Economics Department Theses and Dissertations

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Browsing Economics Department Theses and Dissertations by Author "Antwi, Yaa Akosa"

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    Essays in health economics
    (2018-06-22) Ghosh, Ausmita; Royalty, Anne Beeson; Simon, Kosali; Freedman, Seth; Morrison, Wendy; Antwi, Yaa Akosa
    My dissertation is a collection of three essays on the design of public health insurance in the United States. Each essay examines the responsiveness of health behavior and healthcare utilization to insurance-related incentives and draws implications for health policy in addressing the needs of disadvantaged populations. The first two essays evaluate the impact of Medicaid expansions under the Affordable Care Act (ACA) on health and healthcare utilization. The Medicaid expansions that included full coverage of preconception care, led to a decline in childbirths, particularly those that are unintended. In addition, these fertility reductions are attributable to higher utilization of Medicaidfinanced prescription contraceptives. The second essay documents patterns of aggregate prescription drug utilization in response to the Medicaid expansions. Within the first 15 months following the policy change, Medicaid prescriptions increased, with relatively larger increases for chronic drugs such as diabetes and cardio-vascular medications, suggesting improvements in access to medical care. There is no evidence of reductions in uninsured or privately-insured prescriptions, suggesting that Medicaid did not simply substitute for other forms of payment, and that net utilization increased. The effects on utilization are relatively higher in areas with larger minority and disadvantaged populations, suggesting reduction in disparities in access to care. Finally, the third essay considers the effect of Medicaid coverage loss on hospitalizations and uncompensated care use among non-elderly adults. The results show that coverage loss led to higher uninsured hospitalizations, suggesting higher uncompensated care use. Most of the increase in uninsured hospitalizations are driven by visits originating in the ED - a pattern consistent with losing access to regular place of care. These results indicate that policies that reduce Medicaid funding could be particularly harmful for patients with chronic conditions.
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    Specification and estimation of the price responsiveness of alcohol demand: a policy analytic perspective
    (2016-01-13) Devaraj, Srikant; Tezra, Joseph V.; Antwi, Yaa Akosa; Jones, Josette; Wu, Jisong
    Accurate estimation of alcohol price elasticity is important for policy analysis – e.g.., determining optimal taxes and projecting revenues generated from proposed tax changes. Several approaches to specifying and estimating the price elasticity of demand for alcohol can be found in the literature. There are two keys to policy-relevant specification and estimation of alcohol price elasticity. First, the underlying demand model should take account of alcohol consumption decisions at the extensive margin – i.e., individuals' decisions to drink or not – because the price of alcohol may impact the drinking initiation decision and one's decision to drink is likely to be structurally different from how much they drink if they decide to do so (the intensive margin). Secondly, the modeling of alcohol demand elasticity should yield both theoretical and empirical results that are causally interpretable. The elasticity estimates obtained from the existing two-part model takes into account the extensive margin, but are not causally interpretable. The elasticity estimates obtained using aggregate-level models, however, are causally interpretable, but do not explicitly take into account the extensive margin. There currently exists no specification and estimation method for alcohol price elasticity that both accommodates the extensive margin and is causally interpretable. I explore additional sources of bias in the extant approaches to elasticity specification and estimation: 1) the use of logged (vs. nominal) alcohol prices; and 2) implementation of unnecessarily restrictive assumptions underlying the conventional two-part model. I propose a new approach to elasticity specification and estimation that covers the two key requirements for policy relevance and remedies all such biases. I find evidence of substantial divergence between the new and extant methods using both simulated and the real data. Such differences are profound when placed in the context of alcohol tax revenue generation.