Data Sources: I use the Healthcare Cost and Utilization Project’s Nationwide Inpatient Sample (NIS) from 2000 to 2011. The NIS is a 20% sample of all inpatient claims. The Manhattan Institute supplied data on the availability of health savings accounts in each state. State PTR implementation dates were gathered by Hans Christensen, Eric Floyd, and Mark Maffett of University of Chicago’s Booth School of Business by contacting the health department, hospital association, or website controller in each state.
Study Design: The NIS data was collapsed by procedure, hospital, and year providing averages for the dependent variable, Cost, and a host of covariates. Cost is a product of Total Charges within the NIS and the hospital’s Cost to Charge ratio. A new binary variable, PTR, was defined as ‘0’ if the year was strictly less than the disclosure website’s implementation date, ‘1’ for afterwards, and missing for the year of implementation. Then, using multivariate OLS regression with fixed effect modeling, the change in cost from before to after the year of implementation is estimated.
Principal Findings: The analysis estimates the effect of PTR to decrease the average cost per procedure by 7%. Specifications identify within state, within hospital, and within procedure variation, and reports that 78% of the cost decrease is due to within-hospital, within-procedure price discounts. An additional model includes the interaction of PTR with the prevalence of health savings accounts (hereafter, HSAs) and procedure electivity. The results show that PTR lowers costs by an additional 3 percent with each additional 10 percentage point increase in the availability of HSAs. In contrast, the cost reductions from PTR were much smaller for procedures more frequently coded as elective.
Conclusions: The study concludes price transparency regulations can lead to a decrease in a procedure’s costs on average, primarily through price discounts and slightly through lower cost procedures, but not due to patients moving to cheaper hospitals. This implies that hospitals are taking initiative and lowering prices as the competition’s prices become publically available suggesting that hospitals – not patients – are the biggest users of price transparency websites. Hospitals are also finding some ways to provide cheaper alternatives to more expensive procedures. State regulators should evaluate if a better metric other than charge prices, such as expected out-of-pocket payments, would evoke greater patient participation. Furthermore, states with higher prevalence of HSAs experience greater effects of PTR as expected since patients with HSAs have greater incentives to lower their costs. Patients should expect a shift towards plans that offer these types of savings accounts since they’ve shown to have a reduction of health costs on average per procedure in states with higher prevalence of HSAs.
This research paper focuses on how the idea of suffering has evolved over time in the United States healthcare system. Different aspects like long vs short-term illnesses, bias, and more were inspected to determine how they play a part in increased or decreased patient suffering. The final determination of how suffering in the system has evolved and what to do with this information is also discussed.
The United States spends far more on healthcare than other developed countries, and it is increasing at a rapid pace that places intense financial pressure on the American public. The high levels of spending are not attributable to increased quality of care or a healthier general population. Rather, the culprits are a combination of uniquely American social and cultural factors that increase the prevalence of chronic illness coupled with a large and complex healthcare industry that has a multitude of stakeholders, each with their own motivations and expense margins that inflate prices. Additionally, rampant lack of transparency, overutilization and low-quality care contribute to unnecessarily frequent and expensive payments. Public and private institutions have implemented legislation and programs that provide temporary relief, but powerful lobbying efforts by healthcare-related organizations and a general American aversion to high government involvement have prevented the United States from creating effective, long-lasting reform.
The outlying cities of Phoenix's West Metropolitan experienced rapid growth in the past ten years. This trend is only going to continue with an average expected growth of 449-891% between 2000 and 2035 (ADOT, 2012). Phoenix is not new to growth and has consistently seen swaths of people added to its population. This raises the question of what happened to the people who lived in Phoenix's West Valley during this period of rapid change and growth in their communities? What are their stories and what do their stories reveal about the broader public history of change in Phoenix's West Valley? In consideration of these questions, the community oral histories of eight residents from the West Valley were collected to add historical nuance to the limited archival records available in the area. From this collection, the previous notion of "post-war boomtowns” describing Phoenix’s West Valley was revealed to be highly inaccurate and dismissive of the residents' experiences who lived and formed their lives there.
The outlying cities of Phoenix's West Metropolitan experienced rapid growth in the past ten years. This trend is only going to continue with an average expected growth of 449-891% between 2000 and 2035 (ADOT, 2012). Phoenix is not new to growth and has consistently seen swaths of people added to its population. This raises the question of what happened to the people who lived in Phoenix's West Valley during this period of rapid change and growth in their communities? What are their stories and what do their stories reveal about the broader public history of change in Phoenix's West Valley? In consideration of these questions, the community oral histories of eight residents from the West Valley were collected to add historical nuance to the limited archival records available on the area. From this collection, the previous notion of "post-war boomtowns” describing Phoenix’s West Valley was revealed to be highly inaccurate and dismissive of the residents' experiences who lived and formed their lives there.
Many would contend that the United States healthcare system should be moving towards a state of health equity. Here, every individual is not disadvantaged from achieving their true health potential. However, a variety of barriers currently exist that restrict individuals across the country from attaining equitable health outcomes; one of these is the social determinants of health (SDOH). The SDOH are non-medical factors that influence the health outcomes of an individual such as air pollution, food insecurity, and transportation accessibility. Each of these factors can influence the critical illnesses and health outcomes of individuals and, in turn, diminish the level of health equity in affected areas. Further, the SDOH have a strong correlation with lower levels of health outcomes such as life expectancy, physical health, and mental health. Despite having influenced the United States health care system for decades, the industry has only begun to address its influences within the past few years. Through exploration between the associations of the SDOH and health outcomes, programming and policy-making can begin to address the barrier to health equity that the SDOH create.