Impact of Language Access Laws on LEP Infant Mortality Rates
by Andrew Ryan Griffin
Abstract
Starting with Executive Order 13166 in 2000, the United States federal government began to address the language disparity issues in health care. Around the same time, several states have begun to pass language access (LA) legislation mandating translation and interpretation services at hospitals for limited English proficient (LEP) individuals. This study uses these multiple discontinuities to evaluate the effect of language access laws on infant mortality rates, adequacy of care, Apgar scores, and the number of prenatal visits from the years 1995 to 2004 for limited English proficient families. I find ambiguous results of language access laws positively impacting infant mortality rates or Apgar scores, but I find clear positive impacts on the adequacy of care and the number of prenatal visits. These findings suggest that language access laws have a clear effect on reducing barriers for limited English proficient mothers, and improving the care mothers receive. Furthermore, there is limited evidence that it improves infant health or outcomes, but the increase of prenatal visits and adequacy of care likely indirectly leads to improving infant mortality rates and Apgar scores. More research is needed into discovering how those mechanisms work and the costs of language services.
Professor Michelle Conolly, Faculty Advisor
JEL Codes: I10, I18, I19
The Effects of Pharmaceutical Price Regulation on Probability of Patenting in OECD Countries
by Rachel Korn
Abstract
The introduction of parallel trade mechanisms allowing for the free trade of pharmaceutical goods in the European Economic Area represents a significant departure from the standard monopolistic competition pricing structure in the pharmaceutical market, in which firms have a great deal of control over pricing. Another mechanism, external reference pricing, also contributes to undermining traditional price structures by imposing a price ceiling on drugs. As these methods of regulating pricing in the healthcare market are receiving growing interest in countries such as the United States, it is prudent to consider their effects. It is apparent that parallel trade and external reference pricing decrease average drug costs, but little has been said about their effects on drug availability. Using global patent data from the European Patent Office PATSTAT database as a proxy for drug availability, I investigate how parallel trade and external reference pricing affect the decision of firms to file a pharmaceutical patent in a given country. I accomplish this through a logistic regression model with a difference-in-differences approach to estimate the probability of patenting a pharmaceutical in an OECD country, given that a patent has previously been approved in the United States. I find that the presence of parallel trade in a country significantly decreases the probability of patenting and increases patent lag time while external reference pricing unexpectedly increases the probability of patenting and decreases patent lag time. These findings demonstrate the complexity in attempting to create policy to regulate rising pharmaceutical prices, as doing so may increase affordability of existing drugs in a country while decreasing availability of new ones.
Professor Michelle Connolly, Faculty Advisor
JEL Codes: I1, I11, I19
Has Tort Reform Been Effective in Abating the Medical Malpractice Crisis? An Empirical Analysis from 1991-2012
By Raj Singh and Jiten Solanki
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.
Advisor: Tracy Falba | JEL Codes: I1, I18, I19 | Tagged: Defensive Medicine, Medical Malpractice, Tort Reform
The Relationship between and Geographic Distribution of Breast Cancer Statistics: Diagnosis, Survival, and Mortality in Selected Areas in the United States, 1973-2004
By Timothy Rooney
Using breast cancer registry data from the United States and regression models controlling for race, marital status, and county-level variation, this research analyzes the connections between these statistics and the geographic variation of each of them. In doing so, it determines that stage of diagnosis has a significant impact on survival likelihood and the likelihood of death due to breast cancer. It also determines that survival reduces mortality likelihood. Additionally, it determines that stage of diagnosis, survival, and mortality all vary geographically, postulating that the reason for this variation is due to lifestyle variation and uneven medical talent distribution.
Advisor: Charles Becker, Michelle Connolly | JEL Codes: I1, I10, I19 | Tagged: Cancer, Diagnosis, Health, Mortality, Survival
