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- Creators: Department of Supply Chain Management
- Member of: Barrett, The Honors College Thesis/Creative Project Collection
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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.
As educational tactics circulate globally, so too does the prospect of understanding sustainability amongst informed individuals and what it means for our society. Just in the past few decades, the environmental movement has changed the way in which people think about their own impact upon the planet. It is becoming a facet of common knowledge for society to realize the potential detriment of their actions, and for this, we should be grateful. However, there is much work to be done regarding all aspects of sustainability and environmental crises. This paper offers a look into the world of sustainable sunscreen usage, something that is not often thought about as an aspect of sustainable consideration. The task of this research opportunity was to examine a sample of survey respondents and connect their responses from 15 questions to different hypotheses. Alongside the discussion of sunscreen filters damaging sensitive ocean ecosystems, this research also looks into the overall importance of sunscreen for one’s health and the ways in which it can be used safely. My hope is that readers will realize the value of using sunscreen on a daily basis and become better informed of sustainability challenges and healthcare disparities.