Differential impacts of states’ policies: Three essays on healthcare provision and health outcomes. Restricted; Files Only

Abstract

Often health policy aiming to improve healthcare delivery and health outcomes has unintended consequences. When unintended consequences become social costs, it is the goal of policy makers to minimize their impact. In this dissertation I evaluate the effects of three policies on healthcare delivery and health outcomes for different population groups. In chapter one and chapter two I study the joint effects of modifications to joint and several liability, and scope of practice restrictions for certified nurse midwives on labor delivery and birth outcomes for nulliparous and primiparous pregnancies with a history of one previous c-section. I find that the possible distortion of liability cause by these two laws can increase unnecessary procedure use and affect birth outcomes. My findings suggest that there are efficiency gains linked to reforms to the joint and several liability rule, and relaxation of the scope of practice restrictions for healthcare providers. Lastly, in chapter three, I study, summarize and analyze literature evaluating the effects of Medicaid Managed Care on healthcare costs, access, quality and efficiency, concluding that future research should focus on efficiency analysis, social determinats of health, and high risk populations.

Table of Contents

Chapter 1: The heterogeneous effects of malpractice liability laws on low-risk pregnancies in states with scope of practice barriers. 1

Introduction 1

Background 5

         Medical malpractice 8

SOP laws for CNMs 11

Practice agreements and liability 13

Conceptual framework 15

Data and methods 16

             Health outcomes data 16

           JSL reforms data 17

           SOP laws data 18

           County-level characteristics 18

           Sampling 19

           Methods 19

Summary statistics 21

Results 22

Discussion 25

Chapter 2: Once a C-section always a C-section? An analysis of procedure decisions under perceived high risk.  57

Introduction 57

Background 60

Conceptual framework 65

Data and methods 66

             Health outcomes data 66

           JSL reforms data 67

           SOP laws data67

           County-level characteristics 68

           Sampling 68

           Methods 69

Summary statistics 70

Results 72

Discussion 74

Chapter 3: The heterogeneous effects of malpractice liability laws on low-risk pregnancies in states with scope of practice barriers. 106

Introduction 106

Methodology 108

Costs 109

Access 110

Quality 112

Efficiency 115

Discussion 116

About this Dissertation

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School	Laney Graduate School
Department	Health Services and Research Health Policy
Degree	Ph.D.
Submission	Dissertation
Language	English
Research Field	Economics, General Health Sciences, Public Health
Mot-clé	Scope of practice laws Medicaid Managed Care Joint and several liability Certified nurse midwives Efficiency Tort reforms
Committee Chair / Thesis Advisor	Puneet Chehal, Emory University Sara J. Markowitz, Emory University E. Kathleen Adams, Emory University

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