By Michael Levin
Overcrowding in United States hospitals’ emergency departments (EDs) has been identified as a significant barrier to receiving high-quality emergency care, resulting from many EDs struggling to properly triage, diagnose, and treat emergency patients in a timely and effective manner. Priority is now being placed on research that explores the effectiveness of possible solutions, such as heightened adoption of IT to advance operational workflow and care services related to diagnostics and information accessibility, with the goal of improving what is called throughput efficiency. However, high costs of technological process innovation as well as usability challenges still impede wide-spanning and rapid implementation of these disruptive solutions. This paper will contribute to the pursuit of better understanding the value of adopting health IT (HIT) to improve ED throughput efficiency.
Using hospital visit data, I investigate two ways in which ED throughput activity changes due to increased HIT sophistication. First, I use a probit model to estimate any statistically and economically significant decreases in the probability of ED mortality resulting from greater HIT sophistication. Second, my analysis turns to workflow efficiency, using a negative binomial regression model to estimate the impact of HIT sophistication on reducing ED waiting room times. The results show a negative and statistically significant (p < 0.01) association between the presence of HIT and the probability of mortality in the ED. However, the marginal impact of an increase in sophistication from basic HIT functionality to advanced HIT functionality was not meaningful. Finally, I do not find a statistically significant impact of HIT sophistication on expected waiting room time. Together, these findings suggest that although technological progress is trending in the right direction to ultimately have a wide-sweeping impact on ED throughput, more progress must be made in order for HIT to directly move the needle on confronting healthcare’s greatest challenges.
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Advisors: Professor Ryan McDevitt, Professor Michelle Connolly | JEL Codes: I1, I18, O33
By Pranav Ganapathy
We propose and evaluate an auction mechanism for the priority review voucher program. The 2007 voucher program rewards drug developers for regulatory approval of novel treatments for neglected tropical diseases. Previous papers have proposed auctioning vouchers for the priority review voucher program but have offered neither a mathematical model nor a framework. We present a mechanism design problem with one pharmaceutical company producing one drug for a neglected tropical disease. The mechanism that maximizes the regulator’s expected surplus is a take-it-or-leave-it offer, with three different offers based on low, intermediate, and high neglected disease burdens. We demonstrate how mechanism design can be applied to settings in which the buyer pays for public access to a product with regulatory speed. Finally, this paper may be useful to policymakers seeking to improve access to voucher drugs through modifications of the program.
Advisors: Professor David Ridley, Professor Giuseppe Lopomo, Professor Michelle Connolly| JEL Codes: I1, D44, D82
By Audrey Kornkven
In October 2008, a provision of the Deficit Reduction Act of 2005 known as Medicare “Nonpayment” went into effect, eliminating reimbursement for the marginal costs of preventable hospital-acquired conditions in an effort to correct perverse incentives in hospitals and improve patient safety. This paper contributes to the existing debate surrounding Nonpayment’s efficacy by considering varying degrees of fiscal pressure among hospitals; potential impacts on healthcare utilization; and differences between Medicare and non-Medicare patient populations. It combines data on millions of hospital discharges in New York from 2006-2010 with hospital-, hospital referral region-, and county-level data to isolate the policy’s impact. Analysis exploits the quasi-experimental nature of Nonpayment via difference-in-differences with Mahalanobis matching and fuzzy regression discontinuity designs. In line with results from Lee et al. (2012), Schuller et al. (2013), and Vaz et al. (2015), this paper does not find evidence that Nonpayment reduced the likelihood that Medicare patients would develop a hospital-acquired condition, and concludes that the policy is not likely the success claimed by policymakers. Results also suggest that providers may select against unprofitable Medicare patients when possible, and are likely to vary in their responses to financial incentives. Specifically, private non-profit hospitals appear to have been most responsive to the policy. These findings have important implications for pay-for-performance initiatives in American healthcare.
Advisors: Professor Charles Becker, Professor Frank Sloan, Professor Grace Kim| JEL Codes: I1, I13, I18
By Hemal Pragneshbhai Patel
The effect of the economic collapse on health has been extensively documented in Russia since the dissolution of the Soviet Union. The proportion of stunted children in Russia increased substantially in this period, but no study has investigated the mechanisms by which this economic collapse impacted child health outcomes. This paper uses an OLS regression followed by a Binder-Oaxaca decomposition to determine the specific economic factors that significantly contributed to this decrease in child heights.
Advisors: Professor Charles Becker | JEL Codes: I1; I14; J13
By Hemal Pragneshbhai Patel
Increased tourism, especially in developing economies, brings with it more economic opportunities and avenues for development. In Roatán, the largest of Honduras’ Caribbean Bay Islands, tourism has brought economic development that the island had never before experienced. However, the impact of this economic development brought by increasing cruise ship tourism on child health has yet to be investigated. The increase in economic development is expected to improve child health through improved absorbed nutrition, and this paper uses an OLS regression model to examine how differential exposure to tourism development during a child’s crucial early life developmental window impacts later life health outcomes, proxied by height-for-age Z-scores.
Advisors: Professor Dennis Clements, Professor Michelle Connolly | JEL Codes: I1; I15; Z32
By David Blauser Henderson
Adult height is often used to evaluate standards of living experienced in childhood, as it is highly dependent on early-life nutrition (Komlos and Baten, 1998). I employ adult height data collected by the Russian Longitudinal Monitoring Survey (RLMS) to measure well-being among the population of the USSR during two periods of Stalinist repression: The Great Terror from 1937- 1938, and dekulakization, which led directly to the Great Famine of 1932-1933. Heights are normalized by gender and birth year using data from the Survey of Health, Ageing, and Retirement in Europe. I find that both the Great Terror and Great Famine had significant negative impacts on health. In particular, I find the impact of famine on adult height was greatest for those of low socioeconomic status and those born in rural areas. The Great Terror, however, primarily impacted the health of those of high socioeconomic status, those born in urban areas, and those born in areas that were heavily targeted by repression campaigns.
Advisors: Professor Charles Becker, Professor Michelle Connolly | JEL Codes: N5, N54, I15
Assessing the Impacts of an Aging Population on Rising Healthcare and Pharmaceutical Expenditures within the United States
By Rahul Sharma
This paper studies the impact of aging on rising healthcare and pharmaceutical expenditures in the United States with the goal of contextualizing the future burden of public health insurance on the government. Precedent literature has focused on international panels of multiple countries and hasn’t identified significant correlation between age and healthcare expenditures. This paper presents a novel approach of identifying this correlation by using a US sample population to determine if age impacts an individual’s consumption of healthcare services and goods. Results suggest that age has a significant impact on healthcare and pharmaceutical expenditures across private and public insurance.
Advisors: Gilliam D. Saunders-Schmidler and Grace Kim | JEL Codes: H51, H53, I12, I13, I18, I38
By Michael Karamardian
Because Medicare’s prospective payment system for long-term acute-care hospitals (LTCHs) makes a large lump-sum form of payment once patients reach a minimum length-ofstay threshold, LTCHs have a unique opportunity to maximize profits by strategically discharging patients as soon as the payment is received. This analysis explores how the level of competition between LTCHs in geographic markets affects the probability of a patient being strategically discharged. The results show that patients at LTCHs in more competitive markets have a lower probability of being strategically discharged than at those in less competitive markets, suggesting increased competition could help save Medicare funding.
Advisors: Kent Kimbrough and James Roberts | JEL Codes: D22, I11, I18
By Aakash Jain
Previous research has shown that ambient temperature affects human metabolism and behavior. Inspired by these findings, this study examines the effect of lagged annual temperatures in the United States on average reported BMI. The results indicate that higher temperatures in the future will lead to increases in average BMI. A conservative estimate suggests that a 1 °C increase in temperature sustained for 10 years would result in a 0.15 unit increase in average BMI and an additional $15.5 billion in annual health care expenditure.
Advisor: Billy Pizer | JEL Codes: Q5, Q54, I1, I10
The Professor and the Coal Miner: The effect of socioeconomic and geographical factors on breast cancer diagnosis and survival outcome
By Shelley Chen
Previous studies reported that patients who live farther from cancer centers do not necessarily experience delayed cancer detection and shortened survival. However, the results are biased because of the incomplete observation of patient survival, which cannot be properly accounted for with the multivariable regression model. In this thesis, I isolated the effect of the breast cancer patient’s distance to a comprehensive cancer center on the stage of diagnosis and survival using the Cox Proportional Hazards model. I linked data from the Kentucky Surveillance, Epidemiology, and End Results 18, the Kentucky Life Tables, and the Kentucky Area Health Resource Files and identified 37654 patients diagnosed with breast cancer. I estimated the effect of distance on marginal probability of cancer mortality, controlling for non-cancer related death, socioeconomic status, and demographic factors in patients. After controlling for covariates, travel distance between the patient and the nearest comprehensive cancer center was statistically significantly on the breast cancer mortality probability, but not on the stage of diagnosis. In the Kentucky population, patients who were located farther from comprehensive cancer centers experience an increased marginal probability of mortality (proportional hazard = 1.004; 95% CI: [1.000502 1.007311]). The linkage of SEER 18 and AHRF data provided more comprehensive information on the socioeconomic risk factors of cancer mortality than past study datasets. For the stage of diagnosis, a low physician to population ratio and high county-level Medicaid coverage were associated with more advanced stages of diagnosis. In turn, a more advanced stage of diagnosis, lower physician to population ratio, and identification as African American increased the marginal probabilities of mortality.
Advisor: Charles Becker, Kent Kimbrough | JEL Codes: I1, I13, I14 | Tagged: B