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

在美国的医院里，医疗保健的差异无处不在。这项提案旨在了解具有相同潜在健康状况的患者为什么接受不同的治疗、产生不同的成本和体验不同的结果。影响患者护理的因素可想而知很多，但一个因素可能是患者主治医生的素质，另一个因素可能是患者的医疗保险类别。这项提案中的第一个项目询问医生的特征是否可以解释患者治疗、成本和结果的差异。它的重点是2005-2009年间前往佛罗里达州急诊室(ER)并被分配到急诊室医生的患者。它的目的是回答以前在文献中没有解决的问题，例如医生经验和医学院是否解释了患者护理方面的差异。急诊室是有意义的分析实验室，因为急诊室就诊人数随着时间的推移而增加，急诊室为服务不足的人群提供医疗保健。该项目能够促进医生知识领域的发展，同时也对如何向人口中的一大部分提供医疗服务产生影响。第二个项目询问联邦资金的变化如何影响医疗补助计划的登记、支出和医院护理。2011年，随着《美国复苏和再投资法案》到期，所有州的联邦医疗援助百分比(FMAP)都有所下降。作为回应，各州试图通过调整提供者的支付来减少医疗补助支出。该项目使用加利福尼亚州、佛罗里达州和纽约州的数据来确定医疗补助的登记人数、支出和医院利用率如何随着联邦资金的变化而变化。重要的是要确定联邦资金如何影响医疗补助患者获得的医疗保健质量。了解FMAP的后果将为政策制定者提供更多关于县和医院如何应对未来变化的信息。

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.