From Border Walls to Wall Street: The Impact of Institutional Change on Local Health

Abstract

The aim of this dissertation is to stimulate and contribute to social epidemiology literature engaging directly with structural and political drivers of population health in the United States as they relate to current day neoliberal systems and logics. We examine two intensely debated subjects in American discourse: The construction of a border wall along the U.S.-Mexico border and the rise of private equity in healthcare. We empirically evaluated whether construction of a border wall was associated with reduced mortality, as hypothesized by proponents of stricter immigration policies. We find no evidence that border wall construction is associated with either changes in deaths due to overdose or deaths due to homicide. We also evaluate changes in quality and utilization for hospitals and Ambulatory Surgical Centers (ASCs) acquired by private equity. We find that hospitals acquired by private equity were associated with larger increases in net income, charges, charge to cost ratios, and case mix index as well as with improvement in some quality measures after acquisition relative to non-acquired controls. We find no evidence of an association between changes in the average probability of readmission or average volume following a private equity acquisition or any other type of acquisition, compared to changes in control ASCs. Taken together, the dissertation provides analytical examples where social epidemiology may empirically test politically-driven hypotheses intrinsic to population health.