Indiana University-Purdue University Indianapolis (IUPUI) / My dissertation is a collection of three essays on the design of public health
insurance in the United States. Each essay examines the responsiveness of health behavior
and healthcare utilization to insurance-related incentives and draws implications for health
policy in addressing the needs of disadvantaged populations. The first two essays evaluate
the impact of Medicaid expansions under the Affordable Care Act (ACA) on health and
healthcare utilization. The Medicaid expansions that included full coverage of
preconception care, led to a decline in childbirths, particularly those that are unintended.
In addition, these fertility reductions are attributable to higher utilization of Medicaidfinanced
prescription contraceptives. The second essay documents patterns of aggregate
prescription drug utilization in response to the Medicaid expansions. Within the first 15
months following the policy change, Medicaid prescriptions increased, with relatively
larger increases for chronic drugs such as diabetes and cardio-vascular medications,
suggesting improvements in access to medical care. There is no evidence of reductions in
uninsured or privately-insured prescriptions, suggesting that Medicaid did not simply
substitute for other forms of payment, and that net utilization increased. The effects on
utilization are relatively higher in areas with larger minority and disadvantaged
populations, suggesting reduction in disparities in access to care.
Finally, the third essay considers the effect of Medicaid coverage loss on
hospitalizations and uncompensated care use among non-elderly adults. The results show
that coverage loss led to higher uninsured hospitalizations, suggesting higher
uncompensated care use. Most of the increase in uninsured hospitalizations are driven by
visits originating in the ED - a pattern consistent with losing access to regular place of care.
These results indicate that policies that reduce Medicaid funding could be particularly
harmful for patients with chronic conditions.
| Identifer | oai:union.ndltd.org:IUPUI/oai:scholarworks.iupui.edu:1805/17247 |
| Date | 22 June 2018 |
| Creators | Ghosh, Ausmita |
| Contributors | Royalty, Anne Beeson, Simon, Kosali, Freedman, Seth, Morrison, Wendy, Antwi, Yaa Akosa |
| Source Sets | Indiana University-Purdue University Indianapolis |
| Language | en_US |
| Detected Language | English |
| Type | Dissertation |
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