Three Essays on Health Care Access

Government health programs must balance maximizing access and controlling costs while considering equity, geographic variation, and resource constraints. Health care reforms, whether for payment systems, quality measures, or new technologies, can significantly affect health care access. In this dissertation, the author examines how policy changes in three government health programs affect access to care across different settings.

In the first essay, the author analyzes racial and ethnic disparities in COVID-19 vaccine distribution, providing the first national analysis of racial disparities in booster uptake. In this study, the author calculates vaccination rates according to eligible populations and develops an equity metric comparing each group's share of vaccinations to their share of COVID-19 deaths.

In the second essay, the author 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 nontraumatic dental conditions as a proxy for access, the author employs an event study difference-in-difference design that leverages Florida's staggered managed care implementation across counties.

In the third essay, the author uses a simulation model to examine whether expanding cognitive testing in primary care settings could increase access to novel Alzheimer's disease-modifying therapies. Because of the aging U.S. population and a limited number of dementia specialists, the author assesses how implementing blood-based biomarker testing in primary care would affect wait times, health outcomes, and health care costs across U.S. states from 2025 to 2044.