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The Cost-Effectiveness of Shared Medical Appointments for Type II Diabetes at Duke Family Medicine

By Lauren Nahouraii

With increasing healthcare expenditures above the rate of inflation, new health care delivery models are needed. Since care for chronic health conditions accounts for a majority of spending, more cost-effective ways to manage these conditions are especially necessary and could be the most effective in decreasing health care costs. Shared medical appointments (SMAs) are a promising solution because they increase patient education through group appointments while simultaneously increasing productivity by allowing a provider to see patients in a group but bill for them individually. In this study, 38 patient volunteers participated in an SMA as part of a pilot program at Duke Family Medicine (DFM). As part of this program, patients were randomly assigned to groups that offered varying versions of an SMA curriculum over the course of 3 years. Data collected included HbA1c scores, number and type of medications, type of insurance and payments, number and type of visit (including hospital admissions, emergency room visits, primary care and specialty visits), laboratory tests completed, and home address. Data was collected during, after, and for the six months prior to starting the SMAs. Data points from six months prior to the SMAs serve as a control. HbA1c served as the measure of health outcome while the rest of the data was used in estimating the total healthcare costs of control and treatment periods. Any changes in HbA1c were converted into changes in quality adjusted life years (QALYs) for the cost-effectiveness calculations. The estimated total costs and changes in QALYs were used to calculate the average cost-effectiveness of both the control and treatment periods. Given the small sample size, the SMAs appeared to be more cost-effective for patients that attended a majority of the SMA sessions. The cost-effectiveness comparison for all patients was inconclusive. This study’s calculations should be repeated once more patients complete SMAs in order to increase the power of the tests and provide conclusive results for all patients.

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Advisor: Tracy Falba | JEL Codes: I10, I12, I13, I18

Obesity and its Impact on Job Quality

By Kelly Lessard

This study explores the relationship between body mass and job quality in the United States labor force using five variables to represent job quality: hourly wage, training in the past year, desire for training, expectations for success, and job satisfaction. I use the National Longitudinal Survey of Youth 1979 data from 1994 to calculate BMI and assess the job quality indicators. Like past research, I find BMI is negatively associated with wages for the obese population, most significantly for women. Women also suffer a greater body mass penalty for job training and demonstrate lower job satisfaction at a higher BMI.

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Advisor: Alison Hagy, Tracy Falba |  JEL Codes: J7, J31, J71 | Tagged: BMI, Job Quality, Labor Productivity, Obesity

Has Tort Reform Been Effective in Abating the Medical Malpractice Crisis? An Empirical Analysis from 1991-2012

By Raj Singh

This paper evaluates the impact of malpractice reforms on average malpractice payment awards, frequency of malpractice claims, and malpractice premiums for internists, surgeons, and OB/GYNS. We also empirically test the physician-induced demand (PID) hypothesis in the context of the medical malpractice environment. Our results suggest that caps on noneconomic damages and total damages as well as patient compensation funds are successful in reducing average payments, while damage caps and collateral source rule reform were found to lower malpractice claim incidence. When grouping claims by severity level, we find that noneconomic damage caps and patient compensation funds are more effective at reducing average payment with increasing severity level, while total damage caps induce the greatest reductions in payments for cases of medium severity. Also, non-economic damage caps were found to only significantly decrease the incidence of medium severity claims. With regards to malpractice premiums, we found that implementation of total damage caps as well as modification of joint-and-several liability were associated with lower premiums for all specialists. Finally, we evaluate the notion of ‘defensive medicine’ by studying whether higher malpractice premiums result in greater Medicare payments. Based on our model, increases of $10,000 in OB/GYN premiums are estimated to result in a 0.81% rise in total spending. Of the reforms studied, modification of joint-and-several liability had the most significant and consistent effects in reducing Medicare reimbursements for all categories of spending analyzed, and total damage caps were also estimated to effectively slow the growth of spending in specifications without premiums.

Honors Thesis

Data Set 1

Data Set 2

Advisor: Tracy Falba | JEL Codes: I1, I18, I19 | Tagged: Defensive Medicine, Medical Malpractice, Tort Reform

Socioeconomic Factors and the Outcomes of Thailand’s Prevention of Mother-To-Child Transmission program (PMTCT)

By Wichsinee Wibulpolprasert

Since its implementation in 2001, the national program for Prevention of Mother-To-Child Transmission (PMTCT) in Thailand has been successful in substantially reducing mother-to-child HIV transmission. In order to assess and improve the efficacy of the PMTCT program, it is important to identify relevant socio-demographic and biomedical factors associated with antiretroviral compliance and HIV transmission rates. In this paper, we attempt to measure the associations between province specific socio-demographic characteristics, such as average income, education, average household size, and availability of health care providers, on the antiretroviral compliance rate. Then we measure how the antiretroviral completion rates and other biomedical factors affect the probability of mother-to-child HIV transmission among participants in Thailand’s national PMTCT program. We find that education level, mother’s nationality, family size, prenatal care, and the time the pregnant woman learned of her HIV status statistically affect the probability of completing the antiretroviral regimen. The sex of the infant, prenatal care, and the second antiretroviral regimen statistically affect the transmission rates.

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Undergraduate Program Assistant
Jennifer Becker

Director of the Honors Program
Michelle P. Connolly