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- Creators: School of International Letters and Cultures
- Creators: Department of Supply Chain Management
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Description
Objective: To assess and quantify the effect of state’s price transparency regulations (hereafter, PTR) on healthcare pricing.
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.
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.
ContributorsSabol, Joshua Lawrence (Author) / Reiser, Mark (Thesis director) / Ketcham, Jonathan (Committee member) / Dassanayake, Maduranga (Committee member) / Barrett, The Honors College (Contributor) / School of Mathematical and Statistical Sciences (Contributor) / Department of Supply Chain Management (Contributor)
Created2015-05
Description
2015 marks the deadline for the UN Millennium Development Goal 5 to reduce global maternal mortality rate (MMR) by 75% since 1990. As of 2015, MMR has only been reduced by 45%. Many international organizations claim that more medically trained midwives can meet global maternal health care needs. This study investigates two major questions. What is the role of midwives in diverse international maternal healthcare contexts? How do midwives in these different contexts define their roles and the barriers to providing the best care for women? From May to August 2015, I conducted over 70 interviews with midwives in Netherlands, Sweden, Rwanda, Bangladesh, Australia and Guatemala, interviewing between 6 and 13 midwives from each country. The majority of midwives defined their roles as supporting women's individual capacities and power through normal birth, and knowing when to refer when high-risk complications arise. Although thematic barriers vary by country, midwives in all countries believed that maternal healthcare can be improved by increased collaboration between midwives and other health care professionals, better access to culturally appropriate services, and greater public awareness of the role of midwives.
ContributorsCarson, Anna Elizabeth (Author) / Hruschka, Daniel (Thesis director) / Maupin, Jonathan (Committee member) / School of International Letters and Cultures (Contributor) / School of Human Evolution and Social Change (Contributor) / Barrett, The Honors College (Contributor)
Created2016-05
Description
This paper examines the relationship between feminism and social media and evaluates the ability of social media to function as an effective platform for the advancement of feminism's objectives. In the decades before social media became an integral part of culture, the popularity of feminism deteriorated and feminist voices were unsure that it could be revived or popularized again. However, in recent years, women have used social media as a mechanism to communicate and disseminate feminist ideas. The birth of what is called "hashtag feminism" has been a fundamental shift in the way feminism is done and advocated for in modern culture. In light of this dramatic shift in venue for feminist conversations, academic feminists are asking a series of pertinent questions: Is social media good for feminism and the achievement of feminist objectives? What, if anything, has feminism compromised in order to fit into 140 characters or fewer? This paper argues that social media has provided a platform for feminists to share their stories, which has aided in the building of feminist constituencies. This is the most important work of feminism, because it is making society more receptive to feminist principles and ideas, transforming our culture into one that can accept and fight for feminism's objectives. This paper will examine a series of case studies in which social media has hosted feminist conversations. It will analyze the impact of this social media as a venue for feminist narratives and evaluate the use of social media as a feminist platform in the movement to achieve feminism's objectives.
ContributorsGiel, Katelyn Anne (Author) / Woodall, Gina (Thesis director) / Lake, Milli (Committee member) / School of Politics and Global Studies (Contributor) / School of International Letters and Cultures (Contributor) / Barrett, The Honors College (Contributor)
Created2015-12
Description
This article summarizes exploratory research conducted on private and public hospital systems in Australia and Costa Rica analyzing the trends observed within supply chain procurement. Physician preferences and a general lack of available comparative effectiveness research—both of which are challenges unique to the health care industry—were found to be barriers to effective supply chain performance in both systems. Among other insights, the ability of policy to catalyze improved procurement performance in public hospital systems was also was observed. The role of centralization was also found to be fundamental to the success of the systems examined, allowing hospitals to focus on strategic rather than operational decisions and conduct value-streaming activities to generate increased cost savings.
ContributorsBudgett, Alexander Jay (Author) / Schneller, Eugene (Thesis director) / Gopalakrishnan, Mohan (Committee member) / Barrett, The Honors College (Contributor) / Department of Supply Chain Management (Contributor) / Department of English (Contributor)
Created2015-05
Description
The healthcare industry is currently facing significant changes. One of the changes in the industry is a movement towards patient-focused care, which considers the patient as a person and the impact of care on the person. Patient experience is part of patient-focused care, and has similarities to the marketing term customer experience, which contributes to happier customers and long-term financial growth and success for businesses. This thesis defines current issues in patient experience as it relates to hospital manager decision making. Through secondary research, this thesis demonstrates what patient experience is, the role it plays in healthcare and hospital settings, the pressures on hospitals to increase patient experience performance, how patient experience performance is measured, and what strategies or action drive improvements under current performance measurements. Many studies and articles exist examining each of these issues individually. However, these sources do not comprehensively define patient experience in hospitals with perspective on how this influences hospital strategy and decision-making. Previous works on patient experience from the perspective of hospital strategy do not include considerations for recent industry shifts, most notably the Patient Protection and Affordable Care Act. The collected definitions in this thesis provide guidance of relevant concerns hospital managers consider when formulating organization-wide strategy related to patient experience. This thesis explains how patient experience contributes to the success of hospitals in the short-term, medium-term, and long-term and how patient experience may shift its focus over time. Short-term concerns include specific regulations and definitions from the Centers for Medicare and Medicaid services, responsible for over half of all payments to hospitals. Conforming to CMS standards is a matter of survival for most hospitals in the short-term. Hospitals are adjusting to rules and payment models not in existence just two years ago. First, hospitals will adapt, and then hospitals will strive to optimize under new standards as well as respond to adjustments in the rules over the next several years. After patient experience standards are well established, certain aspects of patient experience will be part of long-term differentiation and success for hospitals. Responding comprehensively to the shift towards improving patient experience is a critical aspect for hospitals to weather the many changes in the healthcare industry. Patient experience will provide better care to patients and better financial health to the hospitals that perform above patient experience standards.
ContributorsWilton, Kara Alexandra (Author) / Ketcham, Jonathan (Thesis director) / Ostrom, Amy (Committee member) / Barrett, The Honors College (Contributor) / W. P. Carey School of Business (Contributor) / Department of Supply Chain Management (Contributor) / Department of Marketing (Contributor)
Created2014-05
Description
This longitudinal study examines the relations of anger, gender, and intrusive maternal parenting to empathy in toddlers. Participants (247 toddlers at the initial assessment) were assessed in a laboratory at approximately 18 (T1, N = 247), 30 (T2, N = 216), and 42 (T3, N = 192) months of age. Toddlers' observed anger was measured during a toy removal task and maternal intrusiveness was observed during free play between mother and toddler. Reported empathy was measured using questionnaires completed by mothers and fathers. At 18 months, a positive relation between observed anger and reported empathy was found for boys, but not for girls. At 30 months, maternal intrusiveness positively predicted empathy in boys, but it negatively predicted empathy in girls. These findings provide insight about sex differences in the development of empathy and concern for others in early childhood.
ContributorsTravis, Katherine Elizabeth (Author) / Eisenberg, Nancy (Thesis director) / Spinrad, Tracy (Committee member) / Eggum, Natalie (Committee member) / Barrett, The Honors College (Contributor) / School of International Letters and Cultures (Contributor) / Department of Psychology (Contributor)
Created2013-05
Description
The Science of Water Art project is a collaborative work that brings together professionals, community members, college students and children to think about the role that water plays in each of our lives. Using a sample of 4th grade classrooms in Maricopa County, over 3000 drawings of children's perception of water today and in the future were collected. The 9-11 year olds were asked to draw pictures of 1) how they saw water being used in their neighborhood today (T1), and 2) how they imagined water would be used in their neighborhood 100 years from now (T2). The artwork was collected and coded for nine different themes, including: vegetation, scarcity, pollution, commercial sources of water, existing technology, technology innovation, recreational use, domestic use, and natural sources of water. Statistically significant differences were found between boys and girls for vegetation, technology and domestic use themes. This project allows for a look into how climate change and water insecurity is viewed by younger generations and gives a voice to children so that they may share their outlooks on this vital resource.
ContributorsVins, Holly Elizabeth (Author) / Wutich, Amber (Thesis director) / Newland, Judy (Committee member) / Beresford, Melissa (Committee member) / Barrett, The Honors College (Contributor) / School of International Letters and Cultures (Contributor) / School of Social Transformation (Contributor) / School of Human Evolution and Social Change (Contributor)
Created2013-05
Description
Short-term medical volunteer work via a nongovernmental organization is a popular tool for students in the health care field to gain experience, while further providing communities that normally lack health care options the opportunity to receive free care. One such organization, VIDA Volunteer Travel, has been successful in implementing this model in Central America. However, organizations of this form have not been evaluated for effectiveness or improvement. This exploratory study examines the effectiveness of VIDA based on six qualifying characteristics that make up a successful NGO. The researcher conducted in-depth, semi-structured interviews with 21 individuals, including VIDA staff members in Costa Rica and Nicaragua, health professionals working for VIDA, local community leaders, and volunteers participating in VIDA's programs. Summaries and quotes of these interviews were uploaded and analysed using Atlas.ti to identify common words and themes from the interviews. Informants frequently identified the organization as sustainable, both from a fiscal and ecological standpoint. The organization also successfully managed volunteers, although post-trip follow-up was lacking. Adherence to the mission statement and distribution of supplies allowed for improved organization and successful structure of the organization. Education and health promotion was also emphasized, although implementation of this education into the communities was lacking. Collaboration with the community and volunteers allowed for stringent, successful treatment to be given to patients, and ethical guidelines set up by the organization allowed for self-governance and improvement of the NGO. This study suggests future research opportunities for the organization, to evaluate its own impact and opportunities for improvement. Furthermore, suggestions are addressed that allow the organization to improve upon its well-implemented infrastructure, and allow for future organizations to use VIDA as a model for improvement.
ContributorsPearson, Presley Kyle (Author) / Yoshioka, Carlton (Thesis director) / Wang, Lili (Committee member) / Larsen, Dale (Committee member) / Barrett, The Honors College (Contributor) / School of International Letters and Cultures (Contributor)
Created2013-05
DescriptionThis thesis is a series of essays on the evolution of queer expressions of gender & sexuality in the Star Trek Universe. This project spans the entire history of the franchise but focuses primarily on the Star Trek series Deep Space Nine, Voyager, and Discovery.
ContributorsStargazer, Sisko James (Author) / Himberg, Julia (Thesis director) / Vlahoulis, Michelle (Committee member) / School of Social Transformation (Contributor) / School of International Letters and Cultures (Contributor) / Department of English (Contributor) / Barrett, The Honors College (Contributor)
Created2020-12
Description
Women, Peace, and Security (WPS) practitioners (including policymakers, scholars, and nonprofit leaders) in the U.S. and Canada have often focused their attention on the United Nations’ WPS initiative as a strategy for responding to conflicts abroad, particularly in the Global South. As a result of these limitations, black, Latino, and Indigenous advocates and peacebuilders in the U.S. and Canada remain largely unable to take advantage of WPS frameworks and resources. The subjectivity of the term “conflict” and the range of circumstances where it is used inspire this research. The selective application of the word “conflict” is itself a challenge to security, for conflicts can only be addressed once they are acknowledged and so named. Where does WPS intersect with contemporary Indigenous advocacy? A case study of the #noDAPL movement and the ways that nonviolence and women’s leadership emerged at Standing Rock, ND in 2016 provide a partial answer. Four challenges and recommendations are offered to WPS practitioners who seek to expand the availability of WPS resources to Indigenous peoples in the U.S. and Canada. These challenges and recommendations draw upon existing National Action Plans, legal and policy documents, and data from four interviews conducted with Indigenous women advocates in the U.S. and Canada in 2019. Above all, this paper seeks to encourage WPS practitioners to move beyond “gender mainstreaming” to consider not only how policies and practices impact women and men differently, but also how they may impact Indigenous people and settlers differently.
ContributorsMarques de Mesquita, Carolina (Author) / Lomawaima, K Tsianina (Thesis director) / O'Connor, Brendan (Committee member) / School of International Letters and Cultures (Contributor) / School of Politics and Global Studies (Contributor) / School of Social Transformation (Contributor) / Department of English (Contributor) / Barrett, The Honors College (Contributor)
Created2019-05