Dissertations, Theses, and Capstone Projects

Date of Degree

9-2023

Document Type

Dissertation

Degree Name

Ph.D.

Program

Economics

Advisor

Partha Deb

Committee Members

Michael Grossman

Jessica Van Parys

Subject Categories

Economics | Health Economics

Keywords

health economics, hospital care, new technology, maternal health

Abstract

In Chapter 1, I investigate the effect of a financial incentive from the Centers for Medicare and Medicaid Services (CMS) on new medical procedure technology diffusion. I examine how the incentive affects diffusion among Medicare patients, for whom hospitals receive the incentives, and non-Medicare patients for whom there are no incentives. I answer these two questions by studying the New Technology Add-on Payment (NTAP) program offered by Medicare (Part A). It is unknown whether its incentive is enough to encourage diffusion under the prospective payment system and it also remains unknown whether it spills over to non-Medicare patients or crowds them out. Using the State Inpatient Database (SID) provided by Healthcare Cost and Utilization Program (HCUP), I show that the NTAP program increases new medical procedure technology adoption in hospitals, which is mainly picked up by large hospitals, medical-school affiliated hospitals, and public hospitals. The policy also has a positive spillover effect on non-Medicare patients, despite in a smaller scale. As the NTAP program becomes more expensive, this research is helpful in future policy making.

In Chapter 2, my coauthor and I examine the issue of racial disparities in severe maternal morbidity (SMM) and blood transfusion events during inpatient delivery in the United States. Our findings indicate that SMM and blood transfusion events continue to be prevalent and slowly but steadily increasing. Beneath this trend, substantial disparities based on race are observed. Black women who are hospitalized for births have a significantly higher likelihood of experiencing SMM or requiring blood transfusion compared to their White peers. To understand the role of environmental factors in these disparities, we employ a machine learning technique to select measures of social determinants of health with predictive power and Oaxaca-Blinder decompositions to evaluate the explanatory power of these measures. The results show that environmental factors explain only a small portion of racial disparities.

In Chapter 3, I study the effect of exposure to extreme temperatures during pregnancy on severe maternal morbidity (SMM). Using the State Inpatient Database (SID) from 2010 to 2018, I link maternal health outcomes during delivery to historical weather data during the entire pregnancy. I find that exposure to extremely cold weather during pregnancy increases the risk of severe maternal morbidity (SMM), especially the risk of blood transfusion. I also find that exposure to extremely hot weather during pregnancy increases the probability of a cesarean delivery. These effects are racially unequal, which exacerbates existing racial disparities in maternal health. My findings provide the first estimates of the impacts of prenatal exposure to extreme temperatures on severe maternal morbidity during delivery, while the literature has studied the impact of exposure to weather on pregnancy health and infant health. My findings are relevant to growing interest in understanding climate-related health risk. They are also crucial in understanding the widening racial disparities in maternal health.

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