Thesis advisor: Julie Mortimer / Essays on the effects of health policy payment systems in long-term care and end-of-life care institutions are studied. In the arena of long-term care, state Medicaid agencies have recently implemented pay-for-performance (P4P) programs to address poor quality of care in nursing homes. Using facility-quarter level data from 2003 to 2010, we evaluate the effects of Medicaid nursing home P4P programs on clinical quality measures, relying on variation in the timing of P4P implementation across states. Further, we exploit variation in the structure of states' programs to investigate whether programs that reward certain dimensions of quality are associated with larger improvements. We find P4P decreases the incidence of adverse clinical outcomes by as much as 8%, and the improvements are concentrated among the measures that experienced an increase in their relative returns and share strong commonalities in production. In the Hospice industry, changes to the current reimbursement system are mandated by the Patient Protection and Affordable Care Act. The motivation stems from noticeable hospice utilization changes since the Medicare Hospice Benefit (MHB) introduced a per-diem reimbursement in 1983. This research analyzes the abilities of a multi-tiered payment system, and a simpler two-part pricing system, to accurately match Medicare payments with hospice patient costs. Both systems improve on the current payment mechanism, while two-part pricing is the only system to maintain access to care for all MHB eligible patients. In addition, consumer disutility incurred by driving to airports is estimated and used to define air travel markets. Though an accurate definition of an economic market is important for any study of industry, there is no rule governing what exactly constitutes a market. To define a market we must ask the question ``between which products do consumers substitute,'' knowing that the answer to this question will depend on how ``close'' products are to one another in product space, as well as how close they are to one another, and to consumers, in geographic space. We estimate a discrete choice model of air travel demand that uses known information about the locations of products and consumers, which allows us to study substitution patterns among air travel products at different airports. We evaluate the commonly used city-pair and airport-pair definitions of a market for air travel, and conclude that a city-pair is the appropriate definition. We also employ the Hypothetical Monopolist test for antitrust market definition, as defined by the Department of Justice and Federal Trade Commission, and conclude that the relevant geographic market for antitrust analysis is frequently more narrowly defined as an airport-pair. / Thesis (PhD) — Boston College, 2013. / Submitted to: Boston College. Graduate School of Arts and Sciences. / Discipline: Economics.

Les différences constatées entre les droits et obligations financiers, patrimoniaux et politiques d’un salarié actionnaire et ceux des autres actionnaires suscitent un légitime questionnement juridique. Il apparaît nécessaire de les expliquer car elles interrogent sur la cohérence d’ensemble du droit de l’actionnariat salarié. Les justifications classiquement avancées ne paraissant pas pleinement satisfaisantes, il convient donc de les dépasser.Le particularisme du statut du salarié actionnaire est ainsi attribué à l’existence d’un modèle de l’actionnariat salarié, soigneusement élaboré par le législateur et par la pratique, afin de répondre à plusieurs défis contemporains. La vérification de cette hypothèse implique d’identifier ce modèle. Une recherche en ce sens met en évidence la « double instrumentalisation » de ce type d’actionnariat partagé entre mode de rémunération et mode de gouvernance. Il est ensuite démontré que ces deux traits caractéristiques du modèle de l’actionnariat salarié ont influencé, au niveau individuel, le statut du salarié actionnaire. Son statut est alors construit autour de la volonté de transformer le principal intéressé, essentiellement, en bailleur de fonds de la société qui l’emploie et, subsidiairement, en actionnaire de contrôle. Cette conclusion offre une autre grille de lecture éclairant d’un jour nouveau le droit de l’actionnariat salarié. Cette nouvelle approche permet de fonder des propositions visant à limiter les risques financiers supportés par le salarié actionnaire et à rénover sa participation à la démocratie actionnariale. / The noticed differences between the financial, patrimonial and political rights and duties of an employee shareholder and those of the other shareholders arouse a legitimate legal questioning. It seems necessary to explain them because they question about the coherence of the whole salaried shareholding law. The justifications classically advanced don’t seem completely satisfactory, it is thus advisable to exceed them.The sense of identity of the status of the employee shareholder is so awarded to the existence of a model of the salaried shareholding, carefully elaborated by the legislator and by the practice, to answer several contemporary challenges. The check of this hypothesis implies to identify this model. A research in this way brings to light the " double instrumentalization " of this type of shareholding shared between method of payment and mode of governance. It is then demonstrated that these two characteristic features of the model of the salaried shareholding influenced, at the individual level, the status of the employee shareholder. His status is then built around the will to transform the main person interested, essentially, in financier of the company who employs him and, additionally, on shareholder of control. This conclusion offers another railing of reading enlightening in a new way the salaried shareholding law. This new approach allows establishing propositions to limit the financial risks supported by the employee shareholder and to renew its participation in the shareholder democracy.