Date of Award
8-2025
Document Type
Dissertation
Degree Name
Doctor of Philosophy (PhD)
Department
Economics
Committee Chair/Advisor
F. Andrew Hanssen
Committee Member
Patrick L. Warren
Committee Member
Robert K. Fleck
Committee Member
Matthew S. Lewis
Abstract
The first chapter explores differences in incentives and consequent behavior between for-profit and not-for-profit firms. I investigate a terrible choice nursing homes faced during the pandemic: isolating residents prevents deaths from COVID-19, but increases non-COVID deaths by aggravating mental illnesses such as dementia. I explore how ownership structure led to differences in isolation measures taken and in resultant health outcomes. I model decisions regarding isolation measures as a trade-off between profits and satisfying staff's demands, with not-for-profit managers more constrained in how they consume profits. The model predicts that not-for-profit facilities will have more restrictive isolation measures and, consequently, lower COVID-19 cases. Using cell phone location data, I find that not-for-profit facilities implemented more restrictive isolation measures during the pandemic and thus had fewer COVID-19 cases and deaths. However, not-for-profit ownership is predictive of substantially more non-COVID deaths, such that they had more total deaths than for-profit facilities.
The second chapter investigates the effects of Certificate-of-need (CON) laws. These laws require that healthcare providers receive approval from a state board before offering additional services in a given community. Proponents of CON laws claim that these laws are needed to prevent the oversupply of healthcare services in urban areas and to increase access in rural areas, which are predominantly underserved. Yet, the policy could lower rural access if used by incumbents to limit entry from competitors. We explore the repeal of these regulations in five U.S. states to offer the first estimate of the causal effects of CON laws on rural and urban healthcare access. We find that repealing CON laws causes a substantial increase in hospitals in both rural and urban areas. We also find that the repeal leads to fewer beds and smaller hospitals on average, suggesting an increase in entry and competition in both rural and urban areas.
The third chapter examines the effects of isolation measures implemented during the COVID-19 pandemic. These measures were intended to mitigate disease spread. Yet, isolation had negative mental health effects on residents. These effects were severe and could be long-lasting, and thus may raise the number of non-COVID deaths even more. Using novel cell phone tracking data to estimate isolation measures, we find that isolation measures are predictive of fewer COVID-19 cases. However, these measures are predictive of much higher rates of non-COVID and total deaths in the second year of the pandemic, especially in facilities that have a large proportion of residents with dementia. At the margin, isolation measures are associated with substantially more total deaths. A one standard deviation decrease in isolation in all nursing homes is predictive of 7,305 fewer overall deaths.
Recommended Citation
Melo, Vitor C., "Essays on Healthcare Regulation and Industrial Regulation" (2025). All Dissertations. 4084.
https://open.clemson.edu/all_dissertations/4084