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.
The NSF SBE DDRIG funded two projects for my dissertation in health economics. The first project characterizes physicians by how efficiently they provide medical care. An efficient physician is one who treats patients at the lowest cost without sacrificing health outcomes. The project focuses on emergency room physicians in Florida. ER physicians are important providers of medical care because they are responsible for treating a large share of uninsured, Medicaid, and Medicare patients. The project tested whether observable physician characteristics were able to explain differences in efficiency across physicians within hospitals. The project analyzed five physician characteristics: physician experience, medical school, gender, international medical training, and whether the physician is bi-lingual. It found that physician experience was the only characteristic that explained efficiency. Physicians with less than 6 years of experience charged 5% more than physicians with more experience, with no differences in outcomes. The paper is available through the Columbia Academic Commons and I am preparing it for publication. The second project asks if hospitals respond to changes in the Federal Medical Assistance Percentages (FMAP), the formula that determines the amount of federal Medicaid funding that the states receive. The federal and state governments jointly fund Medicaid, so the federal government matches a large share of state spending. Under the 2009 American Recovery and Reinvestment Act (ARRA), the federal government temporarily increased the FMAP for all states. Beginning in January 2011, however, the ARRA FMAP started to expire and it expired completely by July 2011. With less federal funding and high Medicaid participation rates in 2011, some states reformed their provider reimbursement rates. The project’s assumption is that the FMAP expiration resulted in lower Medicaid reimbursement rates to hospitals. The hypothesis is that hospitals responded by reducing the number of Medicaid patients they admitted. To test the hypothesis, the project uses hospitalization data from Florida, New Jersey, and New York from 2009-2011. The project finds no change in the total number of patients admitted or in the share of Medicaid patients admitted. These preliminary results indicate that hospitals did not change their admission procedures in response to the ARRA FMAP expiration.
