Skip to Main Content
 

Global Search Box

 
 
 
 

ETD Abstract Container

Abstract Header

Three Essays on Access to Health Care in Rural Areas

Abstract Details

2018, Doctor of Philosophy, Ohio State University, Agricultural, Environmental and Developmental Economics.
Rural hospitals provide essential and accessible health care services to nearly 60 million rural Americans while facing serious financial challenges due to their small size and remote location. In order to maintain access to health care for rural residents and to prevent rural hospitals from closing, policymakers have developed programs to provide financial support to rural hospitals. The primary objective of this dissertation is to investigate how public programs affect the access to and use of health care services for rural residents. The first chapter (co-authored with Daeho Kim) examines the impact of Medicare’s Critical Access Hospital (CAH) program on patient access to health care and resulting health outcomes in rural area. In order to improve rural hospitals’ financial viability and to maintain access to health care for the rural population, the CAH program implemented in 1997 allows a rural hospital, once converted to a CAH, to be reimbursed under more generous cost-based reimbursement. Applying an event-study approach to a 30-year panel data that cover the entire rollout of the CAH program, we find that the CAH program has substantially improved CAHs’ financial conditions and as a result, some CAHs that otherwise would have been closed have stayed open. We then show significant increases in rural residents’ health care access and utilization at CAHs. Finally, we provide suggestive evidence that the increased access to and use of health care due to the CAH program has improved patient health in rural area – a reduction in mortality rates in counties with a CAH only after the CAH conversion. The second chapter examines how the differential payments affect the use of swing beds and hospital-based skilled nursing facilities (SNFs) in CAHs by exploiting a change in swing bed reimbursement method from prospective payment system to cost-based reimbursement. Using an event study approach that utilizes the variation in the timing of CAH conversion, I find a remarkable increase in swing bed utilization by 50 to 80 percent in CAHs with a SNF before the conversion, and this increase is fully offset by the decrease in SNF utilization. These results suggest that CAHs substitute swing beds for SNFs in response to the change in swing bed reimbursement method. The third chapter investigates the impact of rural hospital closure on health care utilization and health outcomes for rural residents. I exploit the variation in the timing of hospital closure and use an event-study approach to study the impact of hospital closure. My results show that hospital closures significantly reduce the outpatient and emergency department utilization. Moreover, this impact is larger for counties without any hospitals after closure than counties with at least one hospital remaining. I also present suggestive evidence that rural hospital closures do not lead to an increased in outpatient and emergency department utilization in adjacent counties and worse health outcomes.
Daeho Kim (Advisor)
Joyce Chen (Advisor)
Ani Katchova (Committee Member)
Abdoul Sam (Committee Member)
120 p.

Recommended Citations

Citations

  • Yang, F.-A. (2018). Three Essays on Access to Health Care in Rural Areas [Doctoral dissertation, Ohio State University]. OhioLINK Electronic Theses and Dissertations Center. http://rave.ohiolink.edu/etdc/view?acc_num=osu152353045188255

    APA Style (7th edition)

  • Yang, Feng-An. Three Essays on Access to Health Care in Rural Areas. 2018. Ohio State University, Doctoral dissertation. OhioLINK Electronic Theses and Dissertations Center, http://rave.ohiolink.edu/etdc/view?acc_num=osu152353045188255.

    MLA Style (8th edition)

  • Yang, Feng-An. "Three Essays on Access to Health Care in Rural Areas." Doctoral dissertation, Ohio State University, 2018. http://rave.ohiolink.edu/etdc/view?acc_num=osu152353045188255

    Chicago Manual of Style (17th edition)