Theses and Dissertations at Montana State University (MSU)
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Item Does direct primary care affect medicare opt-out rates? Evidence from state business of insurance legislation(Montana State University - Bozeman, College of Agriculture, 2022) Vogel, Trevor Jacob; Chairperson, Graduate Committee: Mariana CarreraPast economic research has examined factors influencing the degree to which physicians accept assignment from Medicare and allow new Medicare patients into their practice. There is no known examination of physicians' decision to opt out of Medicare completely. I study this decision in the context of Direct Primary Care, a growing alternative to fee-for-service healthcare delivery in the United States that has been enabled by state-level policy shielding DPC practitioners from insurance regulations. Using the publicly available National Provider Identifier Registry and Opt- Out Affidavit datasets in a difference-in-difference framework, I study the effect of said policy on the propensity of physicians to opt out of Medicare. In my main analysis, I estimate that treatment increases the likelihood of family physicians opting out by 38 - 46% of the panel's baseline opt-out rate, but find no consistent effect on internal medicine providers. This relationship is valuable for policymakers and healthcare providers to keep in mind in evaluating DPC and possible Medicare reform.Item Budgeting by the ballot : a look at the Montana initiative process(Montana State University - Bozeman, 1982) Wessel, MarilynItem Development and analysis of the interest-group theory of government(Montana State University - Bozeman, College of Agriculture, 1984) Engen, Eric MathisItem Midwives in Montana : historically informed political activism(Montana State University - Bozeman, College of Letters & Science, 2013) Hill, Jennifer Janna; Chairperson, Graduate Committee: Mary MurphyStates contiguous to Montana legalized direct-entry midwifery only in the 21st century, while the Montana legislature exempted lay midwives from the Medical Practice Act during the 1989 legislative session and approved a licensing protocol for Certified Professional Midwives in 1991. Midwives in Montana examines the historical context of the legalization of midwifery in Montana and identifies significant individuals, groups, and events in the confrontation over home birth in the state. Based on oral histories of legislative participants and drawn from primary and secondary source materials held by individuals and institutions throughout the state, this research compiles scattered documentary evidence to present the history of Montana midwives from territorial days through the legislative events of 1989 and 1991. The efforts of midwifery supporters in the Montana legislature prevailed over organized and well-funded opposition from individual physicians, medical organizations, and hospitals, and resulted in statutory changes that enabled the licensing of homebirth midwives. With a strong rural representation, the 1989 legislative body supported the availability of midwifery care for constituents unable to access urban medical centers. The lobbying strategy employed by midwifery advocates embodied a sophisticated understanding of the conflict between midwives and institutionalized medicine and utilized beliefs about gender and Montana identity to enable legislative success. Additionally, the individuals most closely involved in the lobbying process remained committed to a clearly defined agenda. As a result of their efforts, Montana became the ninth state in the nation to legalize and license homebirth midwives and remains a national leader in homebirth midwifery care.Item An analysis of the enactment of anti-price gouging laws(Montana State University - Bozeman, College of Agriculture, 2008) Davis, Cale Wren; Chairperson, Graduate Committee: Randal R. Rucker.Anti-price gouging (APG) laws are state-level price controls only effective during times of emergency. From standard economic analysis, there are no apparent beneficiaries from price ceilings. Thus, the enactment of APG laws is puzzling from an economic perspective. The passage of APG laws is first analyzed with case studies of all thirty-one state laws. The case studies include information such as disasters that triggered the enactment of the laws, detail on enforcement and penalties, and information on supporters and opponents. This information is used to help determine why policymakers enact the laws. From the case studies, it is apparent that state officials devote significant resources to enforcing APG laws. Thus, it can be concluded that APG are not symbolic, toothless measures. A general lack of understanding of markets also appears to play a role in the laws' enactments.