Essays in the efficient provision of health care: Temporal issues in childhood immunization policy

One of the main targets of health care policy reform is the underserved population. Among this group are preschool children who are not adequately immunized. In the United States, childhood immunization rates for children aged 2 are low by global comparison. In response to goals of a 90 percent immunization rate by the year 2000, federal and state governments are looking for ways to improve immunization delivery. This thesis addresses various economic aspects and policy issues concerning these efforts.The public sector purchases roughly half of all domestically-produced childhood vaccines at a substantial discount. This difference is probably not due in whole to cost differences in providing vaccines to public versus private buyers. Two additional theories are consistent with this pricing structure: third-degree price discrimination and bargaining power. The true cause of the price differentials is important from a policy perspective. The federal government is considering implementing a vaccine purchase program whereby it would purchase vaccine from the manufacturers for distribution free of charge to private and public providers. The success of this type of program in terms of improving social welfare depends on what conditions are giving rise to the pricing structure. The first essay derives an empirical test for price discrimination as opposed to bargaining power using a time series of public and private vaccine prices.No study has yet been undertaken to determine the cost effectiveness of a vaccine purchase program. It may be the case that these policies will not substantially reduce the occurrence of childhood diseases enough to justify their cost. In this respect, this type of cost-benefit analysis concerning vaccines differs from the usual.Also, the factors which interfere with immunization must be identified. Even in states where vaccines are free, immunization rates for preschoolers are not significantly higher than the overall national rate. Clearly, there are factors other than the actual price of the vaccine which affect the demand for immunizations. The second essay addresses this issue as well by examining differences in immunization rates across states. The results add to an understanding of the cost-effectiveness issue.U of I OnlyETDs are only available to UIUC Users without author permissio