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- All Subjects: healthcare
- Creators: School of Molecular Sciences
- 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.
Many would contend that the United States healthcare system should be moving towards a state of health equity. Here, every individual is not disadvantaged from achieving their true health potential. However, a variety of barriers currently exist that restrict individuals across the country from attaining equitable health outcomes; one of these is the social determinants of health (SDOH). The SDOH are non-medical factors that influence the health outcomes of an individual such as air pollution, food insecurity, and transportation accessibility. Each of these factors can influence the critical illnesses and health outcomes of individuals and, in turn, diminish the level of health equity in affected areas. Further, the SDOH have a strong correlation with lower levels of health outcomes such as life expectancy, physical health, and mental health. Despite having influenced the United States health care system for decades, the industry has only begun to address its influences within the past few years. Through exploration between the associations of the SDOH and health outcomes, programming and policy-making can begin to address the barrier to health equity that the SDOH create.
This study examined the differences in mental and behavioral treatment outcomes between use of Telehealth and in-person appointments in effort to mitigate discrepancies that may lessen treatment efficacy.
Refugee women face many challenges to obtaining maternal, reproductive, and sexual health post-resettlement including the language barrier, navigating the healthcare system, finding childcare to attend appointments, and cultural mismatches between their beliefs and practices around the prenatal, childbirth, and postpartum periods and that of the healthcare system in which they resettle into. This cultural barrier poses a challenge to healthcare providers as well as it necessitates that they respect their patients’ cultural beliefs while still providing them with the highest standard of care. Cultural competency training has been used to assist providers in understanding and responding to cultural differences, but gaps still exist when it comes to navigating specific scenarios. The objective of this research was to conduct a literature review of studies pertaining to refugee maternal, reproductive, and sexual healthcare post-resettlement to investigate the following questions: how tensions between biomedically accepted best practices and cultural norms present themselves in these healthcare fields, how healthcare providers take into consideration their patients’ cultural beliefs and norms when providing maternal, reproductive, and sexual healthcare to refugee women, and what can be done to continue to improve the provision of culturally appropriate care to refugee women. Findings from twenty different studies that focused primarily on eight cultural groups identified that Cesarean sections, inductions, and certain family planning methods are significant points of contention regarding cultural norms for refugee women and that they prefer certain foods, birthing positions, and other cultural practices during the delivery. Healthcare providers consider their refugee patients’ cultural beliefs by creating relationships with them built on trust, utilizing community liaisons, and through attempts to accommodate cultural practices when possible. Some potential improvements offered to improve cultural competency were improved cultural competency training that focused on how healthcare providers ask questions and interact with their patients, increased partnership with refugee communities, and an emphasis on patient education surrounding interventions and procedures related to maternal and reproductive health that could cause hesitations. The results of this literature review accentuated the importance of relationships within the field of refugee women’s healthcare, between both refugee patients and their providers and refugee communities and the healthcare systems. Providing refugee women access to more culturally competent healthcare can increase their trust in the healthcare systems of the countries they resettle in and healthcare utilization that can contribute to improved health outcomes for refugee women and their children.