Matching Items (13)
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- All Subjects: healthcare
- Creators: School of International Letters and Cultures
- 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
Human trafficking is not only a social injustice, but also a major global health problem, that our communities cannot ignore. Despite the common misconception that trafficking is only seen in foreign countries or is only related to immigrants, the U.S. is known to be a major trafficking market and destination, with trafficking reported in all 50 states (Bladwin et al., 2011; Shandro et al., 2016; Dovydaitis, 2010). Although trafficking victims are unlikely to have appropriate access to health care, as much as 80% of sex trafficking victims have reported that they encountered a medical professional while under their traffickers' control and went unidentified at the time (Baldwin et al., 2011; Shandro et al., 2016). This exemplifies a serious missed opportunity for intervention. Health care providers should be prepared to identify and care for victims of trafficking as part of their routine clinical practice. This thesis aims to describe trafficking victims' encounters in U.S. health care settings, to assess health care professionals' and students' awareness, knowledge, and beliefs on trafficking, to examine the impact of an educational intervention on this populations' knowledge/belief changes, and to ultimately spread education about this issue to a wide array of communities.
ContributorsFelix, Kaitlyn Nicole (Author) / Larkey, Linda (Thesis director) / Calvin, Samantha (Committee member) / School of Nutrition and Health Promotion (Contributor) / School of International Letters and Cultures (Contributor) / Barrett, The Honors College (Contributor)
Created2018-05
Description
This research will focus on identifying healthcare disparities among different groups of people in Maricopa County, with a focus on the Phoenix area. It takes form in a combination of a review of previously existing data, surveying pregnant women about their health insurance situations before their pregnancies, and surveying college students in Maricopa County about their past and current health insurance situations. The pregnant women who were interview were part of a study called Metabolism Tracking During Pregnancy through the School of Nutrition and Health Promotion at Arizona State University. College students who were interviewed were recruited online and all participants were choosing to respond. This research paper will focus on policies currently in place to try to address healthcare disparities and establishing the presence of healthcare disparities that are preexisting, and using individual responses from a small sample size of minorities and women to represent the larger Phoenix population. Differences in healthcare spending for different groups of people will also be analyzed in order to establish disparities present. This research is significant because if healthcare equality is the goal, then spending distribution to each should be proportional to the size of each subpopulation.
ContributorsGeiser, Rachel (Author) / Reifsnider, Elizabeth (Thesis director) / Cortese, Denis (Committee member) / School of Molecular Sciences (Contributor) / School of International Letters and Cultures (Contributor) / School of Politics and Global Studies (Contributor) / Barrett, The Honors College (Contributor)
Created2018-05
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
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
Due to the COVID-19 pandemic, pre-health individuals around the world encountered a range of challenges. Research and internship opportunities were cancelled, clinical experience was unreachable, and prerequisites became more demanding in a remote setting. I myself was working in a research lab in Switzerland when the pandemic was declared, resulting in my career-altering internship to be cut short six months. My life-long friend, Alejandra, had the same experience and reached out to me with an extraordinary idea to unite and empower pre-health individuals on a national level. With my skills in event planning combined with her vision, we built the National Pre-Health Conference (NPHC): a 3-day virtual event for pre-health individuals to explore medical careers and learn how to pursue their professional goals, particularly during these uncertain times. We held our inaugural conference with the theme A Future in Medicine in 2020 with over 1000 attendees from around the country. In 2021, we held our second-annual conference with the theme Unity in Healthcare with over 1000 attendees as well. In addition to planning the second-annual NPHC, I employed pre-event and post-event surveys to assess the confidence level of attendees before and after the conference in healthcare experience, research experience, standardized testing, community service, academics, essay writing, and completing graduate/professionals school applications. We found that NPHC improved the confidence level of attendees in all categories. Overall, understanding how NPHC benefits pre-health students will help our team improve for future conferences.
ContributorsChildress, Alexia (Author) / Compton, Carolyn (Thesis director) / Lynch, John (Committee member) / Barrett, The Honors College (Contributor) / School of International Letters and Cultures (Contributor) / School of Life Sciences (Contributor)
Created2021-12
Description
Despite differences in schooling and clinical experience prior to practice, advanced practice providers often have similar scopes of practice, which raises concerns about the quality of care being provided. In this paper, we explore if prescribing patterns are comparable between provider types by comparing differences in time spent on pharmacological interventions utilizing a simulated healthcare environment. Physicians (MDs and DOs), Nurse Practitioners (NPs), and Physician Assistants (PAs) actively practicing in Family Practice/Medicine or Internal Medicine in the U.S. state license/recognition were recruited at healthcare conferences and simulation centers. Participants were provided 20 minutes to complete the patient consultation on a Standardized Patient (SP) presenting with a chief complaint of a post-hospitalization follow-up for heart failure, fatigue, and some edema. All encounters were recorded and uploaded to be reviewed by undergraduate evaluators, who were responsible for quantifying the amount of time the participants spent on each of the task categories, including pharmacologic interventions. With a total of 46 participants in this study, the average amount of time spent discussing this activity per visit across each provider type was 14.8 seconds for MDs/DOs, 29.2 seconds for NPs, and 38.8 seconds for PAs. The results of this study suggest that PAs (p= 0.0028) spent significantly more time discussing pharmacological interventions and were significantly more likely to discuss pharmacological interventions (p=0.0243) when compared with physicians (MD/DOs). It is important to note that the sample size of PAs was very small (N=9), which could potentially skew the results and not be representative of the population. With limited literature that examines whether time spent discussing pharmacological interventions is comparable across provider types, it is important for more simulated healthcare research to be conducted on this topic.
ContributorsSeifert, Sabrina (Author) / Paredes, Addlena (Co-author) / Green, Ellen (Thesis director) / Reifsnider, Elizabeth (Committee member) / Barrett, The Honors College (Contributor) / School of International Letters and Cultures (Contributor) / School of Life Sciences (Contributor)
Created2023-05