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This dissertation consists of three stand-alone essays that focus on the economics of preserving health among vulnerable populations, specifically, the chronically ill and elderly. The first paper examines Medicare Part D beneficiaries' choice of when to take up Part D in its initial enrollment period. The findings show that consumers responded to financial incentive embedded in Part D and made their decision accordingly. Elderly consumers tended to enroll earlier if they were facing higher level or greater variation of prescription drug out-of-pocket spending. The second paper describes a microsimulation model the author developed to analyze the cost-effectiveness of alternative chronic kidney disease (CKD) intervention strategies. Using a nationally representative sample, the model generates a large number of life histories over the next 20 years and provides a consistent analytical framework for the evaluation of alternative interventions. The third paper examines the impact of improving high blood pressure control on CKD outcomes at the population level. This strategy was found to improve the health outcomes of CKD and save lifetime medical costs. The results support the idea that more public health efforts should be directed to improve hypertension awareness and control as an effective early intervention strategy for CKD.

Table of Contents

  • Chapter One

    Signing up for Medicare Part D: What Were the Main Determinants for Enrollment Time?

  • Chapter Two

    A Simulation Model to Evaluate the Cost and Effectiveness of Alternative CKD Intervention Strategies

  • Chapter Three

    Hypertension Control and Chronic Kidney Disease Outcomes among US Adults

Research conducted by

This document was submitted as a dissertation in June 2009 in partial fulfillment of the requirements of the doctoral degree in public policy analysis at the Pardee RAND Graduate School. The faculty committee that supervised and approved the dissertation consisted of Emmett Keeler (Chair), Susann Rohwedder, Roberto Vargas, and Shinyi Wu.

This report is part of the RAND Corporation dissertation series. Pardee RAND dissertations are produced by graduate fellows of the Pardee RAND Graduate School, the world's leading producer of Ph.D.'s in policy analysis. The dissertations are supervised, reviewed, and approved by a Pardee RAND faculty committee overseeing each dissertation.

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