Doctoral Dissertation Research in Economics: Essays on the determinants of healthcare differences in US hospitals

Columbia University, New York NY

Investigators

Abstract

Healthcare differences are pervasive in United States hospitals. This proposal aims to understand why patients with the same underlying health conditions receive different treatments, incur different costs, and experience different outcomes. There are conceivably many factors that affect patient care, but one factor may be the quality of the patient's attending physician, and another factor may be the patient's health insurance category. The first project in this proposal asks whether physician characteristics explain differences in patient treatments, costs, and outcomes. It focuses on patients who visit Florida emergency rooms (ER) from 2005-2009 and who are assigned to ER physicians. It aims to answer questions previously unaddressed in the literature, such as whether physician experience and medical school explain differences in patient care. ERs are meaningful laboratories for analysis, as ER visits have increased over time and ERs provide healthcare to underserved populations. This project has the ability to advance the field of knowledge on physicians, while also generating implications for how healthcare services are delivered to a large subset of the population. The second project asks how changes in federal funding affect Medicaid program enrollment, spending, and hospital care. In 2011, Federal Medical Assistance Percentages (FMAPs) decreased for all states as the American Recovery and Reinvestment Act expired. In response, states tried to reduce Medicaid spending by adjusting provider payments. This project uses data from California, Florida, and New York to determine how Medicaid enrollment, spending, and hospital utilization changed in response to changes in federal funding. It is important to determine how federal funding affects the quality of healthcare Medicaid patients receive. Understanding the consequences of the FMAP will give policy-makers more information about how counties and hospitals might respond to changes going forward.