Essays on Evaluating Policies for Improving the Adequacy and Distribution of Health Care and Health Workforce in the United States Open Access
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This three-essay dissertation evaluated federal and state policies that aim at improving the adequacy and distribution of health care and health workforce in the United States. The first essay examined the impact of Medicaid expansion and federal funding increases under the Affordable Care Act of 2010 on patient care in community health centers. Using data from federally funded health centers, I found that both Medicaid expansion and increases in federal funding were associated with increased patient volumes and patient visits in health centers. The second essay examined the effect of state legislation on nursing staffing in US hospitals. Using a nationally representative survey of hospitals, I found that staffing mandate had a statistically significant effect on increasing registered nurse and nursing assistant staffing, while the other two approaches, staffing committee and public reporting, had effects on licensed practical/vocational nurses only. The third essay examined the financial impact of the National Health Service Corps and non-Corps staffing in community health centers. Using data from health centers and the Corps, I found that Corps staffing was associated with reduced total care costs, while non-Corps staffing was associated with increases in total care costs and administrative costs in community health centers. These studies provide empirical evidence to inform policies for better addressing the maldistribution and inadequacy of health care and health workforce around the nation.