My dissertation combines the notion of residential sorting from Tiebout (1956) with Grossman’s (1972) concept of a health production function to develop a new empirical framework for investigating what individuals’ residential location choices reveal about their valuation of amenities, the welfare effects of climate change, the forces underlying environmental justice, and the value of a statistical life. Location

choices are affected by age, health, and financial constraints, and by exposure to local amenities that affect people’s health and longevity. Chapter 1 previews how I formalize this idea and investigate its empirical implications in three interrelated essays. Chapter 2 investigates interactions between health, the environment, and income. Seniors tend to move at higher rates after being diagnosed with new chronic medical conditions. While seniors generally tend to move to locations with less polluted air, those who have been diagnosed with respiratory conditions move to relatively more polluted locations. This counterintuitive pattern is reconciled by documenting that new diagnoses bring about increases in medical expenditures, thereby limiting disposable income that can be spent on housing. Relatively cheaper places tend to be more polluted, and higher exposure to pollution leaves seniors more vulnerable to future health shocks. In Chapter 3, I combine information about housing prices with estimates of location-specific effects on mortality to estimate the Value of a Statistical Life (VSL) for seniors - one of the most important statistics used to evaluate policies affecting mortality. Since local amenities correlate with causal mortality effects, but also provide utility independently, the difficulty in controlling for local amenities implies that my VSL estimates are best interpreted as bounds. Chapter 4 builds a new structural framework for evaluating spatially heterogeneous changes to local amenities. I estimate a dynamic model of location choice with a sample of 5.5 million seniors from 2001-2013. Their average annual willingness-to-pay to avoid future climate change in the United States under a “business as usual” scenario ranges from $962 for older, sicker groups who are more vulnerable to climate change’s negative effects on health to -$1,894 for younger, healthier groups, who value warmer winters and are relatively resilient.

Prior research on consumer behavior in health insurance markets has primarily focused on individual decision making while relying on strong parametric assumptions about preferences. The aim of this dissertation is to improve the traditional approach in both dimensions. First, I consider the importance of joint decision-making in individual insurance markets by studying how married couples coordinate their choices in these markets. Second, I investigate the robustness of prior studies by developing a non-parametric method to assess decision-making in health insurance markets. To study how married couples make choices in individual insurance markets I estimate a stochastic choice model of household demand that takes into account spouses' risk aversion, spouses' expenditure risk, risk sharing, and switching costs. I use the model estimates to study how coordination within couples and interaction between couples and singles affects the way that markets adjust to policies designed to nudge consumers toward choosing higher value plans, particularly with respect to adverse selection.

Finally, to assess consumer decision-making beyond standard parametric assumptions about preferences, I use second--order stochastic dominance rankings. Moreover, I show how to extend this method to construct bounds on the welfare implications of choosing dominated plans.

Marketers today have found a way to expose sexualized content to young girls. Intentional or not, girls are taking notice of it and it shows in the increasing numbers of mental and physical disorders. This thesis attempts to synthesis previous research studies and current examples of sexual objectification of women in the hopes to create more awareness on the sexualization of girls. Several aspect play a significant role in shaping young girls including how females are portrayed in the media, how the beauty standards continue to change with the current trends, and how parents are playing an influential role in their children's lives. I will propose some recommendations about what we, as a society, can do to help parents and children grow up in this hyper sexualized world.

Prenatal care is a widely administered preventative care service, and its adequate use has been shown to decrease poor infant and maternal health outcomes. Today however, in the United States, preterm birth rates remain among the highest in the industrialized world, with low socioeconomic women having the highest risk of preterm births. This group of women also face the greatest barriers to access adequate prenatal care in the United States. This paper explores the viability of short message service to help bridge gaps in prenatal care for low socioeconomic women in the United States and provides areas for further research.

The healthcare industry is currently facing significant changes. One of the changes in the industry is a movement towards patient-focused care, which considers the patient as a person and the impact of care on the person. Patient experience is part of patient-focused care, and has similarities to the marketing term customer experience, which contributes to happier customers and long-term financial growth and success for businesses. This thesis defines current issues in patient experience as it relates to hospital manager decision making. Through secondary research, this thesis demonstrates what patient experience is, the role it plays in healthcare and hospital settings, the pressures on hospitals to increase patient experience performance, how patient experience performance is measured, and what strategies or action drive improvements under current performance measurements. Many studies and articles exist examining each of these issues individually. However, these sources do not comprehensively define patient experience in hospitals with perspective on how this influences hospital strategy and decision-making. Previous works on patient experience from the perspective of hospital strategy do not include considerations for recent industry shifts, most notably the Patient Protection and Affordable Care Act. The collected definitions in this thesis provide guidance of relevant concerns hospital managers consider when formulating organization-wide strategy related to patient experience. This thesis explains how patient experience contributes to the success of hospitals in the short-term, medium-term, and long-term and how patient experience may shift its focus over time. Short-term concerns include specific regulations and definitions from the Centers for Medicare and Medicaid services, responsible for over half of all payments to hospitals. Conforming to CMS standards is a matter of survival for most hospitals in the short-term. Hospitals are adjusting to rules and payment models not in existence just two years ago. First, hospitals will adapt, and then hospitals will strive to optimize under new standards as well as respond to adjustments in the rules over the next several years. After patient experience standards are well established, certain aspects of patient experience will be part of long-term differentiation and success for hospitals. Responding comprehensively to the shift towards improving patient experience is a critical aspect for hospitals to weather the many changes in the healthcare industry. Patient experience will provide better care to patients and better financial health to the hospitals that perform above patient experience standards.

The Patient Protection and Affordable Care Act of 2010 was created as an overhaul of the US Healthcare system with a goal of getting all American citizens and legal residents healthcare that was both affordable and of good quality. Now almost a year removed from it going into effect, this study looks to determine how the ACA has worked in getting individuals who were previously uninsured and required charitable-based healthcare into health insurance programs within a small population in Arizona. This study evaluates the type of insurance program, the quality and ease of access of the care, and the general affordability of the healthcare. This study found that 75% of individuals surveyed had gained health insurance in the last year, with 95% expecting to be insured for 2015. The large majority rated the quality of their care and the accessibility of it as good, with corresponding increased use of primary care providers as a health resource. The affordability of the care was still a major issue for those who were found to be uninsured and for those who were insured. Despite affordability issues, self-reported measures of general health and access to care were reported by the majority of respondents to have improved over the last 12 months.

Currently, the medical industry employs an acute treatment process centered on responsiveness and restoration. This method fails those with chronic illness who require disease management and proactivity. As a solution, the medical industry has implemented programs focused on providing integrated, coordinated care. This project examines two primary models to accommodate chronically ill patients: Accountable Care Organizations (ACOs) and Patient Centered Medical Homes (PCMHs). Specifically, this paper examines the data from Pioneer and Medicare Shared Savings Program ACOs. In the aggregate, the data indicate that these programs have been unsuccessful due to several key issues: a lack of patient and physician engagement, failure to incentivize medical professionals and failed collaboration between both ACOs and PCMHs. Remedying these issues would improve the ability of both ACOs and PCMHs to provide integrated, comprehensive care to patients with chronic illnesses.

Objective: To assess and quantify the effect of state’s price transparency regulations (hereafter, PTR) on healthcare pricing.

Data Sources: I use the Healthcare Cost and Utilization Project’s Nationwide Inpatient Sample (NIS) from 2000 to 2011. The NIS is a 20% sample of all inpatient claims. The Manhattan Institute supplied data on the availability of health savings accounts in each state. State PTR implementation dates were gathered by Hans Christensen, Eric Floyd, and Mark Maffett of University of Chicago’s Booth School of Business by contacting the health department, hospital association, or website controller in each state.

Study Design: The NIS data was collapsed by procedure, hospital, and year providing averages for the dependent variable, Cost, and a host of covariates. Cost is a product of Total Charges within the NIS and the hospital’s Cost to Charge ratio. A new binary variable, PTR, was defined as ‘0’ if the year was strictly less than the disclosure website’s implementation date, ‘1’ for afterwards, and missing for the year of implementation. Then, using multivariate OLS regression with fixed effect modeling, the change in cost from before to after the year of implementation is estimated.

Principal Findings: The analysis estimates the effect of PTR to decrease the average cost per procedure by 7%. Specifications identify within state, within hospital, and within procedure variation, and reports that 78% of the cost decrease is due to within-hospital, within-procedure price discounts. An additional model includes the interaction of PTR with the prevalence of health savings accounts (hereafter, HSAs) and procedure electivity. The results show that PTR lowers costs by an additional 3 percent with each additional 10 percentage point increase in the availability of HSAs. In contrast, the cost reductions from PTR were much smaller for procedures more frequently coded as elective.

Conclusions: The study concludes price transparency regulations can lead to a decrease in a procedure’s costs on average, primarily through price discounts and slightly through lower cost procedures, but not due to patients moving to cheaper hospitals. This implies that hospitals are taking initiative and lowering prices as the competition’s prices become publically available suggesting that hospitals – not patients – are the biggest users of price transparency websites. Hospitals are also finding some ways to provide cheaper alternatives to more expensive procedures. State regulators should evaluate if a better metric other than charge prices, such as expected out-of-pocket payments, would evoke greater patient participation. Furthermore, states with higher prevalence of HSAs experience greater effects of PTR as expected since patients with HSAs have greater incentives to lower their costs. Patients should expect a shift towards plans that offer these types of savings accounts since they’ve shown to have a reduction of health costs on average per procedure in states with higher prevalence of HSAs.

In two independent and thematically connected chapters, I investigate consumers' willingness to pay a price premium in response to product development that entails prosocial attributes (PATs), those that allude to the reduction of negative externalities to benefit society, and to an innovative participatory pricing design called 'Pay-What-You-Want' (PWYW) pricing, a mechanism that relinquishes the determination of payments in exchange for private goods to the consumers themselves partly relying on their prosocial preferences to drive positive payments. First, I propose a novel statistical approach built on the choice based contingent valuation technique to estimate incremental willingness to pay (IWTP) for PATs that accounts for consumer heterogeneity, dependence in the decision making processes, and incentive compatibility. I validate the approach by estimating IWTP for a variety of PATs and contrast the theoretical and managerial benefits of using the proposed approach over extant techniques used in the literature for this purpose. Second, I propose a general and flexible statistical modeling framework for estimating PWYW payments that exceed zero. It relies on the joint estimation of three types of consumer decision processes namely, the consumer propensity to default to an explicit price recommendation, the propensity to pay a least legitimate price, and the payment of a freely-chosen non-zero payment. Of particular interest is the model's ability to account for a wide variety of design constraints such as the setting of price bounds, explicit price recommendations, and the provision of a menu of discrete prices to choose from. I validate the approach by estimating PWYW payments for a variety of products such as music licenses, snacks, and sports tickets. I specifically examine and report the differential impact of three managerially controllable variables namely, 'payment anonymity', 'information on payment recipients' and 'information of product value/quality'.