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Browsing by Author "Morrison, Wendy"
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Item Essays in health economics(2018-06-22) Ghosh, Ausmita; Royalty, Anne Beeson; Simon, Kosali; Freedman, Seth; Morrison, Wendy; Antwi, Yaa AkosaMy 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.Item Exploring the Importance of Accounting for Nonlinearity in Correlated Count Regression Systems from the Perspective of Causal Estimation and Inference(2021-07) Zhang, Yilei; Terza, Joseph V.; Vest, Joshua R.; Morrison, Wendy; Gupta, SumedhaThe main motivation for nearly all empirical economic research is to provide scientific evidence that can be used to assess causal relationships of interest. Essential to such assessments is the rigorous specification and accurate estimation of parameters that characterize the causal relationship between a presumed causal variable of interest, whose value is to be set and altered in the context of a relevant counterfactual and a designated outcome of interest. Relationships of this type are typically characterized by an effect parameter (EP) and estimation of the EP is the objective of the empirical analysis. The present research focuses on cases in which the regression outcome of interest is a vector that has count-valued elements (i.e., the model under consideration comprises a multi-equation system of equations). This research examines the importance of account for nonlinearity and cross-equation correlations in correlated count regression systems from the perspective of causal estimation and inference. We evaluate the efficiency and accuracy gains of estimating bivariate count valued systems-of-equations models by comparing three pairs of models: (1) Zellner’s Seemingly Unrelated Regression (SUR) versus Count-Outcome SUR - Conway Maxwell Poisson (CMP); (2) CMP SUR versus Single-Equation CMP Approach; (3) CMP SUR versus Poisson SUR. We show via simulation studies that it is more efficient to estimate jointly than equation-by-equation, it is more efficient to account for nonlinearity. We also apply our model and estimation method to real-world health care utilization data, where the dependent variables are correlated counts: count of physician office-visits, and count of non-physician health professional office-visits. The presumed causal variable is private health insurance status. Our model results in a reduction of at least 30% in standard errors for key policy EP (e.g., Average Incremental Effect). Our results are enabled by our development of a Stata program for approximating two-dimensional integrals via Gauss-Legendre Quadrature.Item The Institute for Research on Social Issues(Office of the Vice Chancellor for Research, 2010-04-09) Ford, David A.; Bell, David; Johnson, Daniel P.; Bao, Wan-Ning; Dickerson-Putman, Jeanette; Morrison, Wendy; Parrish-Sprowl, John; Wilson, Jeffrey S.; Wolf, JamesThe Institute for Research on Social Issues (IRSI) is a collection of collaborating centers and workgroups meant to foster funded research in support of faculty and students who can benefit from its research infrastructure. The poster highlights the activities of IRSI Centers and Workgroups. It features two major funded research projects. “Networks of Heterosexual Risk and HIV” examines the motivations for risk-reducing behaviors between HIV-positive individuals and their HIV-negative partners. Study findings will inform interventions for preventing HIV among partners at risk of infection. “Decision Support through Earth Science Research Results” seeks to augment the current Heat Watch/Warning System (HWWS) with NASA instruments and models used in conjunction with socioeconomic and heat-related mortality data. This activity will enable the production of a more spatially specific warning for areas of risk within the cities, a current limitation of the HWWS.Item The Philanthropic Behavior of Nonprofit Hospitals(2010-02-02T20:14:17Z) Lyons, Alvin L.; Steinberg, Richard; Wittberg, Patricia, 1947-; Morrison, Wendy; Katz, RobertThe study of the nonprofit sector has traditionally focused on nonprofit organizations as recipients of charity. A perspective that has been relatively neglected is that of nonprofit organizations as not only recipients but also as donors of charitable resources. This dissertation explores the phenomenon of philanthropic behavior of nonprofit organizations, using studies of the contributions and community health programs of nonprofit hospitals in Indiana as an example. Philanthropic behavior is defined as actions and programs initiated by a nonprofit organization to meet additional community needs – beyond its primary mission or services. It presents the hypothesis that such activities are undertaken for reasons similar to for-profit organizations – and have comparable organizational benefits. The studies reported in the dissertation show a wide variation in reporting such activities as well as of the organizational structures in place to manage such behavior. This variation is seen even in seemingly similar hospitals such as religious hospitals within an identified system. The dissertation discovers that while nonprofit organizations may engage in philanthropic behavior, these practices go largely unrecognized. Because the actions are not systematically noted or recorded, some very significant residual benefits that nonprofits provide for their defined communities are also unrecognized. It also finds that when these activities are evident, they are driven more by the professional values and actions of individual employees than by organizational policies. The dissertation concludes that drawing conclusions from this study of the data on Indiana hospitals – both from state reports and the IRS Form 990s – is difficult. There is an inconsistency between the two databases as well as within each of the datasets that makes any specific conclusions as to the relative values of different hospitals or to standards is suspect. It notes that while the revised Form 990 should help in overall transparency, the reporting of areas such as health education and donations will most probably continue to be inconsistent. This inconsistency makes the information difficult to use as either an evaluation tool or as policy to encourage community-serving behavior.