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- All Subjects: healthcare
- All Subjects: Survey
- Creators: School of Human Evolution & Social Change
- Creators: Department of Supply Chain Management
- Member of: Barrett, The Honors College Thesis/Creative Project Collection
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.
Creation of a database and Python API to clean, organize, and streamline data collection from an updated Qualtrics survey used to capture applicant information for the Fleischer Scholars Program run by the W. P. Carey UG Admissions Office.
Due to the COVID-19 pandemic, declared in March of 2020, there have been many lifestyle changes which have likely influenced tobacco smoking behavior. Such lifestyle changes include lockdowns, stay at home orders, reduction in social cues related to smoking, increased stress, and boredom among other things. This study utilized a cross-sectional survey which looked into these behaviors, primarily perceived risk to COVID-19, and determined if there is an association between perceived risk and education level/race. Education level is a proxy for income and material resources, therefore making it more likely that people with lower levels of education have fewer resources and higher perceived risk to negative effects of COVID-19. Additionally, people of color are often marginalized in the medical community along with being the target of heavy advertising by tobacco companies which have likely impacted risk to COVID-19 as well.
Creation of a database and Python API to clean, organize, and streamline data collection from an updated Qualtrics survey used to capture applicant information for the Fleischer Scholars Program run by the W. P. Carey UG Admissions Office.