THREE ESSAYS ON ACCESS AND UTILIZATION OF HEALTHCARE

This dissertation examines three critical dimensions of healthcare access and utilization in the United States. The first chapter investigates the relationship between prenatal care adequacy and maternal morbidity outcomes using North Carolina birth records (2011-2019). Employing multivariate logistic regression, the analysis demonstrates that inadequate prenatal care increases the probability of maternal morbidity by 7.2% (OR=1.072, 95% CI: 1.01-1.13) in the general birthing population and by 45.6% (OR=1.456, 95% CI: 1.03-2.07) among individuals with preexisting diabetes and/or hypertension. These findings underscore the protective role of adequate prenatal care, particularly for vulnerable populations with preexisting conditions.The second chapter addresses primary care shortages by examining how nurse practitioners' scope of practice (SOP) legislation affects healthcare utilization. Using Medicare claims data and a difference-in-difference approach with heterogeneous treatment effects, the research reveals that expanding nurse practitioners' SOP increases evaluation and management service utilization by approximately 155 services per 10,000 Medicare beneficiaries (95% CI: -209.4-519.4). This suggests that policy interventions expanding nurse practitioners' authority may improve healthcare access for older adults. The findings indicate that future research should explore additional mechanisms through which SOP expansion affects healthcare access, particularly how nurse practitioners might facilitate access to specialty care through referrals. The third chapter explores non-financial barriers to healthcare utilization among older adults using 2019 Health Survey data. The analysis identifies that dislike of visiting doctors decreases the likelihood of attempting to seek care by 65.7% (95% CI: 0.21-0.56) compared to those without such aversion. Furthermore, significant disparities exist, with non-White respondents 42.8% (95% CI: 0.43-0.76) less likely and Hispanic respondents 46.2% (95% CI: 0.37-0.77) less likely to attempt seeking care compared to their White and non-Hispanic counterparts, respectively.Collectively, this research offers multifaceted insights into factors influencing healthcare access and utilization across different populations. By identifying the importance of prenatal care for maternal health, examining policy interventions to address provider shortages, and understanding non-financial barriers to care-seeking behavior, this dissertation contributes valuable evidence to inform healthcare policies aimed at improving access, reducing disparities, and enhancing health outcomes.