Author ORCID Identifier

https://orcid.org/0000-0001-6389-7263

Semester

Spring

Date of Graduation

2026

Document Type

Dissertation

Degree Type

PhD

College

Chambers College of Business and Economics

Department

Economics

Committee Chair

Daniel Grossman

Committee Member

Heather M. Stephens

Committee Member

Jane E. Ruseski

Committee Member

Brad Humphreys

Abstract

Health outcomes and access to care are shaped by the interaction between public institutions, administrative rules, and responses to health risk. This dissertation investigates how barriers to access, changes in perceived risk, and policy design influence participation in public programs, preventive health behavior, and  treatment continuation. Across three essays in health economics, I examine how individuals respond to disruptions in service delivery, epidemic exposure, and administrative burden, with a focus on vulnerable populations that depend on public systems of care.
The first essay analyzes the impact of Social Security Administration field office closures on participation in federal disability programs during the COVID 19 pandemic. Using the nationwide closure of more than 1,200 field offices as a natural experiment and a difference in differences framework at the ZIP code level, the results show that loss of in person administrative access reduced disability program participation. The effects are substantially larger in non metropolitan areas and in places with low internet access, highlighting how limited digital infrastructure can magnify administrative barriers and reduce access to the social safety net.
The second essay examines whether exposure to the Zika epidemic affected preventive health behavior in Brazil. Exploiting variation in the timing of Zika incidence across municipalities and applying a staggered difference in differences design, the analysis shows that epidemic exposure increased childhood  vaccination activity, especially among children under one year of age. The results suggest that public health shocks can generate broader spillovers into preventive care by increasing perceived risk and encouraging greater engagement with routine health services, particularly in regions with higher disease incidence.
The third essay evaluates how administrative burden affects treatment continuation among adult Medicaid beneficiaries with type 1 diabetes in West Virginia. Focusing on continuous glucose monitoring, the gold standard of care for diabetes management, I study how progressively shorter reauthorization intervals shaped continued device use. The findings show that more frequent renewal requirements led to meaningful reductions in sustained use, with the largest declines occurring under the most restrictive policy. These results indicate that cost containment policies based on repeated authorization may unintentionally reduce access to effective care and undermine treatment continuity.
The findings show that health care access and utilization are highly sensitive to administrative design and perceived risk. This dissertation contributes causal evidence on how administrative barriers and health shocks shape program participation, preventive behavior, and treatment continuity, with implications for the design of policies aimed at improving equitable access to care.

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