Health Economics Commons^™

Differential Impact Of Admission Type And Clinical Complexity On Diabetes Hospitalization Costs Among African American And Hispanic Patients In Southeastern Virginia, Ismail El Moudden, Asra Amidi, Reem Sharaf-Alddin, Michael C. Bittner, Qi Zhang

Department of Obstetrics & Gynecology Faculty Publications

Background

Diabetes mellitus (DM) imposes substantial healthcare costs with documented disparities among African Americans and Hispanic patients. To inform care delivery and resource allocation, this study identified hospitalization cost predictors among African American and Hispanic patients with diabetes in Southeastern Virginia.

Methods

We analyzed 6,011 hospital discharges from the Virginia Health Information database (2016-2020) for adults aged 18-85 with diabetes. Discharges were classified by Medicare Severity Diagnosis-Related Groups: DM with complications/comorbidities (DCC, n = 3,328), DM with major complications/comorbidities (DMCC, n = 1,518), and DM without major complications/comorbidities (DWO, n = 1,165). Because cost distributions were right-skewed (skewness 3.5-8.24), we …

Visit Complexity Differs Between Scarring And Nonscarring Alopecia: A 5-Year Dataderm Analysis, Ian Noel Encarnacion, Noelle Desir, Nicholas Schell, Apoorva Mehta, Temitayo Ogunleye, Susan Taylor

Department of Medicine Faculty Publications

[Introduction] Accurate coding is a critical component of dermatologic practice, influencing reimbursement and documentation of clinical complexity. Although alopecia has significant psychosocial and financial burdens, Current Procedural Terminology (CPT) coding patterns in alopecia management remain largely understudied. Our population-level study using the American Academy of Dermatology's DataDerm clinical registry¹ evaluates alopecia CPT coding trends, pre-2021 and post-2021 evaluation and management (E/M) CPT coding updates,² aiming to inform coding practices and visit complexity, which have significant reimbursement implications.

A Modern Optimization Approach With Data-Driven Analytical Modeling For The Healthcare Business Segment (Hbs) From The S&P 500, Aditya Chakraborty, Chris Tsokos

Epidemiology, Biostatistics, & Environmental Health Faculty Publications

Introduction: The S&P consists of eleven business segments, which are classified according to the type of industry. The current study focuses on developing a non-linear analytical model for the Healthcare Business Segment (HBS) of the S&P 500, as a function of different economic & financial indicators. Materials and Methods: The analytical model used six financial indicators together with four economic indicators to predict the weekly average closing price (WCP) of HBS stocks. Johnson’s SB transformation corrected skewness, while desirability-based optimization identified indicator values maximizing WCP. The model’s performance and generalizability were validated through repeated 10-fold cross-validation. Results: All attributable contributors …

High-Resolution Modeling Of Extreme Heat Events With Socioeconomic Consideration: A Real-Case Wrf-Les Approach, Maryam Golbazi, Frank Liu, Yin-Hsuen Chen, Timothy W. Juliano, Heather Richter

ODU Articles

The overarching goals of this work is to explore best practices for micro-scale modeling of a real case, identify relevant phenomena by using high-resolution modeling, and to explore their implications for public health, and climate resilience strategies in Hampton Roads, VA, USA. This project employs the Weather Research and Forecasting (WRF) model to conduct a comprehensive study of Hampton Roads, utilizing a coupled mesoscale to microscale modeling capable of resolving boundary layer turbulence. This study has three primary objectives: (1) to establish the optimal mesoscale to Large-Eddy Simulation (LES) configurations for complex geographical regions such as the Hampton Roads (HR) …

Athletic Trainers' Perspectives On Resources And Preparation Needed For Successful Salary Negotiation, Kimberly R. Detwiler, Cailee E. Welch Bacon, Indigo B. White, Leanne E. Jones, Julie M. Cavallario

Rehabilitation Sciences Faculty Publications

Context

Many athletic trainers (ATs) work under high stress, long hours, and low pay. These conditions often lead ATs and athletic training students to leave the profession. Previous studies show that over half of ATs do not negotiate salary, often because they feel the offer is fair or fear losing the job. Additional support is needed to help ATs prepare for negotiations, as current resources are limited.

Objective

This study explored ATs’ views on the resources need to prepare for salary negotiations during the hiring process.

Design

Consensual qualitative research.

Setting

Individual video interviews.

Patients or Other Participants

Twenty-eight participants …

Disparities In Cardiovascular Disease Outcomes And Economic Burdens Among Minorities In Southeastern Virginia, Ismail El Moudden, Asra Amidi, Reem Sharaf Alddin, Michael Bittner, Qi Zhang

Department of Obstetrics & Gynecology Faculty Publications

Background

Cardiovascular diseases are the leading cause of mortality in the United States, presenting significant public health challenges and financial burdens, particularly in Southeastern Virginia, where African American and Hispanic (AA&H) populations are disproportionately affected.

Methods

This retrospective observational study analyzed data from 30,855 hospital discharges of AA&H patients across Southeastern Virginia from 2016 to 2020, focusing on individuals aged 18 to 85 with cardiovascular diseases. Utilizing the Virginia Health Information database, we examined demographic information, clinical data, and healthcare utilization patterns through hypothesis tests and regression models to explore associations between these variables and the economic impacts of cardiovascular …

A Stock Optimization Problem In Finance: Understanding Financial And Economic Indicators Through Analytical Predictive Modeling, Aditya Chakraborty, Chris Tsokos

Epidemiology, Biostatistics, & Environmental Health Faculty Publications

Given the significant impact of healthcare stock changes on the global economy, including its GDP and other financial factors, we endeavored to create an analytical prediction model for forecasting the annual percentage change of these stocks. Our model, which is nonlinear, incorporates five key discoveries. We focused on predicting the average weekly closing price (pWCP) of AbbVie Inc. (North Chicago, IL, USA)'s healthcare stock (ABBV) from 1 August 2017 to 31 December 2019. The stock was chosen based on the low beta risk, high dividend yield, and high yearly percentage return criteria. Alongside predicting the weekly stock price, our model …

The Geometry Of Dynamic Time-Dependent Best-Worst Choice Pairs, Sasanka Adikari, Norou Diawara, Haim Bar

Mathematics & Statistics Faculty Publications

There has been increasing interest in best–worst discrete choice experiments (BWDCEs) in health economics, transportation research, and other fields over the last few years. BWDCEs have distinct advantages compared to other measurement approaches in discrete choice experiments (DCEs). A systematic study of best–worst (BW) choice pairs can be traced back to the 1990s. Recently, new ideas have been introduced to the subject. Calculating utility helps measure the attractiveness of BW choices. The goal of this paper is twofold. First, we extend the idea of the BW choice pair to include dynamic, time-dependent transition probability and capture utility at each time …

Assessment Of Spatio-Temporal Variations In Pm2.5 And Associated Long-Range Air Mass Transport And Mortality In South Asia, Md Sariful Islam, Shimul Roy, Tanmoy Roy Tusher, Mizanur Rahman, Ryley C. Harris

Political Science & Geography Faculty Publications

Fine particulate matter (PM_2.5) is associated with adverse impacts on ambient air quality and human mortality; the situation is especially dire in developing countries experiencing rapid industrialization and urban development. This study assessed the spatio-temporal variations of PM_2.5 and its health impacts in the South Asian region. Both satellite and station-based data were used to monitor the variations in PM_2.5 over time. Additionally, mortality data associated with ambient particulate matter were used to depict the overall impacts of air pollution in this region. We applied the Mann–Kendall and Sen’s slope trend analysis tool to investigate the …

Time Dependent Attribute-Level Best Worst Discrete Choice Modelling, Amanda Working, Mohammed Alqawba, Norou Diawara, Ling Li

Mathematics & Statistics Faculty Publications

Discrete choice models (DCMs) are applied in statistical modelling of consumer behavior. Such models are used in many areas including social sciences, health economics, transportation research, and health systems research and they are time dependent. In this manuscript, we review references on the study of such models, develop DCMs with emphasis on time dependent best-worst choice and discrimination between choice attributes. Referenced measurements of the dynamic DCMs are simulated. Expected utilities over time are derived using Markov decision processes. We study attributes and attribute-levels associated with the quality of life of seniors, report the estimation results, and discuss our findings.

Identifying Barriers To Attendance In Counseling Among Adults In The United States: Confirming The Factor Structure Of The Revised Fit, Stigma, & Value Scale, Michael T. Kalkbrenner, Edward S. Neukrug

Counseling & Human Services Faculty Publications

The primary aim of this study was to cross-validate the Revised Fit, Stigma, & Value (FSV) Scale, a questionnaire for measuring barriers to counseling, using a stratified random sample of adults in the United States. Researchers also investigated the percentage of adults living in the United States that had previously attended counseling and examined demographic differences in participants’ sensitivity to barriers to counseling. The results of a confirmatory factor analysis supported the factorial validity of the three-dimensional FSV model. Results also revealed that close to one-third of adults in the United States have attended counseling, with women attending counseling at …

Health Capital Investment And Time Spent On Health Related Activities, Juan Du, Takeshi Yagihashi

Economics Faculty Publications

One key component in the health capital investment model in (Grossman, M. Journal of Political Economy, 80: 223–255, 1972) is time spent on improving health. However, few empirical studies have examined how time spent on health investment is determined. In this paper, we fill this void in the literature by investigating how people allocate their time for different types of health-related activities in response to economic variables. Using the American Time Use Survey, we distinguish health-enhancing and health-deteriorating leisure activities, with the rationale that these activities may respond differently to socioeconomic environment. We find that health-enhancing and health-deteriorating time respond …

Social Health Insurance Coverage And Financial Protection Among Rural-To-Urban Internal Migrants In China: Evidence From A Nationally Representative Cross-Sectional Study, Wen Chen, Qi Zhang, Andre M. N. Renzaho, Fangjing Zhou, Hui Zhang, Li Ling

Community & Environmental Health Faculty Publications

INTRODUCTION: Migrants are a vulnerable population and could experience various challenges and barriers to accessing health insurance. Health insurance coverage protects migrants from financial loss related to illness and death. We assessed social health insurance (SHI) coverage and its financial protection effect among rural-to-urban internal migrants (IMs) in China.

METHODS: Data from the '2014 National Internal Migrant Dynamic Monitoring Survey' were used. We categorised 170 904 rural-to-urban IMs according to their SHI status, namely uninsured by SHI, insured by the rural SHI scheme (new rural cooperative medical scheme (NCMS)) or the urban SHI schemes (urban employee-based basic medical insurance (UEBMI)/urban …

Goods-Time Elasticity Of Substitution In Health Production, Juan Du, Takeshi Yagihashi

Economics Faculty Publications

We examine how inputs for health production, in particular, medical care and health-enhancing time, are combined to improve health. The estimated elasticity of substitution from a constant elasticity of substitution production function is significantly less than one for the working-age population, rejecting the unit elasticity of substitution used in previous studies.

Health Care Use, Out-Of-Pocket Expenditure, And Macroeconomic Conditions During The Great Recession, Juan Du, Takeshi Yagihashi

Economics Faculty Publications

We study how macroeconomic conditions during the Great Recession affected health care utilization and out-of-pocket expenditures of American households. We use two data sources: the Consumer Expenditure (CE) Survey and the Survey of Income and Program Participation (SIPP); each has its own advantages. The CE contains quarterly frequency variables, and the SIPP provides panel data at the individual level. Consistent evidence across the two datasets shows that utilization of routine medical care was counter-cyclical, whereas hospital care was pro-cyclical during the Great Recession. When we examine the pre-recession period, the relationship between macroeconomic conditions and health care use was either …

Health Care Inflation And It's Implications For Monetary Policy, Takeshi Yagihashi, Juan Du

Economics Faculty Publications

Motivated by recent findings on the cyclical movement of both health and health spending, we construct a general equilibrium model that distinguishes health care demand from the demand for other goods. Using this model, we are able to generate inflation dynamics and cyclicality of health that match the US data. When the model is subjected to an expansionary monetary policy shock, it yields different output and inflation responses compared with a two-sector model with homogeneous demand. We show that the trade-off between leisure and health spending plays an important role in model dynamics. The model further predicts different degrees of …

Estimating Cost Adjustments Required To Accomplish Target Savings In Chronic Disease Management Interventions: A Simulation Study, Rafael Diaz, Joshua G. Behr, Bruce S. Britton

VMASC Publications

Chronic diseases are persistent ailments that are not preventable or curable with medication or vaccination. Many of the leading chronic conditions in industrialized societies may be related to lifestyle choices. The prevalence of these chronic conditions significantly affects the health, suffering, and longevity of patients. This paper demonstrates the utility of system dynamics as an approach to model and simulate the behavior of key cost factors in the implementation of population health management interventions. The study uses modeling and simulation as an evaluative method to identify potential savings stemming from an intervention within a well-defined population group. The model is …

Modeling Solutions For Prevention Of Medicare Insolvency For The Baby Boomer Generation (Born 1946 - 1964), Gregory Thomas Scott

Health Services Research Dissertations

Medicare, a United States social insurance program operated by the United States federal government, began operating in a deficit in the year 2010. More funding was expended than revenue received for medical care, creating significant shortfalls for the Medicare Trust Fund. This study examined possible initiatives to describe Medicare funding related to issues as financial shortfalls utilizing mathematical modeling and simulation. The Park Conceptual Model is a framework created to identify internal and external changes that influence bankruptcies related to municipalities, and this Model served as the theoretical basis for this study.

The following study addressed insolvency as negative cash …

Formal And Informal Care: An Empirical Bayesian Analysis Using The Two-Part Model, Juan Du

Economics Faculty Publications

Informal care provided to the elderly by their children is proposed as a less expensive alternative to institutional long-term care. This paper explores how the elderly's consumption of medical care changes in response to changes in the informal care they receive from their children. Many earlier studies have ignored both the endogeneity of informal care and the complicated nature of health care utilization data. This paper develops a two-part model with informal care treated as an endogenous regressor and imposes exclusion restrictions on the selection process. The model is fitted using the Bayesian Markov Chain Monte Carlo (MCMC) methods, in …

A System Dynamics Model For Simulating Ambulatory Health Care Demands, Rafael Diaz, Joshua G. Behr, Mandar Tulpule

VMASC Publications

Introduction: This article demonstrates the utility of the system dynamics approach to model and simulate US demand for ambulatory health care service both for the general population and for specific cohort subpopulations over the 5-year period, from 2003 to 2008. A system dynamics approach that is shown to meaningfully project demand for services has implications for health resource planning and for generating knowledge that is critical to assessing interventions.

Methods: The study uses a cohort-component method in combination with structural modeling to simulate ambulatory health care utilization. Data are drawn from the National Ambulatory Medical Care Survey and the National …

Measurement Of Hospital Performance: Environmental And Organizational Factors Associated With Cost, Debra Kay Dierksmeier Anderson

Health Services Research Dissertations

As U.S. health care expenditures top the $1 trillion mark, there is increased interest in measuring the performance of health care providers. For bottom line oriented payors such as government and business, the focus is on measuring cost. As hospitals account for over one-third of health care expenses, hospital cost per admission is a common measure of performance.

Many environmental and organizational factors come into play in determining hospital cost per admission. This research examines several of these factors, using Raymond Zammuto's model of organizational effectiveness assessment. Using Zammuto's framework, this research looks at the relationship of social, physical, and …