Essay Health Services

Three Essays on Health Care

Hitoshi Shigeoka

Title:
Three Essays on Health Care
Author(s):
Shigeoka, Hitoshi
Thesis Advisor(s):
Almond, Douglas V.
Date:
2012
Type:
Theses
Degree:
Ph.D., Columbia University
Department(s):
Economics
Persistent URL:
https://doi.org/10.7916/D8GF11MQ
Abstract:
This dissertation has been motivated by the question of how countries should optimally structure health care. Especially, there are two important economic and policy questions asked that extend beyond the area of health economics. The first is how the expansion of health insurance coverage affects the utilization and health of its beneficiaries (extensive margin); the second is how generous should health insurance be (intensive margin) to balance the provision of care and financial protection against risk while containing medical expenditures. The three chapters in this dissertation aim to make empirical contributions to these ongoing research questions. First chapter, "The Effect of Patient Cost-Sharing on Utilization, Health and Risk Protection: Evidence from Japan" addresses the second question. It investigates how cost-sharing, requiring patients to pay a share of the cost of care, affects the demand for care, health itself, and risk protection among the elderly, the largest consumers of health service. Previous studies of cost-sharing have had difficulty separating the effect of cost-sharing on patients from the influence of medical providers and insurers. This paper overcomes that limitation by examining a sharp reduction in cost-sharing at age 70 in Japan in a regression discontinuity design. I find that price elasticities of demand for both inpatient admissions and outpatient visits among the elderly are comparable to prior estimates for the non-elderly. I also find that the welfare gain from risk protection is relatively small compared to the deadweight loss of program financing, suggesting that the social cost of lower cost-sharing may outweigh social benefit. Taken together, this study shows that an increase in cost-sharing may be achieved without decreasing total welfare. Third chapter, "Effects of Universal Health Insurance on Health Care Utilization, Supply-Side Responses and Mortality Rates: Evidence from Japan" (with Ayako Kondo) address the first question. Even though most developed countries have implemented some form of universal public health insurance, most studies on the impact of the health insurance coverage have been limited to specific subpopulations, such as infants and children, the elderly or the poor. We investigate the effects of a massive expansion in health insurance coverage on utilization and health by examining the introduction of universal health insurance in Japan in 1961. We find that health care utilization increases more than would be expected from previous estimates of the elasticities of individual-level changes in health insurance status such as RAND Health Insurance Experiment in the US. The two chapters addressed above focus on consumers' incentives. Second chapter, "Supply-Induced Demand in Newborn Treatment: Evidence from Japan" (with Kiyohide Fushimi) examines the incentives faced by medical providers. Since medical providers exert a strong influence over the quantity and types of medical care demanded, measuring the size of supply-induced demand (SID) has been a long-standing controversy in health economics. However, past studies may underestimate the size of SID since it is empirically difficult to isolate SID from other confounding hospital behaviors, such as changes in the selection of patients. We overcome these empirical challenges by focusing on a specific population: at-risk newborns, and we measure the degree of SID by exploiting changes in reimbursement caused by the introduction of the partial prospective payment system (PPS) in Japan, which makes some procedures relatively more profitable than other procedures. We find that hospitals respond to PPS adoption by increasing utilization and increasing their manipulation of infant's reported birth weight, which determines infants reimbursement and maximum length of stay. We also find that this induced demand substantially increases hospital reimbursements without improving infant health, implying that the additional money spent has no commensurate health gains.
Subject(s):
Economics
Item views
17484
Metadata:
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Suggested Citation:
Hitoshi Shigeoka, 2012, Three Essays on Health Care, Columbia University Academic Commons, https://doi.org/10.7916/D8GF11MQ.

Sample Medical School Essays


This section contains two sample medical school essays

  1. Medical School Sample Essay One
  2. Medical School Sample Essay Two

Medical School Essay One

Prompt: What makes you an excellent candidate for medical school? Why do you want to become a physician?

When I was twelve years old, a drunk driver hit the car my mother was driving while I was in the backseat. I have very few memories of the accident, but I do faintly recall a serious but calming face as I was gently lifted out of the car. The paramedic held my hand as we traveled to the hospital. I was in the hospital for several weeks and that same paramedic came to visit me almost every day. During my stay, I also got to know the various doctors and nurses in the hospital on a personal level. I remember feeling anxiety about my condition, but not sadness or even fear. It seemed to me that those around me, particularly my family, were more fearful of what might happen to me than I was. I don’t believe it was innocence or ignorance, but rather a trust in the abilities of my doctors. It was as if my doctors and I had a silent bond. Now that I’m older I fear death and sickness in a more intense way than I remember experiencing it as a child. My experience as a child sparked a keen interest in how we approach pediatric care, especially as it relates to our psychological and emotional support of children facing serious medical conditions. It was here that I experienced first-hand the power and compassion of medicine, not only in healing but also in bringing unlikely individuals together, such as adults and children, in uncommon yet profound ways. And it was here that I began to take seriously the possibility of becoming a pediatric surgeon.

My interest was sparked even more when, as an undergraduate, I was asked to assist in a study one of my professors was conducting on how children experience and process fear and the prospect of death. This professor was not in the medical field; rather, her background is in cultural anthropology. I was very honored to be part of this project at such an early stage of my career. During the study, we discovered that children face death in extremely different ways than adults do. We found that children facing fatal illnesses are very aware of their condition, even when it hasn’t been fully explained to them, and on the whole were willing to fight their illnesses, but were also more accepting of their potential fate than many adults facing similar diagnoses. We concluded our study by asking whether and to what extent this discovery should impact the type of care given to children in contrast to adults. I am eager to continue this sort of research as I pursue my medical career. The intersection of medicine, psychology, and socialization or culture (in this case, the social variables differentiating adults from children) is quite fascinating and is a field that is in need of better research.

Although much headway has been made in this area in the past twenty or so years, I feel there is a still a tendency in medicine to treat diseases the same way no matter who the patient is. We are slowly learning that procedures and drugs are not always universally effective. Not only must we alter our care of patients depending upon these cultural and social factors, we may also need to alter our entire emotional and psychological approach to them as well.

It is for this reason that I’m applying to the Johns Hopkins School of Medicine, as it has one of the top programs for pediatric surgery in the country, as well as several renowned researchers delving into the social, generational, and cultural questions in which I’m interested. My approach to medicine will be multidisciplinary, which is evidenced by the fact that I’m already double-majoring in early childhood psychology and pre-med, with a minor in cultural anthropology. This is the type of extraordinary care that I received as a child—care that seemed to approach my injuries with a much larger and deeper picture than that which pure medicine cannot offer—and it is this sort of care I want to provide my future patients. I turned what might have been a debilitating event in my life—a devastating car accident—into the inspiration that has shaped my life since. I am driven and passionate. And while I know that the pediatric surgery program at Johns Hopkins will likely be the second biggest challenge I will face in my life, I know that I am up for it. I am ready to be challenged and prove to myself what I’ve been telling myself since that fateful car accident: I will be a doctor.


Medical School Essay Two

Prompt: Where do you hope to be in ten years’ time?

If you had told me ten years ago that I would be writing this essay and planning for yet another ten years into the future, part of me would have been surprised. I am a planner and a maker of to-do lists, and it has always been my plan to follow in the steps of my father and become a physician. This plan was derailed when I was called to active duty to serve in Iraq as part of the War on Terror.

I joined the National Guard before graduating high school and continued my service when I began college. My goal was to receive training that would be valuable for my future medical career, as I was working in the field of emergency health care. It was also a way to help me pay for college. When I was called to active duty in Iraq for my first deployment, I was forced to withdraw from school, and my deployment was subsequently extended. I spent a total of 24 months deployed overseas, where I provided in-the-field medical support to our combat troops. While the experience was invaluable not only in terms of my future medical career but also in terms of developing leadership and creative thinking skills, it put my undergraduate studies on hold for over two years. Consequently, my carefully-planned journey towards medical school and a medical career was thrown off course. Thus, while ten-year plans are valuable, I have learned from experience how easily such plans can dissolve in situations that are beyond one’s control, as well as the value of perseverance and flexibility.

Eventually, I returned to school. Despite my best efforts to graduate within two years, it took me another three years, as I suffered greatly from post-traumatic stress disorder following my time in Iraq. I considered abandoning my dream of becoming a physician altogether, since I was several years behind my peers with whom I had taken biology and chemistry classes before my deployment. Thanks to the unceasing encouragement of my academic advisor, who even stayed in contact with me when I was overseas, I gathered my strength and courage and began studying for the MCAT. To my surprise, my score was beyond satisfactory and while I am several years behind my original ten-year plan, I am now applying to Brown University’s School of Medicine.

I can describe my new ten-year plan, but I will do so with both optimism and also caution, knowing that I will inevitably face unforeseen complications and will need to adapt appropriately. One of the many insights I gained as a member of the National Guard and by serving in war-time was the incredible creativity medical specialists in the Armed Forces employ to deliver health care services to our wounded soldiers on the ground. I was part of a team that was saving lives under incredibly difficult circumstances—sometimes while under heavy fire and with only the most basic of resources. I am now interested in how I can use these skills to deliver health care in similar circumstances where basic medical infrastructure is lacking. While there is seemingly little in common between the deserts of Fallujah and rural Wyoming, where I’m currently working as a volunteer first responder in a small town located more than 60 miles from the nearest hospital, I see a lot of potential uses for the skills that I gained as a National Guardsman. As I learned from my father, who worked with Doctors Without Borders for a number of years, there is quite a bit in common between my field of knowledge from the military and working in post-conflict zones. I feel I have a unique experience from which to draw as I embark on my medical school journey, experiences that can be applied both here and abroad.

In ten years’ time, I hope to be trained in the field of emergency medicine, which, surprisingly, is a specialization that is actually lacking here in the United States as compared to similarly developed countries. I hope to conduct research in the field of health care infrastructure and work with government agencies and legislators to find creative solutions to improving access to emergency facilities in currently underserved areas of the United States, with an aim towards providing comprehensive policy reports and recommendations on how the US can once again be the world leader in health outcomes. While the problems inherent in our health care system are not one-dimensional and require a dynamic approach, one of the solutions as I see it is to think less in terms of state-of-the-art facilities and more in terms of access to primary care. Much of the care that I provide as a first responder and volunteer is extremely effective and also relatively cheap. More money is always helpful when facing a complex social and political problem, but we must think of solutions above and beyond more money and more taxes. In ten years I want to be a key player in the health care debate in this country and offering innovative solutions to delivering high quality and cost-effective health care to all our nation’s citizens, especially to those in rural and otherwise underserved areas.

Of course, my policy interests do not replace my passion for helping others and delivering emergency medicine. As a doctor, I hope to continue serving in areas of the country that, for one reason or another, are lagging behind in basic health care infrastructure. Eventually, I would also like to take my knowledge and talents abroad and serve in the Peace Corps or Doctors Without Borders.

In short, I see the role of physicians in society as multifunctional: they are not only doctors who heal, they are also leaders, innovators, social scientists, and patriots. Although my path to medical school has not always been the most direct, my varied and circuitous journey has given me a set of skills and experiences that many otherwise qualified applicants lack. I have no doubt that the next ten years will be similarly unpredictable, but I can assure you that no matter what obstacles I face, my goal will remain the same. I sincerely hope to begin the next phase of my journey at Brown University. Thank you for your kind attention.

To learn more about what to expect from the study of medicine, check out our Study Medicine in the US section.

Sample Essays

Related Content:

Tips for a Successful Medical School Essay

  • If you’re applying through AMCAS, remember to keep your essay more general rather than tailored to a specific medical school, because your essay will be seen by multiple schools.
  • AMCAS essays are limited to 5300 characters—not words! This includes spaces.
  • Make sure the information you include in your essay doesn't conflict with the information in your other application materials.
  • In general, provide additional information that isn’t found in your other application materials. Look at the essay as an opportunity to tell your story rather than a burden.
  • Keep the interview in mind as you write. You will most likely be asked questions regarding your essay during the interview, so think about the experiences you want to talk about.
  • When you are copying and pasting from a word processor to the AMCAS application online, formatting and font will be lost. Don’t waste your time making it look nice. Be sure to look through the essay once you’ve copied it into AMCAS and edit appropriately for any odd characters that result from pasting.
  • Avoid overly controversial topics. While it is fine to take a position and back up your position with evidence, you don’t want to sound narrow-minded.
  • Revise, revise, revise. Have multiple readers look at your essay and make suggestions. Go over your essay yourself many times and rewrite it several times until you feel that it communicates your message effectively and creatively.
  • Make the opening sentence memorable. Admissions officers will read dozens of personal statements in a day. You must say something at the very beginning to catch their attention, encourage them to read the essay in detail, and make yourself stand out from the crowd.
  • Character traits to portray in your essay include: maturity, intellect, critical thinking skills, leadership, tolerance, perseverance, and sincerity.

Additional Tips for a Successful Medical School Essay

  • Regardless of the prompt, you should always address the question of why you want to go to medical school in your essay.
  • Try to always give concrete examples rather than make general statements. If you say that you have perseverance, describe an event in your life that demonstrates perseverance.
  • There should be an overall message or theme in your essay. In the example above, the theme is overcoming unexpected obstacles.
  • Make sure you check and recheck for spelling and grammar!
  • Unless you’re very sure you can pull it off, it is usually not a good idea to use humor or to employ the skills you learned in creative writing class in your personal statement. While you want to paint a picture, you don’t want to be too poetic or literary.
  • Turn potential weaknesses into positives. As in the example above, address any potential weaknesses in your application and make them strengths, if possible. If you have low MCAT scores or something else that can’t be easily explained or turned into a positive, simply don’t mention it.

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