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- Creators: School of Mathematical and Statistical Sciences
- Status: Published
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
Abstract The United States has a very long history of putting laws into place that enable certain people to immigrate equally, but prevent others from doing so, thus promoting large undocumented populations. In many instances the people creating these laws cite worries that the people attempting to enter the United States are a hazard to the country. Some examples of this include :the "Chinese Exclusion Act", which prevented people from China from immigrating, the internment of Japanese Americans during WWII, and the creating of various laws that designated Irish people as not being white during the 18th century. Now there is a debate over whether or not people who come to the United States undocumented with their parents at a young age should be barred from living here. These Dreamers are at the center of this often debated issue. A set of hour-long interviews has been conducted with seven dreamers in order to get their opinions on several topics. These include SB1070, the Dream Act, HB56, and a variety of other topics. In addition a comprehensive timeline and review of legislation concerning immigration has been created to provide a historical context. Lastly, my own conclusion about this topic have been presented.
ContributorsSprute, Eric Michael (Author) / Larson, Elizabeth (Thesis director) / Lennon, Tara (Committee member) / Barrett, The Honors College (Contributor) / Department of Chemistry and Biochemistry (Contributor)
Created2015-05
Description
The 284 residents of the rural community of Cooper Landing, Alaska are subject to many health risks. Cooper Landing is home to a large population of older adults whom suffer from a disproportionate physician to population ratio. Limited rural health care infrastructure and poor physician to population ratios are not conducive to primary health care implementation. Limited access to primary health care is linked to vast health disparities in rural communities like Cooper Landing. Preventive care and healthy lifestyle incentives have been largely overlooked as viable alternatives to primary health care access. In Cooper Landing, implementation of such incentives has proved to be either underutilized or unsuccessful by the private, public, and nonprofit sectors. To remedy this, the Rural Alaska Wellness Project (RAWP), a nonprofit organization, carries out its mission to promote health and wellness by providing a community resource for preventive care in Cooper Landing, Alaska. RAWP intends to increase the availability of the Cooper Landing School's gymnasium for community use, donate fitness equipment, implement TeleHealth initiatives, and host annual health fairs through grant funding, generous donations, and fundraising activities.
ContributorsNolan, Erin Sachi (Author) / Shockley, Gordon (Thesis director) / Hrncir, Shawn (Committee member) / Barrett, The Honors College (Contributor) / Department of Chemistry and Biochemistry (Contributor) / Department of Psychology (Contributor)
Created2015-05
Description
The OMFIT (One Modeling Framework for Integrated Tasks) modeling environment and the BRAINFUSE module have been deployed on the PPPL (Princeton Plasma Physics Laboratory) computing cluster with modifications that have rendered the application of artificial neural networks (NNs) to the TRANSP databases for the JET (Joint European Torus), TFTR (Tokamak Fusion Test Reactor), and NSTX (National Spherical Torus Experiment) devices possible through their use. This development has facilitated the investigation of NNs for predicting heat transport profiles in JET, TFTR, and NSTX, and has promoted additional investigations to discover how else NNs may be of use to scientists at PPPL. In applying NNs to the aforementioned devices for predicting heat transport, the primary goal of this endeavor is to reproduce the success shown in Meneghini et al. in using NNs for heat transport prediction in DIII-D. Being able to reproduce the results from is important because this in turn would provide scientists at PPPL with a quick and efficient toolset for reliably predicting heat transport profiles much faster than any existing computational methods allow; the progress towards this goal is outlined in this report, and potential additional applications of the NN framework are presented.
ContributorsLuna, Christopher Joseph (Author) / Tang, Wenbo (Thesis director) / Treacy, Michael (Committee member) / Orso, Meneghini (Committee member) / Barrett, The Honors College (Contributor) / School of Mathematical and Statistical Sciences (Contributor) / Department of Physics (Contributor)
Created2015-05
Description
The central goal of this thesis is to develop a practical approach to validating the correctness of SSA forms. Since achieving this goal is very involved for a general program, we restrict our attention to simple programs. In particular, the programs we consider are loop-free and are comprised of simple assignments to scalar variables, as well as input and output statements. Even for such a simple program, a full formal treatment would be very involved, extending beyond the scope of an undergraduate honors thesis.
ContributorsLusi, Dylan Patrick (Author) / Bazzi, Rida (Thesis director) / Fainekos, Georgios (Committee member) / Barrett, The Honors College (Contributor) / School of Mathematical and Statistical Sciences (Contributor) / Computer Science and Engineering Program (Contributor)
Created2015-05
Description
One major issue that surgeons face during closed body cavity surgery is fogging of the lens surfaces. The cloudy and opaque lens surface caused by water vapor present in closed body cavities forces the surgeon to repeatedly remove the endoscope, wipe it, and reinsert it back into the patient. This presents several risks such as increased surgery time, greater scarring, and an increased chance of infection. In order to address this issue, the development of the Thin Fluid Film Device (TFFD™) VitreOx™ aims to render the lens surface hydrophilic, whereas it is typically hydrophobic. By creating a hydrophilic polymeric nanomesh, the 3-D water droplets can be trapped to lie flatter, thus resulting in a flatter 2-D sheeting effect. The light can no longer be refracted at different angles off of the 3-dimensional water beads, thus eliminating the opacity of the lens surface.
Two animal trials were performed involving a rat and two pigs in order to prove the efficacy of VitreOx™ in addition to being compared with competitor, Covidien Clearify. A laparoscopy was performed on each animal, and the length of time that the endoscope took to fog was measured post product application. The results of the optimized animal clinical trials involving two Yucatan pigs showed that the scope treated with Covidien’s Clearify began fogging within 8 minutes and continued to do so for the remained of the surgery, as opposed to the scope with VitreOx™ which remained fog free for the full 90-minute procedure. The results proved the efficacy of our product.
The second part of the thesis aimed to optimize HemoClear™, the blood evacuating TFFD™. This was done by testing a higher concentration of 6 mg/mL fibrinogen as compared to previous work. After conducting an experiment designed to mimic closed-body cavity surgery it was determined that the HemoClear™ eliminated fog 67% of the time and evacuated blood with a success of 83%. Future work aims to continue testing at this concentration with variances in mixing and application technique.
Two animal trials were performed involving a rat and two pigs in order to prove the efficacy of VitreOx™ in addition to being compared with competitor, Covidien Clearify. A laparoscopy was performed on each animal, and the length of time that the endoscope took to fog was measured post product application. The results of the optimized animal clinical trials involving two Yucatan pigs showed that the scope treated with Covidien’s Clearify began fogging within 8 minutes and continued to do so for the remained of the surgery, as opposed to the scope with VitreOx™ which remained fog free for the full 90-minute procedure. The results proved the efficacy of our product.
The second part of the thesis aimed to optimize HemoClear™, the blood evacuating TFFD™. This was done by testing a higher concentration of 6 mg/mL fibrinogen as compared to previous work. After conducting an experiment designed to mimic closed-body cavity surgery it was determined that the HemoClear™ eliminated fog 67% of the time and evacuated blood with a success of 83%. Future work aims to continue testing at this concentration with variances in mixing and application technique.
ContributorsSinha, Saloni Agarwal (Author) / Culbertson, Robert (Thesis director) / Herbots, Nicole (Committee member) / Watson, Clarizza (Committee member) / Barrett, The Honors College (Contributor) / Department of Chemistry and Biochemistry (Contributor)
Created2015-05
Description
Understanding the relationships between chemistry students' motivation, performance, and gender can help identify and inform ways in which chemistry education might be improved. Students from four CHM 101 classes with two different instructors were surveyed using an adapted Science Motivation Questionnaire II, and motivation data was analyzed with respect to final course performance. Gender data was available for two of these classes, and motivation results analyzed by gender for these classes. Exam scores and gender data was obtained from one of the instructors for CHM 101 courses taught over the past five years and were also analyzed. The motivational study involved small sample sizes, especially in the motivation by gender study. Career motivation, grade motivation, self-efficacy, and total motivation declined over the course of the semester in the four classes combined. Self-efficacy and career motivation were found to predict final course performance only at the end of the semester. Self-efficacy strongly predicted performance, and career motivation was negatively correlated with performance. Female students had higher grade motivation at the end of the semester and lost more self-efficacy over the course of the semester than male students. Gender-performance analysis showed that male students scored slightly higher on exams on average, but that female students received a higher percentage of "A"s and a lower percentage of "D"s, "E"s, and "W"s in the majority of the semesters.
ContributorsJohnson, Walter Gregory (Author) / Gould, Ian (Thesis director) / Wolf, George (Committee member) / Austin, Ara (Committee member) / Barrett, The Honors College (Contributor) / Department of Chemistry and Biochemistry (Contributor) / School of Life Sciences (Contributor) / School of Historical, Philosophical and Religious Studies (Contributor)
Created2015-05
Description
Hepatitis C virus (HCV) is a globally prevalent infection which is a main contributor to the global burden of liver disease. Due to its ability to establish a chronic infection, and the lack of usefulness of traditional neutralizing antibody vaccine design in producing a protective immune response, a preventative vaccine has been notoriously difficult to produce. To overcome this, a vaccine using non-structural protein 3 (NS3) as a target to elicit a T cell specific immune response is thought to be a possible strategy for eliciting a protective immune response against hepatitis C infection. In this paper, a recombinant strain of measles virus (MV) that expresses HCV NS3 protein was analyzed. The replication fitness of this recombinant virus also indicates that this construct replicates at a higher rate than parental measles strain. It is also demonstrated through western blot analysis of protein expression and immunofluorescence that this recombinant virus expresses both the inserted HCV NS3 protein, as well as native measles proteins.
ContributorsWoell, Dana Marie (Author) / Reyes del Valle, Jorge (Thesis director) / Nickerson, Cheryl (Committee member) / Julik, Emily (Committee member) / Barrett, The Honors College (Contributor) / Department of Chemistry and Biochemistry (Contributor) / School of Human Evolution and Social Change (Contributor)
Created2015-05
Description
Microwave hydrolysis of egg-white lysozyme was optimized using 1H liquid-state nuclear magnetic resonance (NMR) spectroscopy experiments for amino acid analysis (AAA). Time held under microwave hydrolysis was arrayed for 2, 4, 6, 8, 10, and 15 minutes. Correlations from gCOSY 2D NMR experiments combined with 1H assignments in the one-dimensional chemical shift spectra identified 18 of the 20 amino acids found in lysozyme. Comparison with Uniprot database amino acid composition values revealed the optimal microwave hydrolysis time lies between 4 and 6 minutes. Identification of lysozyme was confirmed with the ExPASy online database search tool AACompIdent. The microwave hydrolysis procedure presented is a simple analytical technique allowing quick and reliable sample preparation in less than one hour that requires no separation or derivation of amino acids residues prior to detection.
ContributorsEdwards, Maximillian Ashur (Author) / Yarger, Jeff (Thesis director) / Marzke, Robert (Committee member) / Barrett, The Honors College (Contributor) / School of Mathematical and Statistical Sciences (Contributor) / Department of Chemistry and Biochemistry (Contributor)
Created2015-05
Description
In this paper, I analyze representations of nature in popular film, using the feminist / deconstructionist concept of a dualism to structure my critique. Using Val Plumwood’s analysis of the logical structure of dualism and the 5 ‘features of a dualism’ that she identifies, I critique 5 popular movies – Star Wars, Lord of the Rings, Brave, Grizzly Man, and Planet Earth – by locating within each of them one of the 5 features and explaining how the movie functions to reinforce the Nature/Culture dualism . By showing how the Nature/Culture dualism shapes and is shaped by popular cinema, I show how “Nature” is a social construct, created as part of this very dualism, and reified through popular culture. I conclude with the introduction of a number of ‘subversive’ pieces of visual art that undermine and actively deconstruct the Nature/Culture dualism and show to the viewer a more honest presentation of the non-human world.
ContributorsBarton, Christopher Joseph (Author) / Broglio, Ron (Thesis director) / Minteer, Ben (Committee member) / Barrett, The Honors College (Contributor) / School of Sustainability (Contributor) / School of Mathematical and Statistical Sciences (Contributor) / School of Geographical Sciences and Urban Planning (Contributor)
Created2015-05