Three essays in this dissertation explore the behavior of individuals in response to the housing crisis and its consequences, and the impact of the pandemic on the short-term rental markets. The first essay examines the economic outcomes of young people who have returned to their parents' home, using data from 2003-2017 waves of the National Longitudinal Survey of Youth 1997 Cohort (NLSY 97). The economic outcomes of boomerang movers did not improve compared to the period of independent living, and the income gap with young people who remained independent widened. The residential movement of young people who make boomerang moves has an impact on their income, but this effect is short-lived. Going back to a parental house changes the region and urban form significantly, and movement of urban form from the central city to the suburban and from the suburban to out of the MSA has a negative impact on income. Findings from the study suggest implications. First, more affordable housing should be provided to reduce boomerang moves. Second, ways to increase job opportunities should be explored to reduce the short-term negative impact of boomerang move. Finally, education and vocational training opportunities must be increased to close the income gap among young people. The second essay seeks to answer the following questions through the experiences of individual households due to the foreclosure. First, did foreclosed households regain homeownership? Second, is there a relationship between socio-demographic characteristics of foreclosed household and regaining homeownership? Third, where do homeowners who have lost their homes migrate? Finally, what characteristics of the neighborhood help foreclosed households recover? While previous studies have focused on the resilience of housing markets and regions, this study explores the link between regional characteristics and individual household recovery. The recovery of financially disadvantaged households is an important issue for communities and states. Identifying the mechanism that is responsible for household recovery has implications for implementing programs to aid household recovery. This study primarily relies on the 2005 -2019 Panel Study of Income Dynamics (PSID). Since 2009, PSID has added survey questions about foreclosure; Whether a foreclosure process has begun, the year and month of the start, the result of the process, and whether a foreclosed home is a primary residence. The findings of this study suggest that the government's recovery assistance program should aim to support relocation to areas with lower poverty rates and higher job and educational opportunities. The final essay explores changes in short-term rentals resulting from the COVID-19 pandemic. To identify the impact of the COVID-19 pandemic, this study uses New York City's Airbnb listing data from Inside Airbnb (IA), as well as supplemental data such as American Community Survey (ACS) data. Change in the number of STRs is divided into (1) the number of units left the platform and (2) the number of new units. The former relates to the survival of existing STR units and, the latter to the location choice of new units. The results show that the impact of several variables on survival and generation mechanisms changed since the COVID-19 pandemic. Since the survival mechanism and the generation mechanism of short-term rentals are different, they should be considered separately in regulating the STR to stabilize local housing markets. / Doctor of Philosophy / Although research has been conducted on the housing crisis and recovery of the housing market, there are still unanswered questions from two aspects. First, have the individuals affected by the crisis recovered? Were the individual decisions in response to the crisis effective? Second, how has the new crisis caused by the COVID-19 pandemic impacted the housing market? Are different characteristics observed from previous housing crises? While the evidence is reported that the relationship between the new crisis and housing demand has changed, the impact of the pandemic on contemporary housing crises such as gentrification and reduced housing stock is unknown. This dissertation explores the trajectories of individual behavior in the housing market, using various data sources and methodologies. Of the three essays in this dissertation, the first two essays explore the behavior of individuals in response to the housing crisis and its consequences, and the final essay explores the impact of the pandemic on the short-term rental markets. The first essay investigates the economic outcomes of young people who return to their parental homes after periods of independent living using NLSY97 data. The second essay investigates the relationship between neighborhoods and the economic recovery of households using Panel Study of Income Dynamics. The third essay explores changes in the survival and generation mechanism of Airbnb units associated with the COVID-19 pandemic using New York City's Airbnb listing data. The results of each study commonly lead to the conclusion that housing affordability should be improved. It also suggests that more affordable housing should be provided in areas of greater opportunities. This dissertation ultimately contributes to identifying individuals at risk from external shocks and suggesting goals and strategies for a healthy housing market.

Housing in prosperous American cities is becoming increasingly expensive, forcing many municipal governments to re-evaluate how they will continue to serve lower-income residents and ensure equitable access to housing and resources. In the City of Alexandria, the Alexandria Re-Development and Housing Authority (ARHA) has worked in recent years to partner with private developers to convert its existing stock of low-density, designated-affordable housing into more dense, mixed-income communities. This is possible because many of its existing communities sit on land in now-prime locations where the City currently allows the most density, as well as bonus density through a variety of mechanisms. While these projects have succeeded to some extent, the City is unfortunately still seeing a rapid rise in rents accompanied by a rapid decrease in available affordable housing of all types, in both privately-developed and publicly-subsidized communities. Increasing income disparity is also simultaneously driving lower-income to middle-class residents to suburban and exurban sites where limited access to municipal resources and public transportation can be highly detrimental to quality of life. While additional density is the knee-jerk response to many of affordability's challenges, often the resulting built solutions seem incomplete – achieving the basic goal of housing more residents, but failing to build thriving and diverse communities that connect people the way previous communities may have. After all, the pragmatics of building generally point towards maximizing square footage, monetary return, and speed of delivery by using conventional and commonly-accepted solutions, with less energy given to resident outcomes, and how people might be affected by the change to their living environments and communities. As Jan Gehl and Jane Jacobs examined in Cities for People and The Death and Life of Great American Cities respectively, simple pragmatics do not make for livable environments. A truly humanist approach to design for living in cities requires not only good policy, practice, and engagement, but also architectural strategies that respond to how humans relate to each other and their surroundings. Convergence explores how designers can contribute to making urban housing better for everyone by addressing housing affordability, person-to-person interaction, and community engagement in increasingly-dense environments. Its primary objectives are: • Encouraging neighborliness by increasing chance encounters as well as reducing the sharp threshold between private and public space often found in apartment-style buildings. • Increasing the visibility of human activity to the street in a multi-floor, multi-family project. • Using new mass timber methods and modularity to improve initial building construction and cost while also incorporating sustainable practices to reduce resource use and operating cost. • Anticipating that modification and reconfiguration will be required in the future, and offering defined parameters to simplify that process. • Creating a variety of unit sizes while also offering future flexibility to respond to changing community needs. • Combining the familiar with the novel to connect the new community to its surroundings, bridge experiences, and manage change. / Master of Architecture / In the City of Alexandria, the Alexandria Re-Development and Housing Authority (ARHA) owns several affordable housing sites in desirable locations that it has been working to convert into more dense, mixed-income housing in partnership with private developers. While these projects have succeeded to some extent, housing in the City continues to become increasingly expensive, and wages for low-income and lower-middle class residents are not keeping pace with the increase in cost of living. This phenomenon is pushing many long-time and/or lower-wage residents to the suburbs and exurbs, limiting access to municipal resources and public transportation, and reducing quality of life. As a result, communities and families with long histories in the City are breaking apart and dispersing. Many advocates, policymakers, designers, and developers have turned to additional density as the most immediate response to these concerns. However, additional density isn’t enough; new buildings may house more people, but fail to address the other aspects of building thriving and diverse communities that connect people the way previous communities may have. Good housing and good communities need more than square footage, so it is time to look beyond conventional solutions. New approaches are needed to respond to how people are affected by changes to their living environments and communities, and create the kinds of positive outcomes that should be part of any new housing project. Therefore, if we want to design for living in cities, we have to have good policies, practices, and engagement, but we also need architectural strategies that respond to how humans relate to each other and their surroundings. Convergence explores how designers can contribute to making urban housing better for everyone by addressing housing affordability, person-to-person interaction, and community engagement in increasingly-dense environments. Its primary objectives are: • Encouraging neighborliness by increasing chance encounters as well as reducing the sharp threshold between private and public space often found in apartment-style buildings. • Increasing the visibility of human activity to the street in a multi-floor, multi-family project. • Using new mass timber methods and modularity to improve initial building construction and cost while also incorporating sustainable practices to reduce resource use and operating cost. • Anticipating that modification and reconfiguration will be required in the future, and offering defined parameters to simplify that process. • Creating a variety of unit sizes while also offering future flexibility to respond to changing community needs. • Combining the familiar with the novel to connect the new community to its surroundings, bridge experiences, and manage change.

This dissertation examines the effects of physician ownership of hospitals on the quality of patient-centric care in the U.S. The health care sector in the U.S. is becoming more aligned with markets and in turn, with consumers’ preferences. In consumer driven service industries, consumer satisfaction is considered a key criterion to judge quality. In the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) patient satisfaction surveys, physician-owned hospitals (POHs) get more top 5-Star ratings than other hospitals. However, it is not known whether higher perceived patient satisfaction is because of better inpatient experience or due to better health related outcomes. Ratings also do not clarify variations between specialty and general service POHs. The study compares the quality of care in POHs with that in other major forms of hospitals (corporate-owned, and not-for-profit). The Affordable Care Act (ACA) regulated physician ownership of hospitals due to concerns that physicians’ profit motive might negatively affect the quality of care. This non-experimental study used bivariate and multivariate analyses to examine variation in the quality of care among types of hospitals in 2017 and 2018 using patient satisfaction and clinical outcomes as indicators of quality. This study used two samples, a full and a restricted sample. Full sample compared all POHs (specialty and general service) with other hospitals. Restricted sample included only general service hospitals. Patients in POHs were found to have higher perceived satisfaction, and viewed providers’ practices more favorably in the full sample. In the restricted sample, however, not-for-profit (NFP) hospitals provided relatively better care. Corporate-owned hospitals had lowest patient satisfaction and poorest outcomes. Results indicate POHs are competitive with not-for-profit hospitals on patient satisfaction dimension of quality care. Multivariate analyses suggest that the effects of physician ownership go away when mediation by providers’ practices is considered. NFP hospitals, however, continue to provide better overall value of care. The results do not support reconsideration of the ACA restrictions on POHs. Patient satisfaction may be contingent upon patient-centric practices than type of hospital, but hospital ownership may affect preference for some practices over others. Outcomes may not matter when patients’ perceptions measure quality. / Ph. D. / The health care sector is becoming more closely linked to markets, and consumer experience and satisfaction, like any other consumer services industry due to growing influence of for-profit hospitals and hospital forms. Physician-owned hospitals are a relatively new form of hospitals in the U.S. Along with more traditional not-for-profit and corporate-owned hospitals; physician-owned hospitals compete for patients and patient dollars. Many physician-owned hospitals are specialty and surgical hospitals, in addition to general service hospitals. According to federal government surveys, patients usually perceive medical care provided by physician-owned hospitals to be of superior quality to that of other kinds of hospital. However, physician-owned hospitals are a type of for-profit hospital, and it is not clearly known if general service physician owned hospitals provide similar care as specialty hospitals. This research compared possible quality differences between specialty and general service physician-owned hospitals as well as with corporate-owned and not-for-profit hospitals. The results indicate that patients’ perceptions of quality of care are not consistent for physician-owned specialty and general service hospitals; the higher patient perception ratings for physician-owned hospitals reflect the better performance of specialty hospitals. In comparison with other hospitals, not-for-profit hospitals seem to provide better quality of care (tapped by both patient satisfaction and clinical outcomes) than for-profit hospitals. Corporate-owned hospitals were found to have lowest quality of care. Patients should consider tradeoffs between having better inpatient experiences and better outcomes of care.

On March 23, 2010, President Barack Obama signed the Patient Protection and Affordable Care Act (PPACA) into law. This reform, it is argued, is projected to increase insurance coverage of pre-existing conditions, to expand access to insurance for more than 30 million Americans, and to increase estimated National medical spending while lowering projected Medicare spending. This thesis sought to investigate and analyze the perceptions of senior citizens in Central Florida about PPACA and their perceived effects on the healthcare quality provided to them under this law. Four sections of PPACA bill, thought to specifically pertain to the elderly, were selected for this study; respondents were asked their opinions regarding PPACA's aspects of: (1) the reform on preventive healthcare services; (2) Medicare Part D (prescription drugs); (3) Medicare; and (4) Medicaid. This thesis employed both qualitative and quantitative methodologies; data were collected and analyzed with findings presented and discussed.

This study investigates the institutional learning from attempts at securing affordable housing inclusion within Transit-Oriented Developments (TOD) through institutional change in Reykjavík, Iceland. As Reykjavík embarks on the ambitious City Line project, a bus-rapid transit network aimed at sustainably shaping urban growth, ensuring affordable housing near transit stations has become critical. Past attempts to achieve housing affordability have fallen short since Reykjavík still, to this day, experiences a great lack of affordable housing. Thus, this research employs an institutional learning framework to explore the barriers to and opportunities for ensuring affordable housing in TODs. Through expert interviews and document analysis, the study’s findings highlight the institutional challenges hindering the realisation of affordable housing goals within TODs. These include the vagueness of upper-level policies and terminology, the influence of land ownership, and implementation gaps in planning. Additionally, the research identifies opportunities for institutional change, such as strengthening standardisation from state-level policies, including principles of transit-accessible development in the extensions and re-evaluation of the City Line network, and addressing issues of timescale alignment between the implementation of TODs and the City Line. The study contributes to the limited Icelandic literature on institutional analysis in urban planning and offers ideas for enhancing social inclusivity and housing accessibility for Reykjavík’s future transit communities.

Cette thèse inscrite dans la tradition intellectuelle de l’American Political Development analyse les liens dialectiques entre l’entrepreneuriat des présidents des États-Unis sur la question de l’assurance maladie, l’essor du système de santé américain contemporain et son produit le plus récent, le Patient Protection and Affordable Care Act (2010). Il s’agit d’analyser les influences réciproques entre un exécutif qui subit de très fortes contraintes institutionnelles dans ce champ précis des politiques publiques et un système de santé dont les fondements et les contours sont en perpétuelle mutation. Les réformes de santé, de par leur nature transversale et polémique, leur complexité mais aussi leur poids dans l'économie américaine, agissent directement sur les équilibres de la gouvernance publique. Elles doivent être considérées comme un laboratoire et un accélérateur d’innovations pour la présidence, dans un système politique où sa sphère d’action est limitée, tant par les freins et des contre-pouvoirs que par l’influence d’autres entrepreneurs politiques dotés d’une légitimité d’action égale voir supérieure à se saisir de la question épineuse de la santé. L’adoption du PPACA, sa promulgation par un président démocrate après un siècle de rendez-vous manqués avec les réformes ambitieuses de l’assurance maladie, ainsi que sa mise en œuvre compliquée, offrent un cas d’étude de premier plan sur les évolutions de l'exécutif étasunien et sur la normalisation d’un entrepreneuriat présidentiel hétérodoxe. / This dissertation which falls within the intellectual tradition of American Political Development explores the dialectical links between the entrepreneurship of US presidents on health care reform, the development of the American health care system and its latest product, the Patient Protection and Affordable Care Act (PPACA), which was signed into law in 2010. This work analyses the mutual forces of influence at work between a deeply constrained executive in this particular field of public policy and a health care system whose foundations and contours are in constant mutation. Given its controversial nature, its complexity and its weight in the US economy, health care reform directly affects the dynamics of public governance. Health care reform must therefore be considered as a laboratory and an accelerator of innovations for the presidency, in a political system in which its sphere of action is limited, as much by checks and balances as by the influence of other entrepreneurs who enjoy equivalent if not greater legitimacy than the executive branch to take action on the thorny issue of health care. The passage of the PPACA, the fact that it was signed into law by a democratic president after a century of failed attempts at ambitious reform as well as its arduous implementation, are a picture perfect case study on the evolutions of the presidential institution and on the routinization of heterodox presidential entrepreneurship.

The Patient-Centered Medical Home (PCMH) is an innovative, team-based health care model that was applied during the implementation of the Affordable Care Act (ACA). However, the competencies for PCMH health care social worker team members are not identified within this model. Thus, the purpose of this phenomenological study focused on identifying the core competencies that will enable social workers to perform competently in PCMHs. This study also explored the roles and training needs as related to improving the competence of social workers. Sandberg’s and Parry’s conceptualization of the competency model was used as the theoretical framework. Data were acquired through interviews with 10 PCMH social workers. These data were then inductively coded and analyzed using a modified Moustakas method. Key findings indicated that these social workers believed that improvements in competencies may include training and knowledge with mental health and physical health knowledge which consist of diagnoses, interventions, medications, symptoms, and terminology. It was also noted that knowledge of evidence-based practices for mental health interventions and patient-centered, team-based principles were essential to ACA policy implementation. The positive social change implications of this study include recommendations to health care leadership, educational institutions, and other PCMH providers to develop competency-based training for social workers. Recommendations are also put forth to adapt social work curriculum to ensure the effective implementation of the principles of the ACA policy and to improve social work practice in PCMH health care settings.

Nonprofit housing organizations primarily exist to address the housing needs of low-income residents, whose housing needs are not sufficiently met by the public or private housing market. NHOs are very similar to private corporations in their size, productivity and commitment to the “bottom line.” However, unlike private firms, NHOs are “mission driven” instead profit-driven corporations. The development of affordable housing in the nonprofit housing sector requires a myriad of financial and non-financial resources. As competition for financial resources intensifies many organizations are adopting strategies as a means to not only reduce organizational uncertainty and sustain them, but also increase or maintain organizational capacity. The evolution of the role of nonprofit organizations coupled with market pressures such as attracting investment, competing for clients, and retaining and hiring skilled employees shapes the need for them to adopt market culture strategies (Salamon, 1999). A key strategy of market culture is collaboration (Frost and Sullivan, 2006). This dissertation study was designed to examine interorganizational relationships between nonprofit housing organizations in the Richmond Metropolitan area, and the influence of organizational characteristics, environmental conditions, and resource availability on an organization’s Level of Collaboration. Furthermore, the study examined the attitudes and perceptions of executive directors of collaboration. The primary research question is: Do nonprofit housing organizations display identifiable patterns of relationships with each other? This study contributes several important findings to furthering the understanding of collaboration within the nonprofit sector, and the relationship between organizational characteristics, environmental conditions, and resource availability and an organization’s Level of Collaboration (interorganizational relationships). Study findings convey that the examination of the network itself using social network analysis is a useful tool for examining relationships and identifying opportunities for collaboration. For this network it revealed that the organizations interact on an informal basis as well as identified the prominent actors are in the network. The findings of this study suggests that there are two key factors that influence nonprofit organizations establishing relationships interorganizational learning and personal characteristics.

This research focuses on obesity and other major risk factors for chronic diseases such as Type II Diabetes Mellitus, Heart Disease, and Stroke. Worksite wellness programs have been successful in this realm of health promotion and disease prevention for heart disease and stroke, but their effectiveness in treating diabetes has been uncertain partially due to poor patient compliance, lack of stress reduction strategies, poor diet and lack of persuasive health education on the risk of being obese. Published peer-reviewed articles were reviewed, coded and analyzed to determine best practices, using a modified systematic review approach. The findings from these studies yield results that were used to develop a new employer-sponsored wellness program that is in accordance with the recently passed Affordable Care Act. / Includes bibliography. / Thesis (M.S.)--Florida Atlantic University, 2014. / FAU Electronic Theses and Dissertations Collection

The Diploma work "Health care reform in the United States of America" is the sequel of the Bachelor work of 2008 called "The liberal health care system of the United States of America". The work is focused on the financial means and changes which has been effective since singing The Patient Protection and Affordable Care Act (acronym PPACA) into the United States law on 23rd March 2010 by the democratic president Barack Obama. The special attention is drawn to permanently increasing health care costs and defrauding of money within the social heath care program Medicare that is designated for seniors 65 and over as well as handicapped people. This work deals with Massachusetts Mandatory Health Insurance Program of 2006, which has been used like a model for the new federal law PPACA. The practical part presents the particular changes brought by the new law, including their impact on the chosen social groups -- the uninsured, the employers, the families and their kids, the seniors and the people with "pre-existing conditions". Since the Health care reform is the political issue as well, at the end there are mentioned some pros and cons opinions.