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- Creators: Dean, W.P. Carey School of Business
- Member of: Barrett, The Honors College Thesis/Creative Project Collection
- Resource Type: Text
- Status: Published
Description
The Patient Protection and Affordable Care Act of 2010 was created as an overhaul of the US Healthcare system with a goal of getting all American citizens and legal residents healthcare that was both affordable and of good quality. Now almost a year removed from it going into effect, this study looks to determine how the ACA has worked in getting individuals who were previously uninsured and required charitable-based healthcare into health insurance programs within a small population in Arizona. This study evaluates the type of insurance program, the quality and ease of access of the care, and the general affordability of the healthcare. This study found that 75% of individuals surveyed had gained health insurance in the last year, with 95% expecting to be insured for 2015. The large majority rated the quality of their care and the accessibility of it as good, with corresponding increased use of primary care providers as a health resource. The affordability of the care was still a major issue for those who were found to be uninsured and for those who were insured. Despite affordability issues, self-reported measures of general health and access to care were reported by the majority of respondents to have improved over the last 12 months.
ContributorsHonan, Timothy Francis (Author) / Ketcham, Jonathan (Thesis director) / Jehn, Megan (Committee member) / Barrett, The Honors College (Contributor) / Department of Chemistry and Biochemistry (Contributor) / School of Historical, Philosophical and Religious Studies (Contributor)
Created2015-05
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
Prenatal care is a widely administered preventative care service, and its adequate use has been shown to decrease poor infant and maternal health outcomes. Today however, in the United States, preterm birth rates remain among the highest in the industrialized world, with low socioeconomic women having the highest risk of preterm births. This group of women also face the greatest barriers to access adequate prenatal care in the United States. This paper explores the viability of short message service to help bridge gaps in prenatal care for low socioeconomic women in the United States and provides areas for further research.
ContributorsMiles, Kelly Nicole (Author) / Ketcham, Jonathan (Thesis director) / Santanam, Raghu (Committee member) / Barrett, The Honors College (Contributor) / W. P. Carey School of Business (Contributor) / Department of Marketing (Contributor) / Department of Finance (Contributor)
Created2014-05
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 thesis uses the Foucauldian model of the biopolitical state to explain the regulation of refugee women’s bodies who have undergone female genital cutting/mutilation (FGC/M). The main theoretical framework for this thesis is inspired by Dr. Khiara Bridges’ work: Reproducing Race: An Ethnography of Pregnancy as a Site of Racialization (2011). Her book explains how “material and societal conditions appear to affirm the veracity of race” (Bridges, 2011, 10). She describes pregnancy as a “racially salient event” that inevitably engages racial politics. In her book, she illustrates how the material body is the primary sign of racial difference (Bridges, 2011, 47). I argue that race and culture are inscribed in the body, and FGC/M is a physical representation of that inscription. As a result, a physical representation of racialization opens women with FGC/M to far more scrutiny and regulation. I define the United States and France as biopolitical states whose values and agendas regulate and police bodies to behave according to their norms. The value set that underlies the United States is predicated on principles of sovereignty, federalism, and an emphasis on a Puritanical work ethic where an individual must earn their benefits from the state. In France, however, there is less stigma surrounding social welfare but there is forced cultural assimilation that results in a singular, secular French identity. These value systems then inform the tools to police behavior. The tools, or systems, I have identified for this thesis are the adoption of human rights instruments into domestic law, refugee policy, healthcare systems, and regulation of women’s reproductive health. All of these macro-level systems then inform individual patient-provider relationships since those interactions are not independent of these systems. I argue that refugee women who have undergone FGC/M deviate from these prescribed norms and thus are subjugated to overwhelming biopolitical regulation.
ContributorsRamakumar, Asha Anjali (Author) / Reddy, Swapna (Thesis director) / Switzer, Heather (Committee member) / College of Health Solutions (Contributor) / Dean, W.P. Carey School of Business (Contributor) / School of Social Transformation (Contributor) / Barrett, The Honors College (Contributor)
Created2020-05
Description
The purpose of this analysis is to determine the economic impact that the distribution of the SolarSPELL digital library system to Peace Corps volunteers in Vanuatu will have on the citizens of Vanuatu by quantifying the potential for SolarSPELL and its health education content to reduce rates of certain illnesses and thereby reduce the demands on the Vanuatu healthcare system. The research was carried out by researching the most prominent non-communicable diseases in Vanuatu that could be affected by lifestyle changes as a result of exposure to the health education content on the SolarSPELL and determining the expected changes in rates of each non-communicable disease as well as the expected changes in the individual and hospital costs, the loss of income due to missed work, transport costs within Vanuatu, and international medical evacuation costs. Ultimately, these costs were collectively reduced by approximately 2.046% due to SolarSPELL intervention, a reduction of approximately $7,000. However, given the limited scope of available information within the healthcare system of Vanuatu, it can be inferred that the impact of the distribution of the SolarSPELL is likely significantly larger. Consequently, it is recommended that the Vanuatu Ministry of Health, the SolarSPELL team, and the Peace Corps implement policies to increase the volume of healthcare data collected in Vanuatu in order to assist in future analyses of the healthcare system.
ContributorsErspamer, Brett Thomas (Author) / Ross, Heather (Thesis director) / Silverman, Daniel (Committee member) / Dean, W.P. Carey School of Business (Contributor) / Department of Economics (Contributor) / Barrett, The Honors College (Contributor)
Created2019-05
Description
Upon analyzing the literature that is available on refugee populations in conjunction with our personal experiences with these populations, we ultimately decided to develop a mobile app that targeted the source of the numerous disparities we saw. These disparities ranged from increased prevalence of chronic diseases to difficulty in going to doctor's appointments due to transportation challenges. We focused on the three areas of government assistance, clinical health, and general well-being through our mobile app, Refugee Aid Initiative. This mobile app is designed to provide refugee populations with the resources necessary to build healthier, happier, and more independent lives for themselves and their families. Here, we focus on not only highlighting resources that are available but also adding supplementary information that helps refugee populations fully take advantage of the resources that are available to them.
ContributorsElsabbagh, Zaid (Author) / Bcharah, George (Co-author) / Sellner, Erin (Thesis director) / Jakubczak, Laura (Committee member) / Barrett, The Honors College (Contributor) / Dean, W.P. Carey School of Business (Contributor) / School of Life Sciences (Contributor)
Created2022-05
Description
The United States healthcare system plays a very important role in everyone’s lives. Americans rely on the system for their overall health and well-being. It is imperative that all Americans have equal access to and quality of healthcare services and healthcare should not differentiate between minorities and nonminorities. The Hispanic population does not have or receive equitable healthcare in comparison to their nonHispanic white counterparts. Due to extreme gaps in quality of and access to care, Hispanics are at risk to endure worse health outcomes. This review dives into defining the necessary definitions of healthcare and racial disparities, looks at what causes these disparities and gaps in care, what outcomes are more prevalent in the Hispanic American population because of the inequities, what solutions are already in place to combat these issues and finally, what solutions need to be implemented at the administration level of healthcare organizations to better treat the Hispanic population in the ways in which they deserve.
ContributorsFaltz, Jaclyn (Author) / Don, Rachael (Thesis director) / Reddy, Swapna (Committee member) / Barrett, The Honors College (Contributor) / Dean, W.P. Carey School of Business (Contributor) / School of International Letters and Cultures (Contributor)
Created2022-05