Matching Items (155)
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
Currently, the medical industry employs an acute treatment process centered on responsiveness and restoration. This method fails those with chronic illness who require disease management and proactivity. As a solution, the medical industry has implemented programs focused on providing integrated, coordinated care. This project examines two primary models to accommodate chronically ill patients: Accountable Care Organizations (ACOs) and Patient Centered Medical Homes (PCMHs). Specifically, this paper examines the data from Pioneer and Medicare Shared Savings Program ACOs. In the aggregate, the data indicate that these programs have been unsuccessful due to several key issues: a lack of patient and physician engagement, failure to incentivize medical professionals and failed collaboration between both ACOs and PCMHs. Remedying these issues would improve the ability of both ACOs and PCMHs to provide integrated, comprehensive care to patients with chronic illnesses.
ContributorsWoods, Cassie Marie (Author) / Ketcham, Jonathan (Thesis director) / Samper, Adriana (Committee member) / Barrett, The Honors College (Contributor) / Department of Marketing (Contributor)
Created2015-05
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
Prenatal care is a widely administered preventative care service, and its adequate use has been shown to decrease poor infant and maternal health outcomes. Today however, in the United States, preterm birth rates remain among the highest in the industrialized world, with low socioeconomic women having the highest risk of preterm births. This group of women also face the greatest barriers to access adequate prenatal care in the United States. This paper explores the viability of short message service to help bridge gaps in prenatal care for low socioeconomic women in the United States and provides areas for further research.
ContributorsMiles, Kelly Nicole (Author) / Ketcham, Jonathan (Thesis director) / Santanam, Raghu (Committee member) / Barrett, The Honors College (Contributor) / W. P. Carey School of Business (Contributor) / Department of Marketing (Contributor) / Department of Finance (Contributor)
Created2014-05
Description
The Patient Protection and Affordable Care Act of 2010 was created as an overhaul of the US Healthcare system with a goal of getting all American citizens and legal residents healthcare that was both affordable and of good quality. Now almost a year removed from it going into effect, this study looks to determine how the ACA has worked in getting individuals who were previously uninsured and required charitable-based healthcare into health insurance programs within a small population in Arizona. This study evaluates the type of insurance program, the quality and ease of access of the care, and the general affordability of the healthcare. This study found that 75% of individuals surveyed had gained health insurance in the last year, with 95% expecting to be insured for 2015. The large majority rated the quality of their care and the accessibility of it as good, with corresponding increased use of primary care providers as a health resource. The affordability of the care was still a major issue for those who were found to be uninsured and for those who were insured. Despite affordability issues, self-reported measures of general health and access to care were reported by the majority of respondents to have improved over the last 12 months.
ContributorsHonan, Timothy Francis (Author) / Ketcham, Jonathan (Thesis director) / Jehn, Megan (Committee member) / Barrett, The Honors College (Contributor) / Department of Chemistry and Biochemistry (Contributor) / School of Historical, Philosophical and Religious Studies (Contributor)
Created2015-05
Description
Mathematical epidemiology, one of the oldest and richest areas in mathematical biology, has significantly enhanced our understanding of how pathogens emerge, evolve, and spread. Classical epidemiological models, the standard for predicting and managing the spread of infectious disease, assume that contacts between susceptible and infectious individuals depend on their relative frequency in the population. The behavioral factors that underpin contact rates are not generally addressed. There is, however, an emerging a class of models that addresses the feedbacks between infectious disease dynamics and the behavioral decisions driving host contact. Referred to as “economic epidemiology” or “epidemiological economics,” the approach explores the determinants of decisions about the number and type of contacts made by individuals, using insights and methods from economics. We show how the approach has the potential both to improve predictions of the course of infectious disease, and to support development of novel approaches to infectious disease management.
ContributorsPerrings, Charles (Author) / Castillo-Chavez, Carlos (Author) / Chowell-Puente, Gerardo (Author) / Daszak, Peter (Author) / Fenichel, Eli P. (Author) / Finnoff, David (Author) / Horan, Richard D. (Author) / Kilpatrick, A. Marm (Author) / Kinzig, Ann (Author) / Kuminoff, Nicolai (Author) / Levin, Simon (Author) / Morin, Benjamin (Author) / Smith, Katherine F. (Author) / Springborn, Michael (Author) / Simon M. Levin Mathematical, Computational and Modeling Sciences Center (Contributor) / College of Liberal Arts and Sciences (Contributor) / School of Life Sciences (Contributor) / School of Human Evolution and Social Change (Contributor) / W.P. Carey School of Business (Contributor) / Economics (Contributor) / Julie Ann Wrigley Global Institute of Sustainability (Contributor)
Created2015-12-01
Description
While non-invasive breast cancer treatments may be considered less costly in the short-term, over the course of a lifetime, a more aggressive treatment can be overall less costly, especially with recurrence cases; however, these more aggressive treatments are not necessarily covered by insurance and are difficult to discuss in the short amount of time in physician consultations. This analysis studied data from 982 women diagnosed with breast cancer over a five-year period to evaluate monetary costs associated with treatment options and incorporated five in-depth interviews to understand experiences and non-monetary costs. Data showed the most expensive option was a unilateral mastectomy with radiation therapy and the least costly option was breast conserving surgery. Interviews determined each woman evaluated the monetary costs with each treatment but most heavily focused on personal values, biases and recommended opinions when deciding on a treatment. The use of prompt sheets before physician appointments and consultations, along with the addition of financial counselor meeting with each patient can improve patient satisfaction and alleviate stress by simplifying a woman's choice in deciding a treatment. In addition, increased insurance coverage to include every treatment chosen by women (rather than on a case-by-case basis), specifically contralateral prophylactic mastectomy and additional screening options, could decrease long term costs \u2014 both monetarily and in quality of life for patients.
ContributorsOsumi, Alana (Author) / LaRosa, Julia (Thesis director) / Sivanantham, Jai (Committee member) / Barrett, The Honors College (Contributor) / W.P. Carey School of Business (Contributor)
Created2018-12
Description
In 2016, in the United States alone, the cosmetics industry made an estimated 62.46 billion dollars in revenue (Revenue of the Cosmetic Industry in the U.S. 2002-2016 | Forecast). With a consistent increase in sales in the last several years, the industry has reached continued success even during times of hardship, such as the Great Recession of 2008. The use of Corporate Social Responsibility (CSR), external campaigns, and thoughtful packaging and ingredients resonates with targeted consumers. This has served as an effective strategy to maintain growth in the industry. Cosmetic companies promote their brand image using these sustainability tactics, but there seems to be a lack of transparency in this unregulated industry. The purpose of this thesis is to determine if the cosmetics industry is a good steward of the sustainability movement. Important terms and concepts relating to the industry will be discussed, then an analysis of sustainability focused cosmetic brands will be provided, which highlights the extent to which these brands engage in activities that promote sustainability. This is followed by an application of findings to a company that could benefit from using such practices. Overall, the analysis of the different brands proved to be shocking and disappointing. This is due to the sheer amount that scored very poorly based on the sustainability criteria developed. The cosmetics industry is too inconsistent and too unregulated to truly act as a good steward for sustainability. Though some companies in the industry succeed, these accomplishments are not consistent across all cosmetic companies. Hence, the cosmetics industry as a good steward for sustainability can only be as strong as its weakest link.
ContributorsMamus, Sydney Wasescha (Author) / Ostrom, Amy (Thesis director) / Kristofferson, Kirk (Committee member) / Department of Marketing (Contributor) / W.P. Carey School of Business (Contributor) / Barrett, The Honors College (Contributor)
Created2018-05
Description
This report was commissioned to provide an analysis and evaluation of consumer perceptions and branding as it relates to the political and social climate in America. To be able to do this, the paper analyzes shifts in the external environment as well as researching case studies and online consumer perception surveys. Overall, this paper aims to examine the distributed survey and attempt to correlate and identify how branding, consumer perceptions, and social and political issues all can work and affect one another. Through the administration of this survey, we were able to formulate a conclusion that points towards the importance of brands actively adhering to changing consumer preferences, ideals, and expectations.
ContributorsClark, Sydney (Co-author) / Loera, Carolina (Co-author) / Montoya, Detra (Thesis director) / Samper, Adriana (Committee member) / W.P. Carey School of Business (Contributor) / Department of Marketing (Contributor) / Barrett, The Honors College (Contributor)
Created2018-05
Description
The use of generalized linear models in loss reserving is not new; many statistical models have been developed to fit the loss data gathered by various insurance companies. The most popular models belong to what Glen Barnett and Ben Zehnwirth in "Best Estimates for Reserves" call the "extended link ratio family (ELRF)," as they are developed from the chain ladder algorithm used by actuaries to estimate unpaid claims. Although these models are intuitive and easy to implement, they are nevertheless flawed because many of the assumptions behind the models do not hold true when fitted with real-world data. Even more problematically, the ELRF cannot account for environmental changes like inflation which are often observed in the status quo. Barnett and Zehnwirth conclude that a new set of models that contain parameters for not only accident year and development period trends but also payment year trends would be a more accurate predictor of loss development. This research applies the paper's ideas to data gathered by Company XYZ. The data was fitted with an adapted version of Barnett and Zehnwirth's new model in R, and a trend selection algorithm was developed to accompany the regression code. The final forecasts were compared to Company XYZ's booked reserves to evaluate the predictive power of the model.
ContributorsZhang, Zhihan Jennifer (Author) / Milovanovic, Jelena (Thesis director) / Tomita, Melissa (Committee member) / Zicarelli, John (Committee member) / W.P. Carey School of Business (Contributor) / School of Mathematical and Statistical Sciences (Contributor) / Barrett, The Honors College (Contributor)
Created2018-05