Three Essays on Health Policy: Utilization, Policies, and Prices of Hospital Services

Abstract

How does policy influence the utilization, finances, and prices of hospitals in the United States? This dissertation addresses this question through three essays that employ a variety of quantitative methodologies and data sources. Using a regression discontinuity design and all-payer claims data from Colorado, Chapter 1 estimates the association between reaching age-19 Medicaid eligibility thresholds and healthcare utilization by sex and presence of chronic conditions. Utilization changes were driven mainly by females, particularly those with chronic conditions, and hospital-based care was not affected by the eligibility change. Using descriptive quantitative methods and hospital cost report information, Chapter 2 studies payments made through three Medicare programs to rural hospitals and their resulting impact on hospitals’ finances, Overall, many rural hospitals rely on Medicare’s special payment programs, but funding unpredictability, complicated and overlapping eligibility rules, and payment formulas based on historic costs create challenges for hospitals’ finances. Using an event study difference-in-differences design with commercial claims data, Chapter 3 studies how both inpatient and outpatient prices at rural hospitals change after merger or acquisition. We found no significant changes in prices after transactions occurred.