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Please use this identifier to cite or link to this item: http://arks.princeton.edu/ark:/88435/dsp01cz30px051
Title: Essays in Health Economics: Healthcare Quality, Spending and Government Interventions
Authors: Karpova, Anastasia
Advisors: Currie, Janet
Contributors: Economics Department
Subjects: Economics
Health care management
Issue Date: 2024
Publisher: Princeton, NJ : Princeton University
Abstract: This dissertation studies healthcare policies and healthcare markets.Chapter 1 investigates how hospitals improved the quality of care in response to a Medicare program that penalized excessive readmissions of elderly patients with heart attacks. I document several changes in patient allocation. First, hospitals reallocated heart attack patients towards doctors with higher estimated quality, higher treatment intensities and higher heart attack caseloads in the pre-program period. Second, there was an increase in the doctors' specialization in heart attack care and an improvement in the quality of doctor-patient matches. Finally, the changes in the quality of care and patient allocation were greater in hospitals that employed or contracted with physicians compared to hospitals unaffiliated with their physicians. This result highlights that doctor-hospital affiliation affects the hospital's ability to impose changes on physicians and to adjust patient assignments. Chapter 2, joint with Priyanka Goonetilleke, Artem Kuriksha and Peter Meylakhs, studies demand for illegal drugs. We use a unique longitudinal dataset obtained by scraping a darknet marketplace that covered the majority of the retail illegal drug trade in Russia. We develop a structural model of demand for illegal drug varieties that we use to evaluate counterfactual drug policies. We find that the legalization of cannabis has the benefit of decreasing the use of riskier drugs while increasing cannabis use. Our estimates show that the recent introduction of new synthetic drugs has significantly increased total drug demand, suggesting that governments should allocate resources to prevent the introduction of new drugs. Finally, our model helps identify the optimal drugs to target for interdiction, specifically those without close substitutes. Chapter 3, joint with Janet Currie and Dan Zeltzer, asks how urgent care centers (UCCs) impact healthcare costs and utilization among nearby Medicare beneficiaries. When residents of a zip code are first served by a UCC, total Medicare spending rises while mortality remains flat. UCC entry is also associated with a significant increase in hospital stays and increased hospital spending accounts for half of the total increase in annual spending. These results raise the possibility that, on balance, UCCs increase costs by steering patients to hospitals.
URI: http://arks.princeton.edu/ark:/88435/dsp01cz30px051
Type of Material: Academic dissertations (Ph.D.)
Language: en
Appears in Collections:Economics

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