An understanding of both the determinants of health care access and the implications of that access is of crucial importance because it enables us to learn about policies and institutions that are welfare enhancing in health outcomes. The first chapter of my dissertation explores how access to sanitaria aided in tuberculosis control in the time before antibiotics. Results indicate that access to an additional sanitaria bed reduced the death rate from tuberculosis for white residents by nearly .695 per 100,000 and had no impact for black residents. The next two chapters investigate the retail health clinic. First, I construct a choice model of clinic location that accounts for both demand and competition effects. I find that clinics are more likely to locate in areas that are populous, wealthy, educated, and white, and that they are less likely to locate in traditionally underserved communities. Second, I combine the results of my predictive model with data on ED visits to determine if clinics help direct patients away from receiving treatment at expensive emergency rooms. I find that access to retail clinics causes a substantial decrease in the number of ED visits for bronchitis and upper respiratory infections. The savings associated with retail clinic induced ED diversion is conservatively estimated to be at least $88 million in 2012 alone. In California, counterfactual analysis suggests that relaxing the barriers to clinic entry would result in $10.5 million in annual health care savings.

Retail clinics are walk-in clinics designed for convenience and for servicing minor health issues and certain acute conditions. The model began as a way of bringing both convenience and care to areas that have lower levels of access to primary care resources. With the implementation of Affordable Care Act (ACA) in March 2010, populations that were previously uninsured were now required to have access to some level of health insurance. These populations presented a potential new market for retail clinics. This research shows that post implementation of the ACA, retail clinics tend to locate in areas with higher incomes and, generally, greater access to primary care.