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- Creators: Barrett, The Honors College
- 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
In this work, I will explain how objectivity in relation to news has changed over the years and why “traditional” objectivity should no longer be a core journalistic standard. I will explore objectivity in the Information Age compared to its formation. I will address the prevalent issues of white privilege and implicit bias issues within the media. Objectivity has been the unrealistic standard for journalism in the United States for over 100 years, and the American public deserves accurate information. A new form of objectivity needs to be established that is more transparent of biases and affiliations, while pushing for inclusive and diverse reporting. As journalists, we need to be thinking of what the future of journalism should be and how we can better serve fellow citizens.
ContributorsMcAllister, Caleb (Author) / Mark, Hass (Thesis director) / P. Richard, Hahn (Committee member) / Dean, Herberger Institute for Design and the Arts (Contributor) / Walter Cronkite School of Journalism & Mass Comm (Contributor, Contributor) / Barrett, The Honors College (Contributor)
Created2019-05
Description
This project will explain the positive impact and effectiveness of Sarbanes-Oxley on corporate responsibility, and through that lens, examine how to make certain subchapters of Title 42, "the Sunshine Act", concerning healthcare fund tracking more transparent and without conflicts of interest. There will be an analysis of the implementation of the Sarbanes-Oxley Act in corporate America and the impact it had on corporate responsibility. There will be a comprehensive review of the history of both the Sarbanes-Oxley Act and the Sunshine Act, along with their origins, stakeholders, and impact on their respective industries. Suggestions to improve certain current United States Code subchapters and subsequent regulations will be announced considering the success that has come from Section 404 of Sarbanes-Oxley.
ContributorsRogers, Anne Marie (Author) / Brian, Jennifer (Thesis director) / Agne, Sara (Committee member) / School of Accountancy (Contributor) / Hugh Downs School of Human Communication (Contributor) / Barrett, The Honors College (Contributor)
Created2017-05
Description
In this paper I examine the dynamics of oil exploitation in the Republic of Kazakhstan to better understand the impact of authoritarian governmental control of this resource on the lives of everyday Kazakh laborers in the extractive industry. In order to do this, I focus on what the state government has done in order to appear more transparent about financial matters in Oil & Gas and how they have addressed or failed to address worker concerns, especially in terms of compensation. More specifically, I look at the Kazakh government's efforts to become EITI-Compliant and at the same time minimize the impact of labor unrest. However, I argue that in its attempt to control society through the regulation of this industry, a "governing of things" in Foucault's terms, the Kazakh government is unintentionally creating ungovernable spaces in the regions of oil exploitation that can be utilized by laborers to negotiate reforms. Furthermore, thanks to an inherent clan culture, this form of modern governmentality actively benefits only the upper echelons of Kazakhstan's political elite, to the exclusion of everyone else, exacerbating problems of regulation, revolt, and subsequent retaliation. I conclude my paper by suggesting topics for further research, such as the exploration of oil's "fetishistic qualities," investigation into other extractive industry transparency or reform initiatives, the study of civil society efforts to promote communication between laborers and their government.
ContributorsTurkina, Alisa (Author) / Popova, Laura (Thesis director) / Zoubtsova, Natalia (Committee member) / W. P. Carey School of Business (Contributor) / School of International Letters and Cultures (Contributor) / Department of Finance (Contributor) / Barrett, The Honors College (Contributor)
Created2017-05
Description
In journalism school, reporters learn to be unbiased, impartial and objective when covering a story. They are to stay neutral and detached from their reporting. However, this standard has become unrealistic and unachievable for many journalists. "Inside Objectivity" is a five-episode podcast that focuses on what journalistic objectivity looks like in the 21st century. In this podcast, you will hear from journalists, scholars, historians, researchers and a news consumer. These guests will provide their thoughts regarding journalistic objectivity and whether this ethical standard needs to be modified. To listen to the episodes and learn more about the podcast, visit insideobjectivity.com.
ContributorsManeshni, Autriya (Author) / Nikpour, Rodmanned (Thesis director) / Russell, Dennis (Committee member) / Barrett, The Honors College (Contributor) / Walter Cronkite School of Journalism and Mass Comm (Contributor) / Department of Psychology (Contributor)
Created2023-05