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Category Archives: I19

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.

Michelle Conolly, Faculty Advisor

JEL codes: I10, I18, I19

View Thesis

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

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.

Honors Thesis

Advisor: Charles Becker, Michelle Connolly | JEL Codes: I1, I10, I19 | Tagged: Cancer, Diagnosis, Health, Mortality, Survival

Questions?

Undergraduate Program Assistant
Matthew Eggleston
dus_asst@econ.duke.edu

Director of the Honors Program
Michelle P. Connolly
michelle.connolly@duke.edu