This study investigates the effect of offering Pre-Exposure Prophylaxis (PrEP) against HIV, as a public policy, on the spread of syphilis through behavioral changes on the willingness to engage on riskier sex behavior (i.e. condomless sex). To explore such phenomena, a Difference in Differences method is applied to groups of municipalities in the southeastern region of Brazil. No significant effect was found after restricting the sample to approximate the underlying characteristics of the groups. The results do not support the findings of the previous studies, performed on smaller target groups, nor contradict them. The inconclusiveness of the results is likely due to, amongst other factors, the small number of individuals both taking PrEP or diagnosed with syphilis, compared to the general population of the municipalities.

In 2007 Tennessee enacted and implemented the Nonsmoker Protection Act (NSPA) to protect nonsmokers by creating 100% smoke-free restaurants. Several venues were exempted, including age-restricted ones such as bars, and tobacco regulation was preempted. Thus, the NSPA is not equitable smoke free policy (SFP) because it has left vast segments of nonsmokers such as employees and patrons of bars unprotected from second-hand smoke (SHS) exposure and thwarted any local initiative to pursue 100% comprehensive SFPs. While this predisposes these nonsmokers to the health dangers of SHS exposure, it makes the NSPA incompatible with the objectives of the Healthy People 2020 and 2030 as well as goals of the state health plan. In 2021, the American Lung Association graded the NSPA “C,” and the United Health Foundation ranked it 42nd out of 50 states. This project assessed the effects of smoke-free venues across different economic domains through quantitative and qualitative data review to determine the implications for venues exempted by NSPA. By delineating any economic effects of SFP across several economic domains, the quantitative data gleaned from NAICS, Census Bureau, and Tennessee Dept. of Revenue were supplemented with interviews of establishments in Tennessee that voluntarily transitioned to smoke-free environment. A total of 7 such establishments with capacities ranging from 50 to over 69,000 people and number of employees ranging from 6 to over 1300 were interviewed. It was discovered that smoke-free environments have positive economic effects on restaurant establishments in Tennessee. By focusing on the SFP effect on restaurant establishments, the findings can be extrapolated to support the case for 100% smoke-free environments for other hospitality locations such as bars, music venues, and casinos. After analysis of trends for retail sales, number of establishments, employment, and payrolls by size of establishment and Metropolitan Statistical Area, a positive economic effect was identified for majority of these indicators between 2010 and 2019, a 10-year period following restaurants becoming smoke-free. Highlights include: Retail sales in Tennessee eating and drinking establishments increased by 62% The number of restaurant establishments increased by 16% Employment in the restaurant sector increased by 23% The qualitative data from the interviews reinforces these findings, with 100% of respondents supporting smoke-free age-restricted venues in their local communities. Thus, it can be inferred from these Tennessee-specific data with high degree of confidence that other hospitality venues will benefit economically in some way by becoming smoke-free with the following considerations: Provide protections from SHS exposure and health risks to nonsmokers; Do not adversely affect sales or employment in the hospitality, entertainment or sport industries, including bars, hotels and motels, and restaurants; Have strong public support and compliance.

This thesis is intended as a broad examination of the distribution of health resources in South Africa. Issues both macro and micro in nature have been covered to provide a perspective that would be Jacking in a narrower study. Although the title refers to a redistribution of resources, the intention of this thesis is to stress the importance of providing appropriate health measures rather than merely apportioning existing facilities evenly. This realization is insufficient, however, if it is not accompanied by the introduction and utilization of analytical approaches for identifying resource selection priorities. The influences on health status are many. In defining appropriate measures to improve health status it is important to be aware of the limitations of medical-care. Chapter three involves a cross-sectional regression analysis of various countries in order to examine the influences certain variables have on health status. This study suggests the need for an integrated approach to improving the health of a population. Merely focusing on medical care will only have a limited affect. However, this does not mean that medical-care is not important. It must just be provided in an appropriate manner. The rest of the thesis evaluates health-care resource distribution in South Africa. The existing distribution of health-care resources in South Africa is ill-suited to the existing health status of the population. There is a bias toward urban based curative facilities. Furthermore, the location of facilities has been based on racial criteria, whereby some areas have sufficient resources for their needs while others do not. Two methods of identifying how these issues should be dealt with are produced in this thesis. The first deals with a method for adjusting the broad distribution of funds toward those areas where need is greatest. The suggestion put forward by this thesis is that a formula be developed that would be able both to define need on a geographical basis, and to allocate resources based on that need. The formula would be used to allocate government health expenditure. This section is based on a formula that was developed in the United Kingdom. The second deals with a method for defining appropriate medical interventions on the micro level. It is called cost-effectiveness analysis (CEA). CEA is used for micro-economic decision-making where a choice has to be made between at least two alternatives for attaining a particular objective. Furthermore, CEA evaluates projects or programmes that are on-going in nature. It should be noted that CEA can also evaluate non-medical interventions to solve a particular health problem. In order to indicate the type of information that a CEA can provide, an investigation into cervical cancer procedures used on black females was produced. The entire black female population of South Africa was examined. A computer simulation of incidence and mortality rates of the disease was used to evaluate various scenarios. The results indicate that significant gains can be made by introducing cervical cancer screening on a large scale in South Africa. A major priority of this thesis was to stress the importance of using economic criteria to assist in making decisions concerning health-care resource allocations. Very little work of this nature is produced in South Africa. Hopefully this will not always be the case.

Bibliography: leaves 215-226. / This study evaluates the costs and effectiveness of preventive and curative procedures currently available for Tuberculosis (TB) control purposes. The procedures examined are as follows : i) BCG vaccinations; ii) Secondary chemoprophylaxis; iii) Health education; iv) Mass screening campaigns; v) Investigation of contacts of infectious TB cases and symptomatic persons, i.e. suspects; and vi) Treatment regimens for notified TB patients. The analysis is largely based on data from the records of 300 randomly selected TB patients, treated at clinics in the Cape Divisional Council area in 1983. The major finding of this study is that resources available for TB control should be reallocated in the direction of secondary chemoprophylaxis, BCG vaccination administration in the Black and Coloured populations, investigation of contacts and suspects, and ambulatory treatment of notified TB patients. Conversely, vaccinating the White population, mass screening campaigns and hospitalisation of TB patients should be given relatively less emphasis in the overall TB control programme. In addition, the proportion of patients confirmed as TB cases by means of bacteriological examinations should be increased to reduce misdiagnosis.

The aim of this work has been to investigate how cost per patient (CPP) data may be visualized for the purposes of Region Östergötland. Visualization could potentially aid decision-makers and managers within the organization who have to deal with aggregated healthcare costs. The work has shown that it is possible to design and implement an interactive web-based visualization tool prototype for the patient data using the Dash visualization library. In order to evaluate how practical the proposed application is from the users’ perspective, interviews have been conducted with the staff of the business intelligence (BI) unit at Region Östergötland. The answers have been positive regarding the usability of the visualization. However, since the application has only served as a prototype yet, further investigations should be made internally to estimate the effect the interactive visualization approach may have on future decision-making processes related to CPP.

Approximately 5 percent of the Swedish population is diagnosed with either type 1 or type 2 diabetes. A growing treatment method for type 1 patients is to supply the body with insulin using a pump. This thesis investigates if the use of pumps improves the health of the patients using two-way fixed effects regressions on quality register data on Swedish diabetes patients. I find statistically significant results indicating health benefits for type 1 diabetes patients, though smaller than previous studies. For future research, I suggest estimating quality of life changes from using an insulin pump in order for policymakers to make fully informed decisions on insulin treatment.

Empirical economics frequently involves testing whether a theoretical proposition is evident in a data set. This thesis explores methods for confronting such theoretical propositions with evidence. Chapter 1 develops a methodological framework for assessing whether binary (`Yes'/`No') observations exhibit a discrete change, confronting a theoretical model with data from an experiment investigating the effect of introducing a private finance option into a public system of finance. Chapter 2 expands the framework to identify two discrete changes, applying the method to the evaluation of adherence to clinical practice guidelines. The framework uses a combination of existing analytical techniques and provides results which are robust and visually intuitive. The overall result is a methodology for evaluation of guideline adherence which leverages existing patient care records and is generalizable across clinical contexts. An application to a set of field data on supplemental oxygen administration decisions of volunteer medical first responders illustrates. Chapter 3 compares the results of two mechanisms used to control industrial emissions. Cap and Trade imposes an absolute cap on emissions and any emission capacity not utilized by a firm can be sold to other firms via tradable permits. In Intensity Targets systems firms earn (owe) tradable credits for emissions below (above) a baseline implied by a relative Intensity Target. Cap and Trade is commonly believed to be superior to Intensity Targets because the relative Intensity Target subsidizes emissions. Chapter 3 reports on an experiment designed to test theoretical predictions in a long-run laboratory environment in which firms make emission abatement technology and output production decisions when demand for output is uncertain, and banking of tradable permits may or may not be permitted. Particular focus is placed on testing whether the flexibility inherent to Intensity Targets can lead them to be superior to Cap and Trade when demand is stochastic. / Thesis / Doctor of Philosophy (PhD)

In this applied microeconomics dissertation, we study the effect of religiosity and life events on risk preferences and how happiness affect altruism. We begin with the first chapter by examining the relationship between high-risk health behavior and religiosity. Religious beliefs can impact an individual's behavior, including their future health. The 2021 CDC analyses shows that sexually transmitted infections (STIs) are still common, with an estimated 1 in 5 people in the US having an STI, and 13% of persons in the US with age 12 years old and above consuming any illicit drugs. We estimate the effect of religiosity on high-risk health behavior using panel data from the General Social Survey and construct a high-risk health behavior index using the CDC high-risk behaviors. The religiosity index was developed by combining religiosity dimensions such as religious service attendance, prayer frequency, and religious affiliation. Ordered probit was performed to test the relationship between high-risk behavior and religiosity. The result indicates that religiosity is negatively associated with high-risk health behavior and is statistically significant. We confirmed that religious people are less likely to be involved in risky behaviors, especially for Catholics. We also find that individuals who switch religion are more likely to engage in high-risk health behaviors. In the second chapter, we examined the relationship between health and happiness and how happiness impacts altruism. The previous economics literature has shown that altruism can create a warm glow or cause happiness; we tested instead whether happy people are more altruistic. Using data from the General Social Survey (GSS) covering the period of 2002, 2004, 2012, and 2014, we employed a two-stage least square approach and performed OLS and ordered probit regression. We use health as an instrumental variable for happiness. Overall, the results indicate that happiness is associated with volunteer work and giving to charity and provide a basis for policy development to focus on promoting factors that contribute to happiness and wellbeing in order to foster pro-social behavior such as volunteering and donation to charity. Lastly, on the third chapter, we investigate how life events affect risk aversion using the German Socio-economic Panel (SOEP) Data. Our fixed effects estimation suggests that experiencing childbirth and losing parents decrease individuals' risk-taking propensity, while getting separated from a spouse or partner increases the willingness to take risks. We also find that changing jobs increases the willingness to take risks, and individuals who become self-employed tend to take more risks. Furthermore, we examine the average treatment effect on the treated (ATET) and find that for family-related events that are relatively beyond control, such as experiencing childbirth or the death of a child, parent, or spouse or partner, people tend to become more risk-averse. On the other hand, people tend to become less risk-averse for circumstances that are relatively within control, such getting married, separated, and divorced.

There's frequent discourse regarding the rising cost of insulin in the US. Insulin is a drug that over 7 million people rely on for survival, and it has tripled in cost over the last decade. The pricing regulation of the drug is dependent on multiple stakeholders, including wholesalers, pharmacy benefit managers, and manufacturing companies. Due to the lack of governmental intervention in the process of pharmaceutical cost regulation in the US, data on the price negotiations and the rebate system between these entities is unavailable in public records, making it difficult to determine a primary cause as the root of the issue of insulin costs. This paper attempts to understand the policies in place that impact the nature of insulin affordability and assesses the Canadian regulation of the cost of insulin to understand the discrepancy between the affordability in Canada in comparison to the affordability of insulin in US. A literature review was conducted to examine the policies and congressional discourse in order to analyze the current insulin market and the policies currently in discussion. Ultimately the discrepancy between the nature of health care in Canada and in the US is characterized by the underlying social principles that govern each country in terms of health policy. The Canadian health care system is built on the foundation that health care is a human right, whereas in the United States, health care is a commodity. The effect of this ideology is observed in the costs and regulation of pharmaceutical insulin.

No / The rise in non-communicable disease as a principal cause of premature mortality and a continuing failure to address health inequalities requires a critical examination of prevailing paradigms in health. In this paper, we offer ecology as an alternative way to view health need and as a guide to action to enhance human health and model a healthy economy. After describing the shortcomings of the prevailing biophysical approach to health, we describe an ecological approach to health that brings to the forefront social and environmental determinants and empowers health workers together with their communities to achieve a health-affirming society and economy.