. I also show how this problem is solved if the doctor and insurer enter into managed care style arrangements. Such arrangements improve insurer and doctor profitability, and restore complete insurance market coverage. In Part II, I consider the design of fundholding schemes which encourage doctors to restrict expensive treatment to severely ill patients. I show that such schemes may be undermined by a patient-doctor side contract. In the face of such patient-doctor collusion, the fundholding scheme may be made collusion-proof by increasing its "power". I show that the optimal collusion-proof scheme may pay the doctor more than his reservation wage. An alternative solution to patient-doctor collusion is to use a partial fundholding scheme that requires some additional co-payment from the patient. Part III analyses New Zealand's internal market reforms. Introduced in 1993, the reforms involved the separation of funding and provision of health care, and were intended to simulate a competitive market environment, thereby improving the incentives of government owned health care providers to be efficient. On the supply side, I look at the internal restructuring of hospitals into private-sector clones. I argue that this commercialisation failed to take account of informational issues within the hospital. On the demand-side, I examine the suitability of internal markets for eliciting optimal innovation from the hospital sector. Again, I find that a standard argument, namely that increased competition leads to innovation, is questionable in the context of the internal market. / Whole document restricted, but available by request, use the feedback form to request access.

This dissertation takes a retrospective look at the first decade of EPA's implementation of the Comprehensive Environmental Response, Compensation and Liability Act commonly known as Superfund. Two models are employed that reflect EPA's implementation of Superfund: a rational threats game-theoretic bargaining model and a discrete choice empirical model. The game theoretic hazardous waste bargaining model produces an elegant and simple decision rule. Using this decision rule, EPA compares the expected transaction costs incurred because of litigation against EPA's prospects for a court-ordered award. The agency enters into bargaining when the savings from avoiding litigation is equal to the court-ordered award. EPA and the coalition of responsible parties bargain about how to share site clean-up costs (mixed funding) and when successful, enter into a voluntary settlement. The discrete choice empirical analysis reveals that high transaction costs, lengthy delays in site clean-ups and limited enforcement/litigation characterize EPAs implementation of CERCLA during the decade ending in 1990. Differences in how EPA implements this legislation across EPA Regions is explored. Compared to the other Eastern EPA Regions, EPA Region 4 is less likely to litigate and more likely to use Superfund monies to clean up hazardous waste sites.

Background: This thesis focuses on the economic analyses of type‐2 diabetes complications defined as macro‐vascular (myocardial infarction, stroke, ischemic heart disease, heart failure) and micro‐vascular (amputation and eye‐related complications leading to blindness in one eye). Diabetes‐related complications are a substantial component of the overall economic, physical and psychological burden of the disease. As the efforts in treating diabetes are geared towards reducing the likelihood of complications, understanding the welfare benefits and future savings from reducing diabetes complications is paramount in determining the cost‐effectiveness of competing diabetes therapies. Aims: The thesis is divided into three essays aiming to (1) characterize changes in the health related quality of life of diabetes patients over time and assess the contributions of diabetes complications to these changes; (2) study the drivers of healthcare expenditure for people with diabetes in terms of both inpatient care and non‐inpatient resource utilization, and estimate the impacts of diabetes‐related complications on health care costs; (3) understand the role played by self‐reported quality of life in predicting mortality after controlling for clinical risk factors. Methods: This thesis uses longitudinal data to answer the questions of interest. A unifying theme across the thesis is the challenge of estimating causal parameters in a context in which there may be substantial observed and unobserved patient heterogeneity. Findings: Failing to account for patient heterogeneity, and in particular un‐measurable variation in patients’ outcomes, is likely to bias the impact of complications on quality of life and on non‐inpatient costs, as well as to confound predicted time to death. In the case of QoL, ignoring heterogeneity is likely to overestimate the impact of complications on self reported utility because the patients who will eventually experience diabetes‐related complications are already on a lower utility path compared to those who do not. In the case of both inpatient and non‐inpatient costs, patients who go on to develop complications have higher cost both pre and post complications. In the case of inpatient costs there is no evidence that unobserved patient heterogeneity matters, while in the case of non‐inpatient utilization the hypothesis of a common baseline level of utilization is rejected in the subset of patients that contribute to the FE identification. This subset however is systematically different from the sample as a whole, being predominately more likely to have complications and other causes of hospitalization. Moreover, a trade‐off occurs when we are interested in predictions; models that exploit within‐patient variation have wider confidence intervals and have thus less precision than population average models. The final substantive chapter finds that HRQoL is significantly associated with survival at the population level and that when patient specific unobserved heterogeneity is taken into account, the power of QoL to predict life expectancy increases. Neglected heterogeneity in frailty causes underestimation of both the extent of positive duration dependence and the impacts of time varying covariates.

Thesis (Ph. D.)--University of Oregon, 2006. / Typescript. Includes vita and abstract. Includes bibliographical references (leaves 127-130). Also available for download via the World Wide Web; free to University of Oregon users.

Background: Elder abuse and its effects are a serious public health issue. However, little is known about therelation between psychological abuse, other factors (e.g. social support) and quality of life (QoL) by domain. This studyaddressed differences in QoL by domain between psychologically abused and non-abused. While considering otherfactors such as social support. Methods: The respondents were 4,467 (2,559 women) randomly selected persons aged 60-84 years living in7 European cities. The mean response across countries was 45.2%. The cross-sectional data were analyzed withbivariate/multivariate methods. Results: Abused respondents contrasted to non-abused scored lower in QoL (autonomy, 67.42 ± 21.26 vs. 72.39± 19.58; intimacy, 55.31 ± 31.15 vs. 67.21 ± 28.55; past/present/future activities, 62.79 ± 19.62 vs. 68.05 ± 18.09;social participation, 65.03 ± 19.84 vs. 68.21 ± 19.77). Regressions showed that abuse was negatively associated withautonomy, intimacy and past/present/future activities, and positively with the social participation. All QoL dimensionswere negatively associated with country and depressive/anxiety symptoms, and positively with social support. Further,variables such as age, sex and somatic symptoms were negatively associated with some of the QoL dimensions andothers such as family structure, education, health care use and drinking positively. The regression model “explained”32.8% of the variation in autonomy, 45.6% in intimacy, 44.8% in past/present/future activities and 41.5% in socialparticipation. Conclusions: Abuse was linked to lower QoL in most domains, but other factors such as depressive symptomsalso carried a negative impact. Social support and to some extent family structure had a “protective” effect on QoL.Abuse, health indicators (e.g. depressive symptoms) and social support should be considered in addressing the QoL ofolder persons. However, QoL was influenced by many factors, which could not be firmly disentangled due to the crosssectionalapproach, calling for longitudinal research to address causality.

Thesis (Ph.D.)--University of Alabama at Birmingham, 2009. / Title from PDF title page (viewed on Feb. 3, 2010). Includes bibliographical references (p. 69-75).

Thesis (Ph.D.)--Brown University, 2008. / Vita. Advisor : James A. Morone.

Thesis (Ph.D.)--Brown University, 2008. / Vita. Includes bibliographical references.

Thesis (Ph.D.)--Lehigh University, 2009. / Adviser: Shin-Yi Chou.