Health Economics
Health Economics: ECON 467-01 (13351) & ECON 652-01(13431)
Dept. of Economics and Public Policy
UMBC/ Fall2020
Step-by-step weekly Assignments to build up a paper
Eight Individual Assignments each 4 points:
Step1- Sep. 13-Data analyses of SAHIE Interactive Data Tool (4%)
Step 2-Sep 27-Data analyses of HCUP Interactive Data Tool (4%)
Step 3-Oct. 17-Send the First Draft of the paper to your reviewer (4%)
Step 4-Oct. 25-Reviewer send constructive feedback
to the authors (4%)
Step 5-Nov. 8-Send the First Draft of the paper to the instructor (4%)
Step 6-Nov. 29-Send Final Draft of the paper to the reviewer (4%)
Step 7-Dec. 6-Reviewer send final constructive feedback to the authors (4%)
Step 8-Dec. 13-Send the Final revised version of the Draft will be sent to the instructor (4%)
Abstract
Here is an example of abstract in comparing California and Florida!
Objectives: The objective of this study is to compare the impact of the Affordable Care Act (ACA) on number of uninsured, low-income Californians and Florida. It also explores the impact of Medicaid Expansion as a public health intervention (I) on number of opioid related hospitalizations as an outcomes (O) of I between 2006 and 2018.
Background: California (P) adopted and Implemented Medicaid expansion (I) on 1/1/2014 while Florida (C) has not adopted Medicaid expansion state. The objective of this study is to compare the outcomes of this public health I on hospitalization and emergency department (O).
Objective:
Methods and key variables and key outcomes of interests
Methods: We used the Secondary data analysis from Small Area Health Insurance Estimates (SAHIE) to compare the percentage of uninsured before and after the Medicaid expansion as a public health intervention (I) between 2006 and 2018.
Usually income levels of 138% and 200% are considered less than or equal to the Federal Poverty Line and therefore they are used as criteria to determine the eligibility to apply for public safety nets, which include healthcare programs and related services.
We also analyzed Healthcare Cost and Utilization Project (HCUP) database to compare the impact of I on utilization of adult inpatient stays by different expected payers. The target outcomes of interests (O) are comparing the number of adult inpatient stays and Opioid-Related Hospital Use by different expected payers in two states from 2006 to 2018 between.
Methods and key variables and key outcomes of interests
Results from SAHIE
Results from HCUP
Summary of results:
Conclusion and /or Policy Decisions:
Introduction
Review a few peer-reviewed articles related to your subject!
Related Articles and Maps for Status of State Medicaid Expansion
HCUP User Support (HCUP-US): www.hcup-us.ahrq.gov
HCUPnet: https://hcupnet.ahrq.gov/#setup
HCUP Statistical Briefs: www.hcup-us.ahrq.gov/reports/statbriefs/statbriefs.jsp
Center on Budget and Policy Priorities. Chart Book: The Far-Reaching Benefits of the Affordable Care Act’s Medicaid Expansion, October 2, 2018
“Stronger Response to COVID-19
Medicaid expansion states were better positioned to respond to the COVID-19 public health emergency and prevent the resulting economic downturn from worsening access to care, financial security, health outcomes, and health disparities. Unfortunately, the remaining states’ refusal to expand has left hundreds of thousands of essential workers without health coverage. It also has worsened health disparities by race and ethnicity, leaving more Black and Hispanic people and American Indians and Alaska Natives uninsured during a pandemic in which they have seen especially high rates of infections and deaths. By adopting expansion quickly, these states could provide coverage and more financial security to millions of people.
Medicaid expansion is serving as a safety net for millions of adults who have lost jobs or income due to the pandemic. Among the 15 states with publicly available enrollment data for February-June 2020, expansion enrollment rose by 3.3 percent for February-April, 6.5 percent for February-May, and 9.8 percent for February-June.”
“Better Health Outcomes, Including Fewer Premature Deaths
Medicaid expansion saved the lives of at least 19,200 adults aged 55 to 64 between 2014 and 2017, a landmark study finds. Conversely, more than 15,600 older adults died prematurely because of state decisions not to expand Medicaid.
Medicaid expansion saved the lives of at least 19,200 adults aged 55 to 64 between 2014 and 2017, a landmark study finds. Conversely, more than 15,600 older adults died prematurely because of state decisions not to expand Medicaid.
Medicaid expansion ranks with other major public health interventions in terms of saving lives, the same landmark study shows. If all states had expanded Medicaid, the number of lives saved just among older adults in 2017 would nearly equal the number of lives saved by seatbelts among people of all ages.
The study’s findings are striking but not surprising. A large body of research has already documented how Medicaid expansion is improving access to care and health outcomes in ways that can help prevent premature deaths.”https://www.cbpp.org/research/health/chart-book-the-far-reaching-benefits-of-the-affordable-care-acts-medicaid
Bymatt Broaddus Aviva Aron-Dine (November 6, 2019). Medicaid Expansion Has Saved at Least 19,000 Lives, New Research Finds State Decisions Not to Expand Have Led to 15,000 Premature Deaths
Again you finish your introduction with presenting your objective
Objectives:
Research Question:
Keu variables, Data
Methods:
Instructions for Step1- Sep. 13-Data analyses of SAHIE Interactive Data Tool
TheAnalyses in Health Disparities: Gaps in Access, Quality, and Affordability of Medical Care
- Please choose two states to compare for both datasets SAHIE and HCUP.
The Links for comparing Cali & FL
SAHIE and HCUP (Please uncheck the counties in SAHIE)!
I-The Small Area Health Insurance Estimates (SAHIE). Interactive Data Tool
II-Healthcare Cost and Utilization Project (HCUP)
A-Fast Stats – Opioid-Related Hospital Use by Community Level income
B- State Trends in Inpatient Stays by Payer
- You need to submit your assignment on Bb in word documentusing SafeAssign
Here are some sample questions to explore in your short essay. But you are not limited to explore only the following questions.
- Use SAHIE Interactive Data Tool to compare the number of insured/Uninsured in two States or two counties (e.g., Baltimore and Montgomery counties in Maryland) in the years 2006 and 2017.
- Download your table in an excel spreadsheet and make a nice table in the word document.
- In a brief essay (1-2 pages), please discuss what region had the highest uninsured rates than the other areas in 2006 and 2017?
- What county in your selected State has the highest rate of uninsured in 2006 and 2017? Check to see if this is related to their income level or age?
- Compare your tables with the charts from “Center on Budget and Policy Priorities” and discuss whether your selected states are one of the those with Medicaid Expansion or not.
- Write a one-page summary of your comparison by referring to the tables and graphs.
Example
Methods: We used the Secondary data analysis from Small Area Health Insurance Estimates (SAHIE) to compare the percentage of uninsured before and after the Medicaid expansion as a public health intervention (I) between 2006 and 2018.
Usually income levels of 138% and 200% are considered less than or equal to the Federal Poverty Line and therefore they are used as criteria to determine the eligibility to apply for public safety nets, which include healthcare programs and related services.
We also analyzed Healthcare Cost and Utilization Project (HCUP) database to compare the impact of I on utilization of adult inpatient stays by different expected payers. The target outcomes of interests (O) are comparing the number of adult inpatient stays and Opioid-Related Hospital Use by different expected payers in two states from 2006 to 2018 between.
PICO
P: California implemented a late Medicaid expansion effective July 1, 2016 (more than two years after the January 1, 2014 target date under the Affordable Care Act).
I: Medicaid Expansion
C: Florida uses a federally facilitated marketplace and is not a Medicaid expansion State.
O: The target outcomes are comparing the number of adult inpatient stays by different expected payers in two states of interests from 2006 to 2018 between these two states.
Results from SAHIE data: Based on Graph 1 and Table 1, the percentage of Californians that remained uninsureddecreased by an overall 15%, in both counties and the state as a whole, due to the ACA, and thatthe rate of opioid related hospitalizations increased, by since 2016, has become relativelystagnant.
Results from HCUP data: Based on Graph 2 and Table 2…….
You need to download all the related tables and graphs with labels and compare them in the results by referring them in the results.
Discussions: ….
Limitations of the study: this paper only shows the association between intervention and outcomes and we don’t control for the causality and so many important variables that may impact the outcomes of the policy intervention.
Conclusions: ……
Policy Implications and direction of future study: …..
References:
Please pay attention in formatting of References
1) Access to Care: Small Area Health Insurance Estimates (SAHIE). Interactive Data Tool
Healthcare Cost and Utilization Project (HCUP)
2) Outcome 1: Opioid-Related Hospital Use by Community Level income
3) Outcome 2: State Trends in Inpatient Stays by Payer
Example of Peer-Reviewed Article:
Moghtaderi, Ali, Bernard Black, Mark Zocchi, Kevin Klauer, Randy Pilgrim, Jesse M Pines (2020). The Three-Year Effect of Medicaid Expansion on Emergency Department Visits and Admissions. Annals of Emergency Medicine
We examine the effect of the Medicaid expansion in 2014 under in the Patient Protection and Affordable Care Act on emergency department (ED) utilization and ED admission rates (fraction of ED visits that lead to hospital admission) during the first 3 post expansion years (2014 to 2016).
Methods: We compared ED utilization and ED admission rates in 151 EDs in 14 expansion states with those in 376 EDs in 14 non-expansion states, using difference-in-differences methods with data from 3 national emergency medicine groups from 2013 to 2016.
Results: In expansion states, the volume of Medicaid-paid ED visits increased 49% (95% confidence interval 34% to 65%), and the volume of uninsured visits decreased 44% (95% confidence interval –52% to –34%) relative to that of nonexpansion states. Both effects on payer mix leveled off during 2015. There was no significant relative change in overall ED …
Step 3-Oct. 11-First Draft of the paper will be sent to your reviewer (4%)
Step 4-Oct. 25-Reviewers send constructive feedback to the authors (4%)
Reviewers use track changesto provide constructive feedback complete the following form.
| Written assignment feedback Form | |
| Author Name: | Reviewer name: |
| Content/Development-60% | |
| Subject Matter:
· Key elements of assignments covered · Content is comprehensive/accurate/persuasive · Displays an understanding of the relevant theory · Major points supported by specific details/examples · Research is adequate/timely · The writer has gone beyond textbook for resources. |
|
| Higher-Order Thinking:
· Writer compares/contrasts/integrates theory/subject matter with work environment/experience · At an appropriate level, the writer analyzes and synthesizes theory/practice to develop new ideas and conceptualizing and performing. |
|
| Organization-16% | |
| · The introduction provides sufficient background on the topic and previews major points
· The central theme/purpose is immediately clear · The structure is clear, logical, and easy to follow · Subsequent sections develop/support the central theme · Conclusion/recommendations follow logically from the body of the paper. |
|
| Style/Mechanics-24% | |
| Format–8%
· Citations/reference page follow guidelines · Properly cites ideas/info from other sources · Paper is laid out effectively–uses, heading and other reader-friendly tools · Paper is neat/shows attention to detail Grammar/Punctuation/Spelling–8% · Rules of grammar, usage, punctuation are followed · Spelling is correct
Readability/Style–8% · Sentences are complete, clear, and concise · Sentences are well-constructed with consistently strong, varied structure · Transitions between sentences/paragraphs/sections help maintain the flow of thought · Words used are precise and unambiguous · The tone is appropriate to the audience, content, and assignment. |
|
How to select your states for comparison?
Some studies have shown positive relationship between expenditure in healthcare increases and GDP via increases in the productivity of human capital. However, there is ongoing debate about the type and optimal amount of healthcare spending for economic development!
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7237575/
Considering all of you have done SAHIE data analysis, what is a simple way to empirically run your data and look at the relationship between the Medicaid expansion and the real GDP growth among the states with and without Medicaid expansion?
https://www.statista.com/statistics/248053/us-real-gross-domestic-product-gdp-by-state/
Status of State Medicaid Expansion Decisions: Interactive Map (Published: Oct 01, 2020)
Two sample studies using SAHIE data
Mark Borgschulte and Jacob Vogler (2020). Did the ACA Medicaid expansion save lives? Journal of Health Economics. Volume 72, July 2020, 102333
https://www.sciencedirect.com/science/article/abs/pii/S0167629619306228
Lizhong Peng, Xiaohui Guo, and Chad D. Meyerhoefer (2019). The effects of Medicaid expansion on labor market outcomes: Evidence from border counties
First published: 20 December 2019 https://doi.org/10.1002/hec.3976
https://onlinelibrary.wiley.com/doi/10.1002/hec.3976
III-HCUP Fast Stats – Opioid-Related Hospital Use
Other data
Diane Alexander and Molly Schnell (August 2, 2020). The Impacts of Physician Payments on Patient Access, Use, and Health
Stephen Zuckerman, Laura Skopec, and Marni Epstein (March 2017).
Medicaid Physician Fees after the ACA. Primary Care Fee Bump
19 States Continue the Affordable Care Act’s Temporary Policy Change
R Abouk, LA Helmchen, A Moghtaderi, J Pines (2019). The ACA Medicaid Expansions and Opioid Mortality: Is There a Link?https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3368434
Description: The Medicaid expansions made addiction treatment more accessible, but they also made it easier to obtain the prescription opioids that can trigger an addiction.
We investigated the association between the Medicaid expansions and drug-related mortalities. Number of studies have investigated this question and found conflicting results.
We add to the literature by explicitly accounting for the properties of illicit drug markets, and by conducting a simulation-based power analysis to assess whether a plausible change in drug-related mortality in expansion states could be detected with our data. We found inconclusive results.
We argue that there are three main challenges in identifying the effect of the Medicaid expansions on drug-related mortality that cannot be sufficiently addressed with the current data:(i) non-parallel pre-expansion trends in drug-related mortality;(ii) the contemporaneous surge in the supply of illicitly manufactured fentanyl, and (iii) lack of statistical power. We argue that more comprehensive data is needed to answer this question.
Discover funding opportunities for your research with ResearchGate
Addressing the Challenges of the Opioid Epidemic in Minority Health and Health Disparities Research in the U.S. (R01 Clinical Trial Optional)
Funding opportunity: Deadline: Nov 13, 2020
Posted: Apr 9, 2018: https://www.researchgate.net/funding
Disaster Recovery National Dislocated Worker Grants to Address the Opioid Crisis
Funding opportunity
Deadline: Jan 1, 2021
Posted: Sep 13, 2018
Description: The U.S. Department of Labor announces the availability of funding to address the opioid crisis through the Disaster Recovery Dislocated Worker Grants program. The Disaster Recovery DWGs are authorized under Section 170 of the Workforce Innovation and Opportunity Act (WIOA).
Funding organization: Employment and Training Administration
Funding type: Grant: Total funding: US $ 100,000,000
Addressing the Challenges of the Opioid Epidemic in Minority Health and Health Disparities Research in the U.S. (R21 Clinical Trial Optional)
Funding opportunity
Deadline: Nov 13, 2020
Posted: Apr 9, 2018
Description: The purpose of this Funding Opportunity Announcement (FOA) is to encourage developmental and exploratory research focused on determining the mechanisms for the variation in the prevalence of Opioid Use Disorder (OUD), and understanding and reducing disparities in opioid care in minority health and h
Funding organization: National Institutes of Health
Funding type: Grant: Total funding: US $ 200,000
https://www.nsf.gov/funding/pgm_summ.jsp?pims_id=5437
Description: The Economics program supports research designed to improve the understanding of the processes and institutions of the U.S. economy and of the world system of which it is a part. This program also strengthens both empirical and theoretical economic analysis as well as the methods for rigorous resear
Funding organization: National Science Foundation
Funding type: Grant
