Theses and Dissertations

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Open Access
Pharmaceuticals, physicians and money
(Colorado State University. Libraries, 2022) Aleksanyan, Yeva, author; Zahran, Sammy, advisor; Mushinski, David, advisor; Pressman, Steven, committee member; Alves Pena, Anita, committee member; Stallones, Lorann, committee member
Pharmaceutical companies have contributed tremendously to improving health and quality of life. Treatments unavailable decades ago now extend lives and eliminate the need for invasive medical procedures. New cures are developed every year through research and development. Pharmaceutical companies typically face high failure rates while investing in research and development, the size of which may reach as high as 2.56 billion dollars (Kakkar, 2015). To increase returns from the products that are finally in the market, pharmaceutical companies engage in medical marketing. Medical marketing, and particularly promotions to physicians, come with a hefty cost to a final consumer. Numerous studies have found associations between promotional payments and brand name prescribing (Yeh et al., 2016; Perlis and Perlis, 2016), even if equivalent low-priced products are available (Akande and Aderibigbe, 2007; Taylor et al., 2016). This dissertation explores pharmaceutical industry-physician relationships and examines the factors influencing the size and frequency of promotional payments to physicians. The dissertation also studies the behavior of physicians and considers why some physicians accept more in payments than others. Chapter one examines the behavior of pharmaceutical companies, the patterns of competition surrounding patent expiration, the generic entry, and the choice of promotional instruments. It discusses the strategies employed by pharmaceutical companies in their efforts to keep competition away from the market and enjoy longer periods of monopoly or duopoly power. The study argues that patent expiration and subsequent entry of generic competitors are strong predictors of promotional payments. Also, pharmaceutical companies drastically change the size and frequency of payments after FDA approval of new dosages or new uses of an existing drug for the purposes of shifting the market away from the generic competition and increasing revenues. Finally, the chapter discusses the issues surrounding the information and persuasion debate, showing that promotional payments serve both purposes. Chapter two examines the role of cultural norms and the regulatory environment in the acceptance of pharmaceutical promotional payments by foreign-trained internal medicine doctors. It shows that the home country's corruption norms and the host country's regulatory environment are both important predictors of corrupt behavior among foreign-trained physicians. In the absence of rules and regulations, physicians from different countries adopt somewhat similar behavior. However, the propensity to accept promotional payments decreases among physicians from less corrupt countries when a host country's regulatory environment restricts acceptance of such payments. The study also finds a strong relationship between tenure, physician gender, and propensity to accept promotional payments. It suggests considering different norms and cultural backgrounds when designing and integrating ethical training in the residency and fellowship curricula. It also recommends adopting more stringent conflict of interest policies in hospitals. Chapter three analyzes the relationship between medical school policies and the propensity of promotional payment acceptance later in a physician's career. It shows that some medical school policies affect the likelihood and the size of accepted promotional payment and interactions with the pharmaceutical representatives later in a physician's career. Restrictive medical school meal policies seem to be especially effective in reducing interactions and acceptance of food and beverage-related payments. The study also finds a strong relationship between tenure, physician gender, physician practice size, and propensity to accept promotional payments. It suggests adopting stringent medical school policies to influence payment acceptance behavior later in physicians' careers.
Open Access
School choice impacts within a local school district
(Colorado State University. Libraries, 2012) Chisesi, Lawrence J., author; Cutler, Harvey, advisor; Alves Pena, Anita, committee member; Shields, Martin, committee member; Wallner, Barbara, committee member
In the mid 1990's, changes in Colorado state law and local school district policy resulted in the opening of magnet and charter schools within a school district in Northern Colorado. Parents now had multiple school choice options that were independent of school assignment based on residency. I use student level data to analyze school choice impacts within the district as they unfolded over time. I test first if there are student achievement gains that can be attributed to school choice. In theory, when parents can better match the needs of their children to the offerings at different schools, student achievement should increase. Using multilevel modeling I find little evidence that school choice yields achievement gains compared to residential based school choice, but do find that some schools that offered differentiated curriculums yielded gains. The negative impacts on student achievement attributed to low family income and from when students change schools explain much of the variation in test scores. I next examine how local public schools may compete for students once parents are given expanded school choice rights. Economic theory suggests that competition for students would force lower performing schools to improve or risk losing their students to higher achieving schools. I test to see if the choices that parents make to attend schools outside their neighborhoods are influenced by prior year academic achievement, the income and ethnic composition of a school and changes in the size of a local school's attendance zone. I find that shrinking attendance zones preceded students choicing into other schools, motivating schools to compete for students. Past performance matters as well, but so does the composition of the student body and how representative the student body is of the community that surrounds the school. Parents show preferences to associate with families with similar incomes and ethnic background. Finally, I study how school choice impacts housing decisions. If school choice breaks the link between residency and local schooling then house prices should reflect this change. Parents would be less willing to pay a premium to live near a higher performing school and should receive less of a discount to purchase a home near a lower performing school. Using prices paid by cohorts of home buyers that subsequently placed their children into district schools, I find support for the hypothesis that the house price-school quality link evaporates with school choice and that changes in housing valuations can be modeled as a function of the number of families choicing into and out of school attendance zones. Prices appear to be moving towards an equilibrium whereby local school quality and distance to the assigned school no longer contribute value to the price of a home.
Open Access
Three essays in feminist economics: empirical & historical applications
(Colorado State University. Libraries, 2022) Small, Sarah F., author; Braunstein, Elissa, advisor; Alves Pena, Anita, committee member; Weiler, Stephan, committee member; Canetto, Silvia, committee member
This dissertation includes three essays in feminist economics. The first two are quantitative empirical studies, which study the interactions between paid work, allocations of housework, and intrahousehold power dynamics. Chapter 1 examines the extent to which men extract unpaid household labor from women to support entrepreneurial ventures. Models using Panel Study of Income Dynamics (PSID) data from 1985 to 2019 illustrate that, in married White couples, women's disproportionate share of housework increases when their husbands take on business ownership. However, there is no evidence that White husbands extend such support when their wives own businesses. In Black couples, wives take on even greater housework shares when they own a business. These dynamics suggest that the success of married White men's entrepreneurship may be built on extracting domestic labor from their wives: a notion consistent with patriarchal rent seeking theories. Chapter 2 offers a quantitative test of hegemonic masculinity theory and demonstrates how men of different race and income groups respond to their women partners out-earning them— an economic 'threat' to masculinity. Results indicate in upper-income White men have a strong aversion to the situation in which a woman out-earns her male partner. As hegemonic masculinity theory would suggest, middle-income White men follow suit, but lower income White men, and Black men in most income groups, do not. The third chapter is a qualitative history of Barbara Bergmann's occupational crowding hypothesis. The chapter situates the hypothesis among contemporary competing theories on the economics of discrimination and explains why the crowding hypothesis did not persist as a major explanation of wage differences in the mainstream of the economics profession. Each chapter contributes to the feminist economic mission to overcome androcentric bias in economic analysis, to speak to power, and to extinguish oppression.
Open Access
Three essays in regional economics: migration, regional portfolio theory, resilience, and agglomeration economies
(Colorado State University. Libraries, 2023) Care, Jonathan Charles, author; Weiler, Stephan, advisor; Braunstein, Elissa, committee member; Alves Pena, Anita, committee member; Thilmany, Dawn, committee member
Cities and counties are dynamic entities that experience constant change, generated from both local and external forces. Some locations are rich in natural amenities, others are powerhouses of manufacturing or provide a rich level of services and quality of life to their citizens. Each location maintains a unique set of characteristics that makes it appealing to a given slice of the population and set of business enterprises. Understanding these characteristics and patterns of migration is a substantial focus in the field of regional economics. Researchers attempt to enhance our understanding by examining this phenomenon through a number of different lenses. Some have examined flows to the largest cities in the country and tried to uncover the underlying reasons for the unique advantages these metropolitan areas possess. Others have examined various measures of risk and reward to see which cities or counties outshine their competitors. Still others attempt to measure the appeal of regions by quantifying their natural amenities or investigating their resilience to negative economic events. Recent global events have brought understanding a number of these regional performance topics to the forefront of both academic and mainstream interest. This dissertation examines several aspects of regional economics with an aim to move the conversation forward along several tracks. The first chapter explores the contribution of regional employment portfolio risk and return measures in a case study of county level migration into Colorado. The level of employment data used in the construction of the employment portfolio measures is varied to see which level of aggregation best contributes to the understanding of migration flows. The results show that the employment portfolio composition of a county does play a role in attracting migrants and highlight interesting findings on economy-wide risk versus individual potential returns. Additionally, we find evidence of labor pooling and agglomeration effects for Colorado's largest counties. A lack of cohesion and consistency across sector-level measures of risk and return suggests that local governments should focus on creating a stable overall business environment, rather than attempting to focus on specific sectors. The second chapter discusses the concept of economic resilience and how it complements discussions relating to regional economic growth. A total of seven models are tested, split between two different formulations of measuring resilience. Testing is performed to identify a set of independent variables that robustly contribute as explanatory determinants of resilience. The results identify several determinants of resilience that are robust across different definitions of economic resilience and provide insights that can be used by local policy makers when considering the tradeoffs between balancing growth and resilience. The chapter ends with a discussion of the strengths and weaknesses of existing measures of resilience and the advantages of future work in this area. The final chapter of the dissertation examines the dual, decades-long decline in both migration rates and the level of economic dynamism within the United States. Specifically, the role of information generated by the churn of resources through the economy is explored within the context of county and metropolitan statistical area (MSA) in-migration rates. The difference in average annual in-migration rates is also examined using a three-fold Blinder-Oaxaca decomposition. This study finds that locally generated information on dynamism does contribute to the decision of whether to migrate. In particular, the findings show a unique role for information gained from regional dynamism when considering migration to smaller metropolitan areas, likely resulting from the more homogeneous identity these regions maintain, in comparison to larger, more multi-faceted, metropolitan areas. The overarching goal of this work is to contribute to the literature on why individuals choose to live where they do. The topics examined over the course of this dissertation permeate several veins of the regional economic literature. However, they all work together in the service of the question "what makes a place attractive to in-migrants?" This is accomplished by looking at the risks and returns to regional employment portfolios, the degree to and speed with which regions rebound from recessions, and how information generated by the churn of resources through the economy helps in the decision to migrate. These topics represent three of the drivers among the broad portfolio of factors regional economics utilizes to try and understand behavior within a country.
Embargo
Two essays on entrepreneurship, bankruptcy and employment concentration, and a detour on homelessness
(Colorado State University. Libraries, 2024) Correas, Ignacio Maria, author; Weiler, Stephan, advisor; Alves Pena, Anita, committee member; Bernasek, Alexandra, committee member; Bajtelsmit, Vickie, committee member
This doctoral thesis is composed of two chapters that attempt to explain some of the causes for the decline of entrepreneurship in the United States since the late 1980s, and a third chapter the motivation for which arose while researching the other two. Chapter one looks at the laws protecting certain assets from repossession in the event of personal bankruptcy and their possible influence on entrepreneurship. As the US Supreme Court has repeatedly held that the raison d'être behind the bankruptcy statutes is to provide individuals with an unencumbered "fresh-start" in life, and that this is done both to promote entrepreneurship and for "humanitarian reasons", it was only logical to follow up this chapter with another one exploring whether bankruptcy exemptions indeed offer some relief from destitution. This became the second chapter in this dissertation. Lastly, the third chapter circles back to the topic of entrepreneurship and looks at whether the concentration of economic activity (particularly employment) in larger enterprises, as is the case with the US labor market when compared to other OECD countries, has an effect on new business creation. As stated, chapter one looks at how the changes in personal bankruptcy laws from 1986 to 2017 influence entrepreneurship. There are two components of the bankruptcy law explored in this section: its debt forgiveness or "fresh start" provision, and the protection from repossession that it extends to certain personal asset categories. The paper finds that the implementation of the 2005 BAPCPA law restricting access to debt discharge during bankruptcy was the most detrimental to entrepreneurship of the two, being strongly associated with a decrease in firm creation. Asset exemptions from repossession have an impact on entrepreneurship also, and larger (inflation adjusted) protections are paradoxically linked to fewer start-ups in general. However, this chapter also finds that immediately following a statutory increase in the exemption amounts there is a transitory rise in firm creation which only lasts for two years. The final verdict is that when it comes to personal bankruptcy law, it is debt forgiveness that encourages entrepreneurship; property protections offer at best a temporary boost to new firm creation but are in general detrimental to it. Alas, and since humanitarian reasons have historically and legally been recognized as a second premise for the US personal bankruptcy law, might asset protections during bankruptcy at least help in this regard? The second chapter in this dissertation thus looks at the connection between the rate of homelessness in a state and the bankruptcy laws applicable to that state from 2007 to 2017. More generous homestead exemptions are surprisingly found to be associated with a significant increment in the rate of homelessness that is between 26 and 30 per 100,000 people. The wildcard exemption on the other hand (which can be used for any asset category) has an opposite effect: a one percent increment in its amount, when measured as a percentage of median household income, lowers homelessness by 219 to 230 individuals for every 100,000 people. Traditional economic indicators such as growth in per-capita Gross Domestic Product (GDP) have the foreseeable impact on homelessness, which is in fact not as strong as that of the asset protections: each one percent increase in GDP per-capita lowers homelessness by roughly 2 people per 100,000. Surprisingly, protections shielding filers from having their homes being taken away during bankruptcy are associated with increases in homelessness, whereas similar safeguards applicable to any asset, although comparatively smaller in amount, are effective in reducing it. The last chapter in this dissertation goes back to the topic of entrepreneurship, and explores the effect that workforce concentration in large employers, regardless of their nature, may have on new firm creation. As such the paper serves as a test of the 'Chinitz's hypothesis of agglomeration being the catalyst for local economic dynamics, and it is new in its approach in that it looks at total general employment in a given area (instead of focusing on particular industries), and because it takes into consideration the share of the workforce in large employers both in the private and the public sectors. The analysis uses economic and demographic data at the county level; given the possibility of feedback effects between the variables measuring the share of the workforce in large employers and the creation of new business, an instrumental variable approach is utilized for estimation. The findings in this last chapter confirm the Chinitz hypothesis, while also considering the effect of public sector employment on the private economy: concentration of the workforce in large employers, regardless of their nature, is determined to be a crucial driver for the local economy as it relates to entrepreneurship and is in fact deleterious to firm creation. The evidence from these three essays suggests that bankruptcy debt forgiveness fosters entrepreneurship, but asset exemptions from repossession and employment concentration in large organizations negatively affect it. However, exemptions allowing a would-be filer to shield any item of their choice from repossession, even if they are modest in amount compared to other exemption categories, help in reducing homelessness. After all, people do need boots if they are to pull themselves up by their bootstraps, as Dr Martin Luther King once noted.

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