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- Creators: School of Molecular Sciences
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Description
This study investigates how the patient-provider relationship between lesbian, gay, and bisexual women and their healthcare providers influences their access to, utilization of, and experiences within healthcare environments. Nineteen participants, ages 18 to 34, were recruited using convenience and snowball sampling. Interviews were conducted inquiring about their health history and their experiences within the healthcare system in the context of their sexual orientation. The data collected from these interviews was used to create an analysis of the healthcare experiences of those who identify as queer. Although the original intention of the project was to chronicle the experiences of LGB women specifically, there were four non-binary gender respondents who contributed interviews. In an effort to not privilege any orientation over another, the respondents were collectively referred to as queer, given the inclusive and an encompassing nature of the term. The general conclusion of this study is that respondents most often experienced heterosexism rather than outright homophobia when accessing healthcare. If heterosexism was present within the healthcare setting, it made respondents feel uncomfortable with their providers and less likely to inform them of their sexuality even if it was medically relevant to their health outcomes. Gender, race, and,socioeconomic differences also had an effect on the patient-provider relationship. Non-binary respondents acknowledged the need for inclusion of more gender options outside of male or female on the reporting forms often seen in medical offices. By doing so, medical professionals are acknowledging their awareness and knowledge of people outside of the binary gender system, thus improving the experience of these patients. While race and socioeconomic status were less relevant to the context of this study, it was found that these factors have an affect on the patient-provider relationship. There are many suggestions for providers to improve the experiences of queer patients within the healthcare setting. This includes nonverbal indications of acknowledgement and acceptance, such as signs in the office that indicate it to be a queer friendly space. This will help in eliminating the fear and miscommunication that can often happen when a queer patient sees a practitioner for the first time. In addition, better education on medically relevant topics to queer patients, is necessary in order to eliminate disparities in health outcomes. This is particularly evident in trans health, where specialized education is necessary in order to decrease poor health outcomes in trans patients. Future directions of this study necessitate a closer look on how race and socioeconomic status have an effect on a queer patient's relationship with their provider.
ContributorsRajan, Sindhu (Co-author) / Bradley, Arianna (Co-author) / Larson, Michelle (Co-author) / Alvarado, Aimee (Co-author) / Ingram-Waters, Mary (Thesis director) / Arnold, Michelle (Committee member) / School of Molecular Sciences (Contributor) / School of Social Transformation (Contributor) / T. Denny Sanford School of Social and Family Dynamics (Contributor) / College of Public Service and Community Solutions (Contributor) / School of Human Evolution and Social Change (Contributor) / School of Historical, Philosophical and Religious Studies (Contributor) / School of Life Sciences (Contributor) / Barrett, The Honors College (Contributor)
Created2016-05
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
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
The purpose of this thesis is to gain a more nuanced understanding of what research is currently going on in the academic realm of supply chain management. This thesis is composed of two parts. The first part contains summaries and personal takeaways from four different supply chain management seminars that were put on by professors who were visiting the ASU campus. These seminars include general topics such as RFID readability, supply chain cash conversion cycles, risk management within the healthcare supply chain, and building trust and trustworthiness in global business. The second part of the thesis will then use a literature review to expand upon the topic of risk management within the healthcare supply chain, and to explore how previous research ties into the current happenings of the industry, as well as its future implications.
ContributorsHemzacek, Noah (Author) / Printezis, Antonios (Thesis director) / Choi, Thomas (Committee member) / Department of Finance (Contributor) / Department of Supply Chain Management (Contributor) / Barrett, The Honors College (Contributor)
Created2018-05
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
Thesis Abstract: Cygnal The healthcare market plays a vital role in how our team worked with innovation space to design a product that fit user needs and could be a sustainable business. Whatever product we design is going to be dictated based off of how the insurance market will pay for it and how much we can charge for our product and services. In fact, the healthcare market is so incredibly unclear with outdated regulations that all of these fraud schemes and inflammatory prices are bound to happen. Stronger government involvement in this instance, I believe would help the issue. In reality, there are so many people taking advantage of the system that you cannot put the blame on anyone exploiting the system. What is clear though, is that they are taking advantage of a system that looks like it was set up to allow them to do so, and in that sense, Medicare is responsible for allowing this market to become warped. The healthcare industry played a vital role in our team for Innovation Space is completing our project. If we do not have a firm understanding on how the insurance market works, how much wheelchair companies are pricing chair components for, and how easily customers can see a financial benefit in switching to our product, it will not survive in the market place. That is why I as the business student am dedicating a lot of time in the final months of our project to make sure that our pricing is accurate, and feasible. The health insurance market, even if it is dysfunctional, will be ultimately paying for our product, and in business if you do not truly know your customer, you are bound to lose him. This paper uncovers why this market is warped and how to do business within it.
ContributorsMefford, Michael James (Author) / Peck, Sidnee (Thesis director) / Boradkar, Prasad (Committee member) / Barrett, The Honors College (Contributor) / Department of Economics (Contributor) / Department of Supply Chain Management (Contributor) / W. P. Carey School of Business (Contributor)
Created2015-05
Description
The purpose of this research was to identify various problems within value analysis teams as well as provide solutions that will help to better align the agents involved in the value analysis process. As healthcare costs continue to rise, and hospital reimbursements fall, value analysis teams will play an even more pivotal role in the success of healthcare organizations. Also, the industry trend toward value-based care is highlighting the importance of these teams. However, interdisciplinary value analysis teams bring to light the underlying agency issue that exists between physicians and hospital administrators, and the general misalignment of values between the participants. In order for these teams to function properly, it is inherent that all of the professionals involved align their incentives. For this study, I studied relevant literature pertaining to value analysis, attended relevant speakers, and then performed interviews with several different professionals involved in healthcare value analysis. I organized and coded this data using the Grounded Theory approach, and was able to identify the underlying issues within these teams. I then created a typology of value analysis teams, based on my respondents, where I segment them into four tiers based on their utilization of data, and their level of physician involvement. Finally, I identified three distinct strategies for developing value analysis teams to implement in order to increase their efficiency and overall success.
ContributorsLindgren, Thomas John (Author) / Schneller, Eugene (Thesis director) / Choi, Thomas (Committee member) / Department of Supply Chain Management (Contributor) / Department of Economics (Contributor) / Barrett, The Honors College (Contributor)
Created2017-05
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
The purpose of this project is to develop a risk assessment tool for the University of California, Riverside (UCR). UCR is health enterprise that manages operations under an environment of innate and uncontrollable risks. Therefore, a risk assessment tool is highly advisable under California State Laws and federal laws. In the case of overlapping laws, federal law will always prevail unless State law explicitly states otherwise. California Health Information Privacy Manual states that California must follow numerous state guidelines and a federal set of guidelines called HIPAA (Health Insurance Portability and Accountability Act of 1996). HIPAA is put in place to protect and serve as an organizational tool to develop a stronger and more secure infrastructure of security measures within healthcare enterprises. Under HIPAA is a Security and Privacy Rule that was implemented by The U.S. Department of Health and Human Services (HHS) and will serve as the basis for the risk assessment tool I developed. The Security and Privacy Rule's main goal is to set a national standard of how electronic protected health information (ePHI) will be appropriately used and disclosed by organizations subject to this rule, also known covered entities. Covered entities include health plans, health care providers and health care clearinghouses unless specifically stated otherwise. Permitted uses and disclosures of PHI or ePHI are outlined in detail and covered entities are expected to follow all aspects of it that pertain to their role within a healthcare system. Under HHS, the Office of Civil Rights (OCR) strictly enforces the Security and Privacy Rules and can issue civil money penalties and/or other major consequences making this a sizable and critical issue in healthcare environments. Each risk and impact must be assessed to determine an overall risk score. This score will then determine what risks need to be immediately addressed and which risks are most critical to UCR. To do this, potential impacts were determined for each section. The impact score can be decided by using a chart that will be discussed in the development section. The likeliness of the risk can be determined by a UCR professional via the provided chart and an overall risk score can be assigned. From here, an action plan can be set and carried out to eliminate possible hazards and imminent risks. Once a Risk Assessment tool is developed, potential risks can be indentified and dealt with appropriately in regard to level of impact and the likelihood of the risk occurring. By reducing risk, a healthcare enterprise can gain greater financial stability, decrease loss and protect vital information that is critical to the success organization.
ContributorsAustin, Hannah N. (Author) / Riley, William (Thesis director) / Hackman, Paul (Committee member) / School of Molecular Sciences (Contributor) / W.P. Carey School of Business (Contributor) / Barrett, The Honors College (Contributor)
Created2018-05
Description
This study uses an exploratory questionnaire to identify major barriers that Syrian refugees face when obtaining basic healthcare. To supplement questionnaire data, providers were also interviewed in order to understand whether identified barriers were internal, due to refugee perceptions, or external, due to gaps in the system that prevented refugees from obtaining healthcare. The study also proposes solutions to enhance health services in order to achieve health equity.
ContributorsShah, Marzia (Author) / Haines, Chad (Thesis director) / Saikia, Yasmin (Committee member) / School of Molecular Sciences (Contributor) / Barrett, The Honors College (Contributor)
Created2016-05