Matching Items (3)
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- All Subjects: Transparency
- All Subjects: Brain Scans
- Creators: Marchant, Gary
- Creators: Dassanayake, Maduranga
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
Data has quickly become a cornerstone of society. Across our daily lives, industry, policy, and more, we are experiencing what can only be called a “data revolution” igniting ferociously. While data is gaining more and more importance, consumers do not fully understand the extent of its use and subsequent capitalization by companies. This paper explores the current climate relating to data security and data privacy. It aims to start a conversation regarding the culture around the sharing and collection of data. We explore aspects of data privacy in four tiers: the current cultural and social perception of data privacy, its relevance in our daily lives, its importance in society’s dialogue. Next, we look at current policy and legislature in place today, focusing primarily on Europe’s established GDPR and the incoming California Consumer Privacy Act, to see what measures are already in place and what measures need to be adopted to mold more of a culture of transparency. Next, we analyze current data privacy regulations and power of regulators like the FTC and SEC to see what tools they have at their disposal to ensure accountability in the tech industry when it comes to how our data is used. Lastly, we look at the potential act of treating and viewing data as an asset, and the implications of doing so in the scope of possible valuation and depreciation techniques. The goal of this paper is to outline initial steps to better understand and regulate data privacy and collection practices. Our goal is to bring this issue to the forefront of conversation in society, so that we may start the first step in the metaphorical marathon of data privacy, with the goal of establishing better data privacy controls and become a more data-conscious society.
ContributorsAnderson, Thomas C (Co-author) / Shafeeva, Zarina (Co-author) / Swiech, Jakub (Co-author) / Marchant, Gary (Thesis director) / Sopha, Matthew (Committee member) / WPC Graduate Programs (Contributor) / Department of Finance (Contributor) / Department of Information Systems (Contributor) / Barrett, The Honors College (Contributor)
Created2019-05
Description
Neuroimaging has appeared in the courtroom as a type of `evidence' to support claims about whether or not criminals should be held accountable for their crimes. Yet the ability to abstract notions of culpability and criminal behavior with confidence from these imagines is unclear. As there remains much to be discovered in the relationship between personal responsibility, criminal behavior, and neurological abnormalities, questions have been raised toward neuroimaging as an appropriate means to validate these claims.
This project explores the limits and legitimacy of neuroimaging as a means of understanding behavior and culpability in determining appropriate criminal sentencing. It highlights key philosophical issues surrounding the ability to use neuroimaging to support this process, and proposes a method of ensuring their proper use. By engaging case studies and a thought experiment, this project illustrates the circumstances in which neuroimaging may assist in identifying particular characteristics relevant for criminal sentencing.
I argue that it is not a question of whether or not neuroimaging itself holds validity in determining a criminals guilt or motives, but rather a proper application of the issue is to focus on the way in which information regarding these images is communicated from the `expert' scientists to the `non-expert' making decisions about the sentence that are most important. Those who are considering this information's relevance, a judge or jury, are typically not well versed in criminal neuroscience and interpreting the significance of different images. I advocate the way in which this information is communicated from the scientist-informer to the decision-maker parallels in importance to its actual meaning.
As a solution, I engage Roger Pielke's model of honest brokering as a solution to ensure the appropriate use of neuroimaging in determining criminal responsibility and sentencing. A thought experiment follows to highlight the limits of science, engage philosophical repercussions, and illustrate honest brokering as a means of resolution. To achieve this, a hypothetical dialogue reminiscent of Kenneth Schaffner's `tools for talking' with behavioral geneticists and courtroom professionals will exemplify these ideas.
This project explores the limits and legitimacy of neuroimaging as a means of understanding behavior and culpability in determining appropriate criminal sentencing. It highlights key philosophical issues surrounding the ability to use neuroimaging to support this process, and proposes a method of ensuring their proper use. By engaging case studies and a thought experiment, this project illustrates the circumstances in which neuroimaging may assist in identifying particular characteristics relevant for criminal sentencing.
I argue that it is not a question of whether or not neuroimaging itself holds validity in determining a criminals guilt or motives, but rather a proper application of the issue is to focus on the way in which information regarding these images is communicated from the `expert' scientists to the `non-expert' making decisions about the sentence that are most important. Those who are considering this information's relevance, a judge or jury, are typically not well versed in criminal neuroscience and interpreting the significance of different images. I advocate the way in which this information is communicated from the scientist-informer to the decision-maker parallels in importance to its actual meaning.
As a solution, I engage Roger Pielke's model of honest brokering as a solution to ensure the appropriate use of neuroimaging in determining criminal responsibility and sentencing. A thought experiment follows to highlight the limits of science, engage philosophical repercussions, and illustrate honest brokering as a means of resolution. To achieve this, a hypothetical dialogue reminiscent of Kenneth Schaffner's `tools for talking' with behavioral geneticists and courtroom professionals will exemplify these ideas.
ContributorsTaddeo, Sarah (Author) / Robert, Jason S (Thesis advisor) / Marchant, Gary (Committee member) / Hurlbut, James B (Committee member) / Arizona State University (Publisher)
Created2014