Srimoyee Bose

Date of Graduation

2015

Document Type

Dissertation

Degree Type

PhD

College

Davis College of Agriculture, Natural Resources and Design

Department

Agricultural and Resource Economics

Committee Chair

Tesfa G Gebremedhin

Committee Co-Chair

Tami G Calvez

Committee Member

Alan R Collins

Committee Member

Usha Sambamoorthi

Committee Member

Peter V Schaeffer

Committee Member

Gerard ED' Souza

Abstract

Therefore the purpose of this study was to empirically demonstrate state-level variations in financing of healthcare, hospital expenditures and health outcomes.;Precisely, aims of the three studies were to: (1) evaluate the state-level variations in healthcare financing and the factors that affect financing of healthcare, (2) examine the state-level variations in hospital expenditures with an application of spatial regression, and (3) assess the determinants of state-level mortality rates using a spatial Durbin fixed effect model. This research used panel data from 2000 through 2009, extracted from publicly available data files.;Findings from the first study were that state-level variations in public financing of health care (Medicare and Medicaid) are associated with demographic composition (proportion of the female population, percentage of individuals over age 65, percentage of Hispanic population), economic factors (unemployment rate, per capita gross domestic product (GDP) of the state, per capita state tax revenue, FMAP rate), political climate (percentage of individuals enrolled in Medicare or Medicaid, rate of enrollment in HMO), healthcare supply factors (active physicians per 100,000 population, number of hospitals and beds) and healthcare needs (obesity rate). Additionally, variations in state-level private insurance financing was proportional to the economic factors (rate of federal funding, per capita state GDP), a supply side factor (active physicians per 100,000 population), political climate (percentage of individuals enrolled in Medicare or Medicaid) and healthcare needs (obesity rate). Lastly, state-level variations in out of pocket expenditures were associated with economic factors (per capita state tax revenue, per capita state GDP), demographic factors (percentage of African-Americans, percentage of female population, percentage of elderly population (aged 65 and above), percentage of Hispanic individuals, proportion of the population below age 17), a supply side factor (active physicians per 100,000 population), political characteristics (percentage of individuals enrolled in Medicare or Medicaid) and healthcare needs (obesity rate).;The second study reported the presence of a positive spatial dependence of hospital spending within one state on its adjacent states. This study also highlighted that rate of binge drinking, total number of hospital beds and hospitals per 1,000 residents, the unemployment rate, the percentage of African-Americans, proportion of active physicians and state gross domestic product (GDP) had positive impacts on its neighboring states' rates of hospital expenses. Moreover, the increasing rate of male population, Hispanic population and the rate of un-insurance of a state had negative impacts on its own rate of hospital costs but positive impacts on its bordering states' rate of hospital spending.;The third study also revealed a significant positive spatial dependence of the mortality rate among neighboring states. Population composition (percentage of African-Americans and percentage of individuals over 65 years of age) significantly increased the mortality rate of a state, while the percentage of Hispanic population, number of active physicians, percentage of married population and percentage with a college degree (bachelors or higher) reduced mortality rates. Higher rates of Hispanic population and better hospital infrastructure of an individual state increased the mortality rates of the neighboring states and higher the education level of the state decreased the mortality rate of the neighboring states. (Abstract shortened by UMI.).

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