关于医疗保健可及性的三篇论文（英）

Three Essays on Health Care AccessLAWRENCE BAKERThis document was submitted as a dissertation in January 2025 in partial fulfillment of the requirements of the Frederick S. Pardee Ph.D. in Policy Analysis at the RAND School of Public Policy. The faculty committee that supervised and approved the dissertation consisted of Roland Sturm (chair), Jodi Liu, Ashley Kranz, and Bryan Tysinger (outside reader).This dissertation was generously supported by the Ann and James Rothenberg Dissertation Award and by the Centers on the Demography and Economics of Aging - Coordinating Center Travel Award (R24 AG066588).Approved for public release; distribution is unlimited.For more information on this publication, visit www.rand.org/t/RGSDA4280-1.About the RAND School of Public PolicyThe RAND School of Public Policy has specialized in graduate-level policy education since its founding in 1970. The RAND School is home to the Frederick S. Pardee Ph.D. in Policy Analysis, which is the original public policy Ph.D. program in the United States and the only Ph.D. program based at an independent public policy research organization. To learn more about the RAND School of Public Policy, visit www.rand.edu.Published in 2025 by the RAND Corporation, Santa Monica, Calif. is a registered trademark. ii Abstract Government health programs must balance maximizing access with controlling costs while considering equity, geographic variation, and resource constraints. Health care reforms, whether in payment systems, quality measures, or new technologies, can significantly impact health care access. This dissertation examines how policy changes in three government health programs affect access to care across different settings. Chapter 1 analyzes racial and ethnic disparities in COVID-19 vaccine distribution, providing the first national analysis of racial disparities in booster uptake. This study makes methodological contributions by calculating vaccination rates based on eligible populations and developing an equity metric comparing each group's share of vaccinations to their share of COVID-19 deaths. While Hispanic populations showed the highest uptake of the first dose, they had the lowest booster rates. Black populations showed consistently low uptake across all doses, which is particularly concerning given their elevated COVID-19 mortality rates. These patterns persisted across states. Chapter 2 evaluates how Florida's 2012 transition from fee-for-service Medicaid to managed care affected children's access to dental services. Using emergency department visits for non-traumatic dental conditions as a proxy for access, this analysis employs an event study difference-in-difference design that leverages Florida's staggered managed care implementation across counties. Results show that managed care was associated with an 11% increase in emergency department visits for dental issues, suggesting the payment reform decreased access to dental care. Chapter 3 uses a simulation model to