DOI
https://doi.org/10.25772/29KQ-B945
Defense Date
2025
Document Type
Dissertation
Degree Name
Doctor of Philosophy
Department
Healthcare Policy & Research
First Advisor
Peter Cunningham, PhD
Second Advisor
Andrew Barnes, PhD
Third Advisor
Bassam Dahman, PhD
Fourth Advisor
Caitlin Martin, MD MPH
Abstract
Abstract
This dissertation examines health equity during times of national public health and economic crises by examining access to care among women of reproductive age. Papers 1 and 2 estimate the effects of the 2020 Covid-19 pandemic in the United States (US). Paper 3 examines the potential effects of the 2008 hyperinflation and subsequent economic crisis in Zimbabwe.
Paper 1 assessed the role of health professional shortage areas (HPSAs) in the Covid-19 pandemic-related temporal trends in mental health access among women in the 18 to 44 years age group with self-reported anxiety and/or depression. The findings suggest decreased unmet prescription needs in the full sample and in HPSAs. The results also suggest an increase in unmet mental health needs due to cost in non-HPSAs in the second year of the pandemic, relative to the pre-pandemic year. This evidence supports maintaining some Public Health Emergency (PHE) actions and policies that could have contributed to a reduction in unmet prescription needs and, alternatively, suggests the need for licensing more prescribing mental health providers.
Paper 2 examined the role of telehealth utilization in the association between race/ethnicity and access to care among women in the 18 to 49 years age group with self-reported hypertension and/or diabetes. The results suggest that Non-Hispanic (NH) Black women were more likely to go to the ER/ED (in the full sample and among telehealth users) relative to NH White women. These findings suggest digital health equity concerns because of the disparities in the need for acute healthcare services among NH Black women (even when they use telehealth services). This work adds to the growing evidence promoting health equity in hybrid integration of telehealth to promote care coordination and telehealth payment parity to ensure that everyone can access the same quality of care.
Paper 3 (Chapter 4) estimated rural-urban disparities in the impact of Zimbabwe’s 2008 hyperinflation and economic crisis on access to care among women and adolescents in the 15 to 49 years age group. The difference-in-differences results suggest that experiencing hyperinflation and the subsequent economic crisis in Zimbabwe was associated with increased unmet medical needs due to cost in the full sample, and among urban residents. This work presents evidence that potentially highlights the impact of urban poverty on access to care in Zimbabwe.
The evidence presented in this dissertation confirms what we know from prior literature – times of national crisis and uncertainty expose or exacerbate disparities in access to care. This knowledge can inform health policies that prioritize health equity when preparing for and reacting to national crises.
Rights
© The Author
Is Part Of
VCU University Archives
Is Part Of
VCU Theses and Dissertations
Date of Submission
5-9-2025