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- All Subjects: healthcare
- Creators: College of Health Solutions
- Creators: Department of Supply Chain Management
- Resource Type: Text
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.
Building on research on family communication and forgiveness, this study seeks to understand how families communicate the value and practice of forgiveness. Through semi-structured interviews, the study asks participants to recall their formative conversations and experiences about forgiveness with their family members and to discuss how those conversations influenced their current perspectives on forgiveness. Interviews from five female undergraduate students yielded seven main themes from where individuals learn how to forgive: 1) Sibling conflicts, 2) Family conversations about friendship conflicts, 3) Conversations with Mom, 4) Living by example, 5) Take the high road, 6) “Life’s too short”, and 7) Messages rooted in faith and morality.
The objective of this thesis is to further understand the obstacles that impoverished families face, which may include: meeting nutritional needs, an earlier introduction to violence, or struggles with family planning. It is crucial to illustrate the effects of poverty on the physical, mental, and emotional health of both children and caregivers. Additionally, the family dynamics and educational challenges for children will also be explored as supplemental research. This study will draw upon psychological theories with an emphasis on maternal and child health. The goal is to empower families to make informed family planning decisions. This project will be focused on supporting families in low-income areas, particularly in Arizona