Date of Award

12-1-2020

Language

English

Document Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

College/School/Department

Department of Economics

Content Description

1 online resource (x, 152 pages) : illustrations (some color)

Dissertation/Thesis Chair

Kajal Lahiri

Committee Members

Pinka Chatterji, Chun-Yu Ho

Keywords

Life expectancy, Health expectancy, Medically underserved areas, Medical policy, Medical personnel, Federal aid to community health services, Older people

Subject Categories

Economics

Abstract

This thesis focuses on various factors affecting health of American adults and the elderly based on the Health and Retirement Study (HRS). In chapter 1, I examine the role of educational and racial differences in life expectancy (LE) and health-adjusted life expectancy (HALE) for Americans at ages 45-64 using Health and Retirement Study (HRS) during 2000-2016. I compute severity-weighted prevalence of diseases with comorbidity adjustments based on the Global Burden of Disease (2015), and map onto the information on 17 doctor-diagnosed diseases and four self-rated disabling health conditions from HRS. This approach allows us to evaluate the importance of major disease and risk factors that explain the dynamics of life expectancy and HALE in recent years, and helps to find that Americans have been experiencing higher prevalence of various diseases and risk factors long before the recent decline in life expectancy in 2014. I find that higher educational attainment has persistently been associated with longer expected healthy life years. White men and women with less than college degree have experienced very sharp decline in HALE, mainly due to the higher prevalence of alcohol use disorder, back pain, emotional and neurological problems. Lastly, I conduct a panel data analysis of individual HALEs to determine how the patterns of HALE have changed differentially over time across gender, education and racial groups, after controlling for age, socio-economic factors, and a host of local area characteristics.In Chapter 2, I investigate the role of the primary care Health Professional Shortage Area (HPSA) on health care utilization and health of the elderly residents in HPSAs. A Shortage of number of primary care physicians (PCPs) in some rural and low-income communities has been a continued issue in the United States. To address this shortage, since 1978 the federal government has designated such communities as primary care HPSAs. HPSA communities have been supported with various federal programs such as training and recruitment of health professionals, additional reimbursement payment to the primary care physicians residing in HPSA, and immigration waivers to certain foreign-born physicians in exchange for service in HPSA designated communities. Even with its long history and abundant resources devoted, there have been only limited research on the effects of the designation of HPSA. In this paper, I examine the effect of primary care HPSA designation on various outcomes including health care utilization, expenditure, health and health-related behavior. Since HPSA designation is not automatic, but has been applied for, I use a propensity score matching to reduce selection bias of the designation and compared the outcomes between HPSA and non-HPSA communities. I find significant effects of living in HPSA communities on higher rates of having preventive care such as blood check for cholesterol and pap-smear in HPSA communities that have experienced significant improvement in the number of primary care physicians. Especially, even after the HPSA communities have been withdrawn due to the increase in number of PCPs and not been supported by the federal programs any more, these communities showed improvement in outcomes such as less number of doctor visits, less nights in hospital, more OOP Rx expenditure, less smoking rate, lower BMI on average, less health problems limiting paid work, and lower rate of high blood pressure, compared to matched non-HPSA communities. In Chapter 3, I explore the effects of prescription drug insurance on mental health of the elderly. Mental health disorder has become one of the most serious health issues among adults and the elderly population in the United States. Because mental illness often leads to not only poor quality of life, but also reduced productivity and employment and even negative externalities on the family members, addressing factors that improve mental health of the population is important. Effective treatment of mental health disorders depends greatly on the availability of appropriate medications and their adherence. Therefore, the lack of prescription drug insurance may seriously worsen mental health due to the costs and consequent non-adherence. In this paper, I empirically confirm that having prescription drugs coverage improves mental health. I employ two binary outcomes indicating i) whether the individual had clinical depression and ii) whether the individual had psychiatric problem from 6 waves of the Health and Retirement Study during 2002-2012. Since individuals with illness are more likely to have health insurance, in order to circumvent possible endogeneity issues, I use a self-selection model with control function approach. I confirm that absence of drug insurance leads to worse mental health, which suggests expanded support in drug coverage to improve the health of low-income patients.

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