Essays on income inequality, minority health and healthcare spending

This set of essays addresses issues related to income inequality, public healthcare supply and population health. Income inequality has been found to affect health in a number of studies. Using data from Behavioral Risk Factor Surveillance System (BRFSS), a telephone survey of adults in the United States, the first chapter of my dissertation studies the effect of state level and county level income inequality on health status and the pathway via public health spending. By using multiple imputation method applied to BRFSS income data, it derives synthetic Gini coefficient at state level and county level for each year from 2000 to 2012. After controlling for smoking, age, education, race, gender, household income and fraction of black, this study finds that both state level and county level income inequality is negatively associated with health status. Furthermore, this paper shows that provision of health related public goods is one of the pathways by which income inequality influences health. And the effects of both income inequality and inefficient level of public health spending are different by income groups and geographic areas. Income inequality has largest negative effect on poorer people and smaller negative effect on people living in big cities.;In the second chapter, life satisfaction approach (LSA) is used to verify the assumption made in chapter 1 that poor people prefer more public healthcare service than rich people does. BRFSS data and government spending data from U.S. Census Bureau are combined to model individual level life satisfaction data from BRFSS as a function of their demographic characteristics, income and public healthcare services. Then the monetary value of public healthcare supply is measured as the marginal rate of substitution between income and public healthcare services that leaves respondent equally happy. After calculating the monetary value of public healthcare service by income group, it is found that poor people are willing to pay higher percentage of their income for an extra unit of supply of healthcare service than rich people do. Besides, the monetary value of income inequality is measured using the same method and the results show that in U.S. rich people more dislike income inequality than poor people do because of the high social mobility.;The third chapter studies the nonlinear effect of county population size on population health in New York State from the aspect of access to healthcare. The effect of county population size on self-rated health status is examined by using a General Additive Model first and then a quadratic term of the effect is assumed for further study. It is found that an inverted U shape of the population size effect exists and Blacks in large counties perform better than themselves in small counties and better than Whites in large counties. Then a structural equation modeling approach with a MIMIC model is used to prove that the supply of healthcare services is one of the pathways that county population size affects health. Supplies of healthcare services in neighboring counties are added in the model to control for spatial spillover effect. At last I extend our study to objective health measures and find similar results.