Document Type

Dissertation

Degree

Doctor of Philosophy (PhD)

Major/Program

Economics

First Advisor's Name

Hakan Yilmazkuday

First Advisor's Committee Title

committee chair

Second Advisor's Name

Alejandro Arrieta

Second Advisor's Committee Title

co-committee chair

Third Advisor's Name

Mihaela Pintea

Third Advisor's Committee Title

committee member

Fourth Advisor's Name

Sheng Guo

Fourth Advisor's Committee Title

committee member

Keywords

healthcare economics, home-visiting programs, smoking cessation

Date of Defense

6-23-2022

Abstract

This dissertation follows a three-essay format. The first chapter examines the impact of a home visiting program on medical expenses and healthcare services utilization implemented by a healthcare maintenance organization. The evaluation uses administrative claims data to estimate the six-month average expenditures following program enrollment. The estimation is carried out by applying a difference-in-differences method to compare spend for patients enrolled in the program to a control group. Estimation using matching methods to address any potential confounding bias is also applied to support estimates and confirms findings. The estimation finds that the program increases average medical expenditures by as much as 30% in the six-month period following enrollment, suggesting it is an ineffective cost control strategy.

The second chapter explores the use of individuals' preferences regarding their willingness to accept payments to quit smoking to identify and target interventions for smoking cessation during pregnancy. Unlike prior studies, which focus on individuals' willingness to pay for and use smoking cessation products, quit rates are estimated using individuals' willingness to accept a stream of payments in exchange for smoking cessation. Estimation via regression analysis techniques finds that when individuals are willing to accept payments, delivery of a subsequent monetary incentive can increase quit rates by an average of 20%. These results suggest that willingness to accept monetary incentives to quit smoking is an effective mechanism to identify participants with a higher chance of successful smoking cessation attempts.

The third chapter builds on the prior chapter by analyzing the reliability of using self-reported quit rates to measure campaign effectiveness, comparing them to urine cotinine levels measured using laboratory-based tests. Public health campaigns often do not have access to laboratory test results to measure the participants' urine cotinine levels because of the associated costs and the complexity of obtaining testing samples. The use of self-reported indicators offers a low-cost mechanism to measure campaign success with significantly easier implementation of results monitoring. Findings show that self-reports overstate quit rates by an average of 11%, providing a frame of reference that allows campaign officials to interpret self-reported data to evaluate campaign effectiveness and performance.

Identifier

FIDC010902

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