Health Economics Commons^™

More Schooling Can Delay The Onset Of Dementia Later In Life, Vikesh Amin, Jere R. Behrman, Jason M. Fletcher, Carlos A. Flores, Alfonso Flores-Lagunes, Iliana Kohler, Hans-Peter Kohler, Shana D. Stites

Employment Research Newsletter

No abstract provided.

Experience Matters: An Application Of The Operative Value Index For Lumbar Fusions, Danyal Quraishi, Advith Sarikonda, D. Mitchell Self, Steven R. Glener, Arbaz A. Momin, Emily L. Isch, Ashmal K. Sami, Matthews Lan, Nicholas Clark, Ashwini Sharan, Srinivas Prasad, Jack Jallo, Joshua Pelta-Heller, Alex R. Vaccaro, James Harrop, Ahilan Sivaganesan

Department of Neurosurgery Faculty Papers

INTRODUCTION: As healthcare systems transition to value-based care models, it is critical to understand factors influencing costs and outcomes in neurosurgery. This study utilizes Time-Driven Activity-Based Costing (TDABC) to assess the impact of surgeon experience and case volume on costs, clinical outcomes, and operative value in lumbar fusions. While TDABC has been applied in various surgical specialties, its use in neurosurgery, particularly in analyzing surgeon-specific factors, remains limited.

METHODS: A retrospective cohort study was conducted at a single center, analyzing lumbar instrumented arthrodesis procedures from 2017 to 2019. Primary variables included surgeon experience (years) and case volume (annual procedures). Confounding …

Pengaruh Vaksinasi Covid-19 Terhadap Kesehatan Dan Kondisi Ekonomi Masyarakat Di Indonesia, Ayu Lestari, Fauziah Zen

Jurnal Ekonomi dan Pembangunan Indonesia

The COVID-19 vaccination is considered crucial for controlling the pandemic and accelerating economic recovery. However, empirical evidence on the impact of vaccination on health and the economy at the district/city level in Indonesia remains limited. This study aims to analyze the impact of vaccination on health outcomes and economic conditions. The methodology used is a fixed effect model with monthly panel data on vaccination and health outcomes (positivity rate and recovery), as well as annual data on per capita expenditure in 514 districts/cities from January 2021 to December 2022. The results show that the first dose of vaccination significantly reduces …

Cost Of Illness Pada Pasien Hipertensi Rawat Jalan Di Puskesmas Gamping 2, Yuni Andriani, Sephia Wulandari, Niken Larasati

Jurnal Ekonomi Kesehatan Indonesia

Hypertension is characterized by increased blood pressure due to various risks that do not function normally in stabilizing blood pressure. According to WHO, the number of hypertension patients worldwide in 2020 reached 972 million (26.4%) and increased in 2021 to 1.2 billion (29.2%). Hypertension treatment must be carried out long, requiring a substantial aggregate treatment cost. Based on BPJS data, in 2014, hypertension accounted for approximately Rp2.8 trillion in healthcare costs, which increased annually until 2016, reaching around Rp4.2 trillion. The purpose of this study is to describe the overall estimated cost of hypertension treatment for outpatients at Puskesmas Gamping …

Status Sosial Ekonomi Dan Pengeluaran Oop Kesehatan Penyandang Disabilitas, Maxent Rg Nainggolan, Riki Relaksana

Jurnal Ekonomi Kesehatan Indonesia

In 2020, the number of persons with disabilities in Indonesia reached 22.97 million. One of the main challenges this population faces is the high burden of health expenditures, particularly those that are urgent and unpredictable. This study aims to analyze the influence of socioeconomic status on out-of-pocket (OOP) health expenditures among households with persons with disabilities in Indonesia. A quantitative approach was employed using secondary data from the 2022 National Socioeconomic Survey (Susenas), utilizing the core module (KOR) and the household expenditure module (KP). Data were analyzed using the two-part regression model to identify the determinants of OOP health spending. …

Determinants Of Catastrophic Health Expenditure Of Households In Indonesia, Rafa Fayza Afrizal, Novira Hasya, Faticha Putri Harda, Wildan Avif Alfathin, Vanissa Nur Latifah, Maxent Rael Nainggolan, Fadillah Rahmah Jaelani, Estro Dariatno Sihaloho

Jurnal Ekonomi Kesehatan Indonesia

The need for healthcare services due to illness is unpredictable, thus burdening patients economically and posing a risk of catastrophic events. The percentage of households with catastrophic health expenditures is defined as out-of-pocket payments exceeding 10% of the household’s capacity to pay for healthcare. Increasing catastrophic expenditure costs can further deteriorate the household’s financial condition. This study analyzes the determinants of catastrophic health expenditures in Indonesian households. A total of 12,892 household samples from the cross-sectional Indonesian Family Life Survey (IFLS) wave 5 (2014) were used in this study. Using a logistic regression model, this study aims to identify various …

Do Anterior-Posterior Lumbar Fusions Provide More Short-Term Value Than Posterior-Only? An Application Of The Operative Value Index, Steven R. Glener, Advith Sarikonda, D. Mitchell Self, Ashmal Sami, Danyal Quraishi, Emily Isch, Arbaz A. Momin, Cheritesh R. Amaravadi, Jack Jallo, Joshua Heller, Ashwini Sharan, Alex R. Vaccaro, Srinivas K. Prasad, James Harrop, Nicholas J. Clark, Ahilan Sivaganesan

Department of Neurosurgery Faculty Papers

BACKGROUND: Lumbar fusion is a common treatment for degenerative spine changes. Although both anterior-posterior (AP) and posterior-only approaches are used, their cost-effectiveness remains uncertain. This study aims to compare the costs and short-term "value" (outcomes per dollar spent) of AP and posterior-only lumbar fusions using time-driven activity-based costing and patient-reported outcomes.

METHODS: A retrospective review of AP and posterior lumbar fusions from 2017 to 2022 was conducted. Time-driven activity-based costing was used to assign intraoperative costs based on resource utilization, and the Oswestry Disability Index (ODI) was collected preoperatively and 3 months postoperatively. The Operative Value Index (OVI) was defined …

Optimizing Costs In Plastic Surgery: A Systematic Review Of Time-Driven Activity-Based Costing Applications, Emily L. Isch, Gabrielle Kozlowski, D. Mitchell Self, Theodore E. Habarth-Morales, Sydney Somers, Ahilan Sivaganesan, David Kim, Heather A. Mcmahon, Andrew Newsman, Matthew Jenkins

Department of Surgery Faculty Papers

BACKGROUND: The rising complexity and cost of healthcare in plastic surgery, particularly in resource-intensive procedures like free flap and breast reconstruction, pose significant financial challenges. Time-driven activity-based costing (TDABC) offers a method to accurately assess these costs by mapping each step of the care cycle based on time and resources consumed. Although TDABC has been utilized in high-cost fields such as neurosurgery and spine surgery, its application in plastic surgery remains underexplored. This systematic review evaluates the literature on TDABC use in plastic surgery to identify key cost drivers and propose strategies for cost-efficiency.

METHODS: A systematic review was conducted …

Working Paper No. 98, Selma Mushkin And The Emergence Of The Field Of Health Economics, Sadie Kautz

Working Papers in Economics

This inquiry seeks to establish that through her effective efforts, Selma Mushkin promoted and shaped the field of Health Economics. Perhaps most importantly, she redefined health as a form of human capital that needed to be considered as both essential and integral to economic growth. In her 1958 paper: “Toward a Definition of Health Economics,” she defined the scope of this emerging field through emphasizing how improved resource allocation could lead to efficiency gains. Appearing as her 1962 article in the Journal of Political Economy, with “Health as an Investment” Mushkin advanced the idea that--much like education--public spending on health …

Urban-Rural Divide In Inequality’S Impact On Substance Abuse, Jonathan E. Flores

Undergraduate Theses, Capstones, and Recitals

This thesis focuses on investigating the relationship between income inequality, measured through the Gini coefficient, and drug addiction, proxied through substance-related mortality. Specifically, this thesis focuses on how these dynamics vary across rural and urban counties in the United States, using population size as a proxy. County-level data from 2016 to 2020 were collected through both the CDC and the Census Bureau and subsequently analyzed using Stata, with crude death rates from drug and alcohol causes serving as a function of the Gini coefficient, labor force participation, racial composition, and other socioeconomic indicators. Through a quadratic version of the model, …

Does Schooling Improve Cognitive Abilities At Older Ages? Causal Evidence From Nonparametric Bounds, Vikesh Amin, Jere R. Behrman, Jason M. Fletcher, Carlos A. Flores, Alfonso Flores-Lagunes, Hans-Peter Kohler

Upjohn Institute Working Papers

We revisit much-investigated relationships between schooling and health, focusing on schooling impacts on cognitive abilities at older ages using the Harmonized Cognition Assessment Protocol in the Health & Retirement Study (HRS) and a bounding approach that requires relatively weak assumptions. Our estimated upper bounds on the population average effects indicate potentially large causal effects of increasing schooling from primary to secondary; yet, these upper bounds are smaller than many estimates from the literature on causal schooling impacts on cognition using compulsory-schooling laws. We also cannot rule out small and null effects at this margin. We do, however, find evidence for …

Causal Effects Of Schooling On Memory At Older Ages In Six Low-And-Middle-Income Countries: Nonparametric Evidence With Harmonized Datasets, Vikesh Amin, Jere R. Behrman, Jason M. Fletcher, Carlos A. Flores, Alfonso Flores-Lagunes, Iliana Kohler, Hans-Peter Kohler, Shana D. Stites

Upjohn Institute Working Papers

Higher schooling attainment is associated with better cognitive function at older ages, but it remains unclear whether the relationship is causal. We estimate causal effects of schooling on performances on the Consortium to Establish a Registry for Alzheimer’s Disease (CERAD) word-recall (memory) test at older ages in China, Ghana, India, Mexico, Russia, and South Africa. We used harmonized data (n=30,896) on older adults (≥50 years) from the World Health Organization Study on Global Ageing and Adult Health. We applied an established nonparametric partialidentification approach that bounds causal effects of increasing schooling attainment at different parts of the schooling distributions under …

More Schooling Can Delay The Onset Of Dementia Later In Life, Vikesh Amin, Jere R. Behrman, Jason M. Fletcher, Carlos A. Flores, Alfonso Flores-Lagunes, Iliana Kohler, Hans-Peter Kohler, Shana D. Stites

Upjohn Institute Policy and Research Briefs

No abstract provided.

Time-Driven Activity-Based Costing For Cervical Myelopathy Surgery: A Step Towards Total Episode Costs, Kavantissa M. Keppetipola, Adam Leibold, Jay Trivedi, Ashmal Sami, Advith Sarikonda, D. Mitchell Self, Emily L. Isch, Steven R. Glener, Srinivas Prasad, Jack Jallo, Joshua E. Pelta-Heller, James Harrop, Alex R. Vaccaro, Ahilan Sivaganesan

Department of Neurosurgery Faculty Papers

INTRODUCTION: Time-driven activity-based costing (TDABC) is a highly accurate method for determining the true cost of delivering a healthcare service. However, TDABC is most often applied to a singular phase of care such as an outpatient visit or a surgical event. Here we broaden the scope by using TDABC to estimate the costs of surgically treating cervical myelopathy - from the moment of surgical scheduling until post-operative hospital discharge.

METHODS: In a single-center retrospective study at a large tertiary academic institution, TDABC was employed to measure pre-operative, intra-operative, and post-operative (inpatient) costs for 63 patients undergoing elective surgery for cervical …

Protecting The Future Of Medical Innovation: Balancing Fiscal Responsibility With The Need For National Institutes Of Health And Federal Health Funding, Irina Petrache, Raed A. Dweik, Michelle Ng Gong, Jesse Roman, M. Patricia Rivera, Karen J. Collishaw

Division of Pulmonary, Allergy, and Critical Care Medicine Faculty Papers

No abstract provided.

An Exploratory Study Of Household Alcohol Consumption From The Us Bureau Of Labor Statistics Consumer Expenditure Survey With A Focus On Market Conditions And Regulatory Structures, Mayya Makarycheva

Dissertations, Theses, and Capstone Projects

Alcohol consumption and use is not just a harmful behavior or a potential recreational activity, but it also may form a way of self-identification.

Each type of beverage apparently has their own profile of dedicated drinkers. Those drinkers are also apparently loyal to the location of purchase. However, one may also consider whether consumption in one location is a predictor of consumption in the other location. This distinct tendency highlights the intricacy of consumption patterns, as on-premise and off-premise consumption simultaneously serve as complements and substitutes in the long run in terms of both location and type of beverage.

The …

Menstrual Math: The Price Of Bleeding, Gabrielle Langston

Dissertations, Theses, and Capstone Projects

This project examines the landscape of menstrual equity in the United States through a data storytelling lens, focusing on state-level policies regarding taxation and access to menstrual products. The analysis explores which states impose sales tax on menstrual products, if state schools provide free menstrual products, and which states ensure access for incarcerated individuals using publicly available datasets from advocacy groups. Additionally, there is an investigation into potential correlations between the gender wage gap and states that tax menstrual products, shedding light on economic and policy disparities.

Through its data visualizations, this project aims to provide a clear, although not …

Federal Health Research Cuts In The Mountain West, 2025, Mia Tschan, Ivan Sun, Sydney Mitchell, Caitlin J. Saladino, William E. Brown Jr.

Health

This fact sheet presents data from the Science & Community Impacts Mapping Project (SCIMaP) report, “Impact of Federal Health Research Cuts,” which predicts economic and job losses resulting from proposed National Institutes of Health (NIH) funding/grants cuts for indirect research costs as of April 9, 2025. This fact sheet focuses on predicted economic and job loss for the Mountain West states of Arizona, Colorado, Nevada, New Mexico, and Utah, and county-level data for the State of Nevada.

Integrating Positive Psychology And Spirituality To Foster Meaning And Well-Being In Older Adults, Crystal Morris

Adultspan Journal

This perspective article explores the integration of positive psychology interventions (PPIs) and spirituality in therapy to foster meaning and well-being in older adults. It highlights exercises such as the positive introduction, positive legacy, character strengths, mindfulness, mindful-based yoga, and a manifestation prayer journaling. The interventions presented are tools to support older adults that may experience depression, difficult life transitions, and the search for renewed meaning. Therapists who integrate PPIs and spirituality into therapy can promote a holistic, non-pathological approach to treatment.

Is Anterior Cervical Discectomy And Fusion More Expensive At Quaternary Care Centers? An Application Of Time-Driven Activity-Based Costing, Jay Trivedi, Advith Sarikonda, Adam Leibold, D. Mitchell Self, Nikolaos Mouchtouris, Steven R. Glener, Ashmal Sami, Kavantissa M. Keppetipola, Emily Isch, Joshua Pelta-Heller, Srinivas Prasad, Ashwini Sharan, James Harrop, Alex R. Vaccaro, Ahilan Sivaganesan

Department of Neurosurgery Faculty Papers

OBJECTIVE: Hospital setting is postulated to be a key driver of cost variation for neurosurgical procedures. Limitations in contemporary costing methodologies have led to the development of time-driven activity-based costing (TDABC). This study applies TDABC to anterior cervical discectomy and fusion (ACDF) to compare intraoperative costs at quaternary care centers versus satellite hospitals affiliated with the same health network.

METHODS: Nine hundred and fifty-eight ACDF cases performed at two quaternary care hospitals (n = 806) and six satellite hospitals (n = 152) were reviewed. Process maps were created to map the intraoperative episode, and TDABC methodology was used to calculate …