Three essays on healthcare access and efficiency

Abstract

[ACCESS RESTRICTED TO THE UNIVERSITY OF MISSOURI AT REQUEST OF AUTHOR.] This dissertation is composed of three papers relating to healthcare access and efficiency. Focus of the first paper is to develop a gravity-based index of healthcare access for Missourians (both at county and sub-county levels). Analysis of the access measures at the county and sub-county levels depict why use of county level access as the basis for policy formulation may not be effective in addressing the disparity in access at sub-county levels. The calculated index is found to be significantly and positively correlated with the rurality of Missouri counties. The second paper deals with the estimation of relative efficiency of Critical Access Hospitals (CAHs) in Missouri using Data Envelopment Analysis and also tests for the efficiency difference between CAHs with other Acute Care Hospitals. Efficiency estimates for CAHs vary considerably, and a majority of the CAHs are inefficient relative to benchmark CAHs. Compared to other rural hospitals and teaching hospitals, CAHs are statistically poor performers. The third paper consists of two steps. First, a state-level healthcare system performance index is estimated for the US states employing stochastic frontier model. A distinct regional pattern is seen with clustering of high-high and low-low performing states. In the second stage, spatial dependence in healthcare system performance among states is tested. Results indicate a significant spatial dependence when the spatial lag model is specified with appropriate weight matrix.