Health Economics Commons^™

Patient-Centered Medical Homes And Hospital Value-Based Purchasing: Investigating Provider Responses To Incentives, Lauryn Walker

Theses and Dissertations

Provider incentives are a commonly used policy tool to mold provider behaviors.¹ However, while we frequently measure the change in patient outcomes, failure to consistently produce changes in outcomes does not mean that providers are not changing their behavior. This paper focuses on two programs with null or inconsistent quality outcomes to try to identify why such inconsistency occurs. The two programs, both ratified in the Affordable Care Act, are 1) patient-centered medical homes (PCMHs), and 2) the Medicare Hospital Value-Based Purchasing (HVBP) program.

Chapter 1: Using data from the Medical Expenditure Panel survey (MEPS), I match provider characteristic …

Evaluasi Ekonomi Penggunaan Antibiotika Profilaksis Cefotaxime Dan Ceftriaxone Pada Pasien Operasi Seksio Sesarea Di Rumah Sakit X, Echa Aisyah, Mardiati Nadjib

Jurnal Ekonomi Kesehatan Indonesia

A prophylactic antibiotic for patients with cesarean section surgery is highly recommended in the clinical guideline. The use of antibiotics is selected by using criteria safety and cost-effectiveness. This partial economic evaluation in the form of cost and outcome analysis was using alongside observational study method, prospective data were collected from April to May 2017 covering 60 patients with cesarean section surgery who received prophylaxis antibiotics, comparing cost-effectiveness between Cefotaxime and Ceftriaxone. The statistical test showed that there were no differences of characteristics in the 60 patients. The analysis based on the hospital perspective carried out in a public hospital …

Increasing Cigarette Excise Tax Prevents Smoking Initiation In Children And Finances National Health Insurance In Indonesia, Ayu Tyas Purnamasari, Pujiyanto Pujiyanto, Hasbullah Thabrany, Renny Nurhasana, Aryana Satrya, Teguh Dartanto

Jurnal Ekonomi Kesehatan Indonesia

Indonesia has ranked third among countries with the highest number of smokers in Asia because the price of cigarettes in those countries is still affordable. The strategy to make the price of cigarettes is not affordable is increasing cigarette excise tax. This instrument is considered the most effective way to control cigarette consumption. The purpose of this study was to find out how the public perceive the increase of the cigarette excise tax to cover the National Health Insurance (NHI) deficit and to identify the factors which affect such perception. This study used mobile phone survey and the sample were …

Determinan Sosial Ekonomi Kepemilikan Jaminan Kecelakaan Kerja Pada Tenaga Kerja Informal Di Indonesia: Analisis Data Susenas 2017, Sri Denti On Madya, Atik Nurwahyuni

Jurnal Ekonomi Kesehatan Indonesia

The number of informal workers is higher than the formal workforce in Indonesia. The coverage of working accident protection is still very low while the work accident rate still tends to be high. This study aims to determine the socio-economic determinants of employ ment accident insurance ownership in informal workers in Indonesia. This study used a cross sectional study design with bivariate analysis using the estimation method of maximum likelihood. The Susenas Data (National Socio-Economic Survey) in 2017 is ana lyzed using logistic/logit regression. The variables observed were age, sex, marital status, health, education, regional complaints, and socio-economic/informal labor income. …

Determinan Sosial Ekonomi Rumah Tangga Dari Balita Stunting Di Indonesia: Analisis Data Indonesia Family Life Survey (Ifls) 2014, Dini Indrastuty, Pujiyanto Pujiyanto

Jurnal Ekonomi Kesehatan Indonesia

Stunting is a chronic nutritional problem in infants characterized by shorter stature compared to their age. Stunting in toddlers has risk at the level of intelligence, vulnerability to disease, lowering productivity which in the long run can hamper economic growth. When adults, children who suffer from stunting are prone to non-communicable diseases. This causes government spending in terms of financing national health insurance to continue to increase. This study aims to analyze the determinants of household socioeconomic factors of stunting toddlers. It used the secondary data of the Indonesian Family Life Survey (IFLS) in 2014 with cross-sectional study design and …

Health Workforce Assessment In Jakarta For Effective Hiv Policy Implementation: Challenges And Opportunities Toward Epidemic Control, Rachel Hoy Deussom

Jurnal Ekonomi Kesehatan Indonesia

Strategic efforts are needed in Indonesia to implement the recently released human immunodeficiency virus (HIV) Test and Treat policy which promotes increased treatment uptake, known to have important economic benefits. Of Indonesia’s estimated 631,635 people living with HIV (PLHIV) in 2018, only 12% are on treatment. The USAID- and PEPFAR-funded Human Resources for Health in 2030 (HRH2030) Program undertook policy analysis and assessed the available health workforce and service delivery at select sites in Jakarta to identify and anticipate Test and Treat implementation gaps. A mixed methods concurrent triangulation design was used, including policy analysis, key informant interviews, and site-level …

The Critical Need For Mental Health Education To Be Mandated In New Mexico's Public Schools, Bonnie L. Murphy

Shared Knowledge Conference

Based on a review of research and best practices in mental health awareness and skills, this inquiry project argues for state legislative policies that would require mental health awareness and skills in the K-12 curriculum. Mental health affects individual accomplishments in every stage of people’s lives beginning in early childhood and throughout the life cycle. Prevention and treatment of mental illness plays a key role in the ability of an individual to cope with loss and develop resiliency and perseverance in challenging times and to make better decisions that improve the individual’s life and the lives of those around them. …

Obesity: The Elephant In The Room We Can No Longer Afford To Ignore, Joanie Sompayrac, Katharine Linehart Trundle

Journal of Health Ethics

Everyone pays the price for the obesity-related illnesses of our fellow citizens – through increased premiums on our group health insurance policies, through reduced productivity of our co-workers, through taxpayer support of hospitals that provide indigent care and through soaring Medicare costs, to name a few. The fact that our entire society often ends up paying many of the costs for the obesity-related illnesses of not only ourselves but also our family members, our friends, our co-workers and even strangers raises questions: Why doesn’t insurance pay to help overweight and obese people to make lifestyle changes that could save us …

Kisumu County Hospital Patient Demographic Analysis: Looking Toward Universal Health Coverage, Lauren Scheffey

Independent Study Project (ISP) Collection

Universal health coverage is priority sought after by developed and developing nations alike, and Kenya sits on the list of countries seeking to achieve this goal in the coming years. The definition of “coverage” can vary by country, but three criteria are commonly found in the discussion of UHC globally: access, affordability, and quality. Affordability is determined by the state’s healthcare financing system; quality refers to the services provided by health facilities; and access, at least in part, concerns the geographic placement of health services providers in relation to the population they intend to serve. This geographic element is the …

Effects Of The Affordable Care Act On Health Care Access And Self-Assessed Health After 3 Years, Charles J. Courtemanche, James Marton, Benjamin Ukert, Aaron Yelowitz, Daniela Zapata

Economics Faculty Publications

Using data from the Behavioral Risk Factor Surveillance System, we examine the causal impact of the Affordable Care Act on health-related outcomes after 3 years. We estimate difference-in-difference-in-differences models that exploit variation in treatment intensity from 2 sources: (1) local area prereform uninsured rates from 2013 and (2) state participation in the Medicaid expansion. Including the third postreform year leads to 2 important insights. First, gains in health insurance coverage and access to care from the policy continued to increase in the third year. Second, an improvement in the probability of reporting excellent health emerged in the third year, with …

Supermarket Retailers’ Perspectives On Healthy Food Retail Strategies: In-Depth Interviews, Olivia Martinez, Noemi Rodriguez, Allison Mercurio, Marie Bragg, Brian Elbel

Publications and Research

Background

Excess calorie consumption and poor diet are major contributors to the obesity epidemic. Food retailers, in particular at supermarkets, are key shapers of the food environment which influences consumers’ diets. This study seeks to understand the decision-making processes of supermarket retailers—including motivators for and barriers to promoting more healthy products—and to catalogue elements of the complex relationships between customers, suppliers, and, supermarket retailers.

Methods

We recruited 20 supermarket retailers from a convenience sample of full service supermarkets and national supermarket chain headquarters serving low- and high-income consumers in urban and non-urban areas of New York. Individuals responsible for making …

Understanding Relationships Between Early Life Toxic Stress, Childhood Socioeconomic Disadvantage, And Allostatic Load In Adolescence, Amanda King

Dissertations (1934 -)

Chronic disease prevalence among children and adolescents is rising, which is thought to result in part from elevations in allostatic load (AL). AL is the cumulative physiological dysregulation that results from exposure to biological, social and environmental stressors over time. Socioeconomic disparities in chronic disease and AL have been well-documented in adult populations, including links between childhood socioeconomic disadvantage (CSD) and AL, yet little is known as to whether CSD may begin to impact AL earlier in life. Differential exposure and vulnerability to stress among racial/ethnic minorities may increase risk for elevated AL among those experiencing CSD. Framed by the …

Risk Adjustment Of Capitation Payment System: What Can Indonesia Adopt From Other Countries?, Asri Hikmatuz Zahroh

Jurnal Ekonomi Kesehatan Indonesia

Capitation calculation in Indonesia is not adjusted by individual and aggregate risk. Without risk adjustment, capitation rates are likely to overpay or underpay primary care. This study aimed to review risk-adjusted capitation payment in other countries for evaluation of capitation payment system in Indonesia. The conduct and reporting of this systematic review followed the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). This study used comprehensive electronic search in five databases: Pubmed, Proquest, Scopus, PMC, and EBSCOHost. Search results from five databases in April 2018, yielded a total 19 titles that will continue to review the …

Cost Benefit Analysis (Cba) Program Pemberian Makanan Tambahan (Pmt) Susu Pada Karyawan Di Pt. Trisula Textile Industries Tbk Cimahi Tahun 2018, Ayu Laili Rahmiyati

Jurnal Ekonomi Kesehatan Indonesia

Cost Benefit Analysis (CBA) for the process of identification , measurement,comparison social benefits and cost project or investment program to evaluate utilization of scarce economic resources so that it can be used efficiently .This research purposes are calculateing benefits and cost in rupiah from the milk supplementary feeding program (PMT) at PT. Trisula Textile Industries Tbk Year 2018 and deciding feasibility of program or policy sustainability from PMT milk. The research is using quantitative approach. Data collection is done through interviews, observations, and study documents. Calculation is using Payback Period (PP), Net Present Value (NPV), Internal Rate Of Return (IRR), …

Economic Evaluation Of Cetuximab For Metastatic Colorectal Cancer (Mcrc): A Protocol For Evidence Synthesis, Septiara Putri, Ery Setiawan, Siti Rizny F. Saldi, Levina Chandra, Amila Megraini, Vetty Yulianty P

Jurnal Ekonomi Kesehatan Indonesia

Colorectal cancer is fairly common compared to other cancers. The incidence and mortality rates are predicted to increase globally. In some cases, cancer can be potentially spread to another organ or metastatic. One of recent available targeted therapies for metastatic colorectal cancer (mCRC) patient is Cetuximab (Erbitux ®), combined with chemotherapy. Despite clinical effectiveness, there is the importance of the evidence related cost-effectiveness of therapy. This study aims to summary, synthesize, and systematically review the economic evaluation studies of Cetuximab for metastatic colorectal cancer (mCRC). Model based economic evaluation of Cetuximab for metastatic colorectal cancer will be searched and included …

Analisis Kesiapan Pembiayaan Hipertensi, Diabetes Melitus Dan Gangguan Jiwa Dalam Mendukung Program Indonesia Sehat Dengan Pendekatan Keluarga (Pis Pk) Tahun 2018-2020, Trihardini Sri Rejeki Astuti, Prastuti Soewondo

Jurnal Ekonomi Kesehatan Indonesia

Healthy Indonesia Program with Family Approach (PIS PK) is a way to expand Puskesmas reach and access to health services through family home visit Overcoming non-communicable diseases (NCD) is a national priority in achieving Healthy Indonesia because the prevalence of NCD continues to increase. Managing NCD specifically hypertension, Diabetes Mellitus and mental disorders are among the indicators of healthy families in achieving PIS PK.This research uses the qualitative method through in-depth interviews and related document. Analysis of readiness of financing for hypertension, Diabetes Mellitus and mental is calculated using costing methode of SPM. The results indicated health spending for PIS …

Efektivitas Biaya Strategi Dots Program Tuberkulosis Antara Puskesmas Dan Rumah Sakit Swasta Kota Depok, Fikrotul Ulya, Hasbullah Thabrany

Jurnal Ekonomi Kesehatan Indonesia

Global TB notification rate at 2016 was 77% and 46.5% in Southeast Asia. Indonesia last 5 years still remain at 32-33% where Depok City reached 58%. In Depok City, private sector contributed 18.7% of the notified TB case in 2016 although only 40% of private hospitals were involved. The aims of this study is to determine cost-effectiveness of DOTS strategy implementation at private hospital and Public Health Centre (PHC). Comparative study carried out for six months with cohort retrospective between PHC, DOTS and Non DOTS hospitals using 36 samples per group. The calculation of the societal perspective with microcosting based …

Measuring Socio-Economic Status Of An Urban Squatter Settlement In Pakistan Using Wami Index, Nousheen Pradhan, Tazeen Saeed Ali, Fauzia Basaria Hasnani, Shireen Shehzad Bhamani, Rozina Karmaliani

Community Health Sciences

Objective: To determine the socio-economic status of a peri-urban community.
Methods: The cross-sectional study was conducted at Deh Chuhar village, Gaddap Town, Karachi from December 2015 to February 2016. The Water/Sanitation, Assets, Maternal Education and Income Index was used. All variables were given a score on the scale of 0-8. The resulting index was illustrated in the form of quintiles.
Results: : A total of 254 households were surveyed. Total population was 2117 with mean number of household members being 8±4. Mean index score was 0.39±0.14 and the median score was 0.375. Percentile distribution of the score indicated that 152(60%) …

The Effect Of Fast Food Restaurants On Type 2 Diabetes Rates, Grace Bailey

CMC Senior Theses

This paper conducts an analysis of county level data to determine the effect of fast food restaurants on type 2 diabetes rates. Due to endogeneity concerns with respect to the location of fast food restaurants, this paper follows the work of Dunn (2010) and uses the number of interstate exits in a given county to serve as an instrument for fast food restaurants. The strength of the instrument, which is theoretically and empirically tested in this paper, imposes some restraints on the interpretation of the findings. Using the Two-Stage Least Squares estimation method, I find that the presence of fast …

Ethics And Cost-Effectiveness Of Naloxone, Allison Groch

Augustana Center for the Study of Ethics Essay Contest

This essay discusses the ethical components involved with using, distributing, and making naloxone readily available for reversing opioid overdoses. The cost-effectiveness of naloxone is also discussed as a reason why naloxone should be widely used in order to help fight the opioid epidemic.

Socio-Economic Determinants Of Physical Activity Across The Life Course: A "Determinants Of Diet And Physical Activity" (Dedipac) Umbrella Literature Review, Grainne O’Donoghue, Aileen Kennedy, Anna Puggina, Katina Aleksovska, Christoph Buck, Con Burns, Greet Cardon, Angela Carlin, Donatella Ciarapica, Marco Colotto, Giancarlo Condello, Tara Coppinger, Cristina Cortis, Sara D’Haese, Marieke De Craemer, Andrea Di Blasio, Sylvia Hansen, Licia Iacoviello, Johann Issartel, Pascal Izzicupo, Lina Jaeschke, Martina Kanning, Fiona Ling, Agnes Luzak, Giorgio Napolitano, Julie Anne Nazare, Camille Perchoux, Caterina Pesce, Tobias Pischon, Angela Polito, Alessandra Sannella, Holger Schulz

Publications

Background To date, the scientific literature on socioeconomic correlates and determinants of physical activity behaviours has been dispersed throughout a number of systematic reviews, often focusing on one factor (e.g. education or parental income) in one specific age group (e.g. pre-school children or adults). The aim of this umbrella review is to provide a comprehensive and systematic overview of the scientific literature from previously conducted research by summarising and synthesising the importance and strength of the evidence related to socioeconomic correlates and determinants of PA behaviours across the life course. Methods Medline, Embase, ISI Web of Science, Scopus and SPORTDiscus …

Three Essays On Maternal And Child Health, Mandar V. Bodas

Theses and Dissertations

This dissertation is a collection of three separate essays on the health of women and children. In the first essay, I along with my co-authors, analyzed the impact of two large, national-level health policies (the Janani Suraksha Yojana (JSY) and the National Rural Health Mission (NRHM)) on maternal health outcomes (proportion of institutional deliveries) in India. We used data from the India Human Development Survey (IHDS) and found that the JSY and the NRHM had a greater impact on institutional deliveries in high-focus states. We also found that the conditions of the public health facilities, did not change after the …

The Effect Of Paid Sick Leave On Physician Office-Based Visits, Korvin Vicente

Theses and Dissertations

This paper uses a balanced sample of workers from cross-sections of the National Health Interview Survey to estimate the causal effects of paid sick leave on the medical care seeking behavior of individuals, as measured by physician office-based visits.

Pregnancy Medicaid Expansions And Fertility: Differentiating Between The Intensive And Extensive Margins, Lincoln H. Groves, Sarah Hamersma, Leonard M. Lopoo

Center for Policy Research

The theoretical and empirical links between public health insurance access and fertility in the United States remain unclear. Utilizing a demographic cell-based estimation approach with panel data (1987-1997), we revisit the large-scale Medicaid expansions to pregnant women during the 1980s to estimate the heterogeneous impacts of public health insurance access on childbirth. While the decision to become a parent (i.e., the extensive margin) appears to be unaffected by increased access to Medicaid, we find that increased access to public health insurance positively influenced the number of high parity births (i.e., the intensive margin) for select groups of women. In particular, …

Socioeconomic Status, Air Quality And Geographic Variation In Emergency Room Visits For Acute Bronchitis On The California Central Coast, Sean Lang-Brown, Heather W. Starnes, Gary B. Hughes

Symposium

IMPORTANCE: Analysis of geospatial variation in acute bronchitis due to socioeconomic and environmental factors can allow the efficient delivery of resources to populations most at risk.

OBJECTIVE: We sought to determine if small scale variation in socioeconomic factors and emergency room (ER) visits for acute bronchitis are associated in small cities or rural communities. We also modeled the effects of air quality on daily rates of ER visits for acute bronchitis in the context of socioeconomic factors to investigate modifying relationships.

DESIGN, SETTING, AND PARTICIPANTS: We examined ER visits for acute bronchitis in San Luis Obispo and Santa Barbara counties …

Congenital Toxoplasmosis In Austria: Prenatal Screening For Prevention Is Cost-Saving, Andrea-Romana Prusa, David C. Kasper, Larry Sawers, Evelyn Walter, Michael Hayde, Eileen Stillwaggon

Economics Faculty Publications

Background:

Primary infection of Toxoplasma gondii during pregnancy can be transmitted to the unborn child and may have serious consequences, including retinochoroiditis, hydrocephaly, cerebral calcifications, encephalitis, splenomegaly, hearing loss, blindness, and death. Austria, a country with moderate seroprevalence, instituted mandatory prenatal screening for toxoplasma infection to minimize the effects of congenital transmission. This work compares the societal costs of congenital toxoplasmosis under the Austrian national prenatal screening program with the societal costs that would have occurred in a No-Screening scenario.

Methodology/Principal Findings:

We retrospectively investigated data from the Austrian Toxoplasmosis Register for birth cohorts from 1992 to 2008, including pediatric …

Do Marketing Strategies Impact Condom Sales In Uganda?, Meyhar Mohammed

Master's Theses

What attracts people to buy condoms? HIV/AIDS remain one of the biggest health dangers of the world, especially in Sub-Saharan Africa. A lot of efforts have been pursued in the past two decades to drastically reduce prevalence of HIV and increase awareness about preventive mechanisms. In order to prevent relapse of success achieved so far, it is important to recognize transformation of consumer behavior due to growth in social networks, education and awareness over time. There are a lot of behavioral triggers captured by social marketing interventions in the field of public health. In an attempt to investigate the role …

Medicaid Managed Care And The Health Care Utilization Of Foster Children, Makayla Palmer, James Marton, Aaron Yelowitz, Jeffery Talbert

Molasky Family Department of Economics and Real Estate Faculty Research

A recent trend in state Medicaid programs is the transition of vulnerable populations into Medicaid managed care (MMC) who were initially carved out of such coverage, such as foster children or those with disabilities. The purpose of this article is to evaluate the impact of the transition of foster children from fee-for-service Medicaid coverage to MMC coverage on outpatient health care utilization. There is very little empirical evidence on the impact of managed care on the health care utilization of foster children because of the recent timing of these transitions as well as challenges associated with finding data sets large …

Race, Age, And Neighborhood Socioeconomic Status In Low Birth Weight Disparities Among Adolescent Mothers: An Intersectional Inquiry, Sheryl L. Coley, Tracy R. Nichols

Journal of Health Disparities Research and Practice

Introduction: Few studies examined socioeconomic contributors to racial disparities in low birth weight outcomes between African-American and Caucasian adolescent mothers. This cross-sectional study examined the intersections of maternal racial status, age, and neighborhood socioeconomic status in explaining these disparities in low birth weight outcomes across a statewide sample of adolescent mothers.

Methods: Using data from the North Carolina State Center of Health Statistics for 2010-2011, birth cases for 16,472 adolescents were geocoded by street address and linked to census-tract information from the 2010 United States Census. Multilevel models with interaction terms were used to identify significant associations between maternal racial …

Incentives To Change: Effects Of Performance-Based Financing On Health Workers In Zambia, Gordon C. Shen, Ha Thi Hong Nguyen, Ashis Das, Nkenda Sachingongu, Collins Chansa, Jumana Qamruddin, Jed Friedman

Publications and Research

Background: Performance-based financing (PBF) has been implemented in a number of countries with the aim of transforming health systems and improving maternal and child health. This paper examines the effect of PBF on health workers’ job satisfaction, motivation, and attrition in Zambia. It uses a randomized intervention/control design to evaluate before–after changes for three groups: intervention (PBF) group, control 1 (C1; enhanced financing) group, and control 2 (C2; pure control) group.

Methods: Mixed methods are employed. The quantitative portion comprises of a baseline and an endline survey. The survey and sampling scheme were designed to allow for a rigorous impact …