Graduation Year
2024
Document Type
Dissertation
Degree
Ph.D.
Degree Name
Doctor of Philosophy (Ph.D.)
Degree Granting Department
Economics
Major Professor
Padmaja Ayyagari, Ph.D.
Committee Member
Gabriel Picone, Ph.D.
Committee Member
Andrei Barbos, Ph.D.
Committee Member
Etienne Pracht, Ph.D.
Keywords
Cancer screening, Medicaid, Medicare, out-of-pocket expenditures
Abstract
In this dissertation, I have analyzed the impact of Medicare on the utilization of cancer screening, healthcare financing, and doctor visits in the USA.
The 1st chapter examines the impact of Medicare on the utilization of cancer screening tools for colorectal, breast and prostate cancers in the USA. Unlike previous studies that primarily explored Medicare's impact on cancer treatment and survival, our study uniquely focuses on how Medicare influences cancer screening, prioritizing the general population over exclusively cancer patients. We have used the Behavioral Risk Factor Surveillance System data in our study. The Regression Discontinuity method has been used for finding any discontinuity for the probability of taking the tests within the last 12 months at age 65. The study revealed a significant increase in the likelihood of individuals undergoing colonoscopy & sigmoidoscopy (0.029), stool blood tests (0.008), and prostate-specific antigen tests (0.041). However, while there is a 2.5 percentage points increase in the probability of taking mammogram at age 65, the relative change is small. Additionally, we did not find any significant change in the likelihood of taking the Clinical Breast Exam at age 65.
The 2nd chapter examines the impact of Medicare on healthcare expenditures and payments made by patients, Medicare, Medicaid, and private insurance companies before and after full expansion of ACA in 2014. We have also checked the Medicare effects on healthcare visits. The analysis covers two time periods, 1996-2013 and 2014-2019, with a focus on identifying discontinuities at age 65 when individuals become eligible for Medicare. The regression discontinuity method has been employed for the study and we took data from the Medical Expenditure Panel Survey. We found significant changes in total charges and total expenses in both periods, the charges, expenses, and doctor visits nearly doubled post 2014 period. While Medicare led to a $143 decrease in annual out-of-pocket expenditures in the pre-2014 period, we did not observe a significant change after the full ACA expansion. Furthermore, in both periods, the payments by Medicaid and Private insurance firms decline significantly once a patient enrolls in Medicare. Additionally, we observed a notable increase in emergency room, office-based provider visits and the number of prescription refills. We conducted the same analysis of these variables within different demographic groups and individuals with Private and Medicaid insurance post age 65. The results show disparities in healthcare across these groups.
Overall, the findings emphasize Medicare's critical role in shaping healthcare behaviors, financial dynamics, and could provide valuable information for policymakers aiming to address healthcare equity and improve preventive care.
Scholar Commons Citation
Karimli, Gazanfar, "The Effects of Medicare on Utilization of Cancer Screening Tools, Healthcare Expenditures, and Doctor Visits" (2024). USF Tampa Graduate Theses and Dissertations.
https://digitalcommons.usf.edu/etd/11185
