UMD Theses and Dissertations
Permanent URI for this collectionhttp://hdl.handle.net/1903/3
New submissions to the thesis/dissertation collections are added automatically as they are received from the Graduate School. Currently, the Graduate School deposits all theses and dissertations from a given semester after the official graduation date. This means that there may be up to a 4 month delay in the appearance of a given thesis/dissertation in DRUM.
More information is available at Theses and Dissertations at University of Maryland Libraries.
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Item THREE ESSAYS ON MARYLAND'S GLOBAL BUDGET REVENUE PROGRAM AND HOSPITAL-BASED NEONATAL CARE(2020) Xie, Liyang; Boudreaux, Michel; Health Services Administration; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Health care spending is a major concern in the United States. State and federal governments have been engaged in a number of health care system reform initiatives designed to contain costs by regulating both price and quantity. Comprehensive evaluations of these initiatives are crucial for policymakers reshaping and expanding reforms. This dissertation evaluates the impact of Maryland's Global Budget Revenue (GBR) program, one of the most innovative statewide hospital payment reforms, on birth-related hospital utilization. The GBR program was designed to provide incentives for hospitals to reduce high-cost services and substitute them for lower-cost population health investments. This is largely accomplished by capitating annual budgets. This dissertation evaluated the effects of GBR on high-cost neonatal services, especially the neonatal intensive care unit (NICU). I examine heterogeneous treatment effects with respect to observable clinical needs and financial incentives. In Chapter One, I provide an overview of Maryland’s GBR program and introduce the conceptual framework. In Chapter Two, I examine the impact of GBR on NICU admissions and infant mortality. I explore the heterogeneity of treatment effects by infant health risk. Chapter Three expands the analysis to broader birth-related hospital services by investigating the impact of GBR on length of stay (LOS), the total cost of care, and utilization of specific high-cost services. Chapter Four departs from GBR and examines NICU utilization related to another critical source of financial incentive – health insurance type. Chapter Five concludes the dissertation. I find that Maryland's GBR program led to a substantial decline in NICU admissions, which was mainly driven by the decrease in admissions of relatively healthy infants, and there are no changes in the infant or neonatal mortality rate. The GBR program is also associated with declines in LOS and high-cost services used for infants. Finally, I observe that infant, maternal, and state characteristics explain the variations in NICU care across insurance type for high-risk infants but not for relatively low-risk infants. My findings provide positive evidence on implementing global hospital budget programs and shed light on the economic incentives affecting NICU care.Item Assessing the Cost of Risk for New Technology and Process Insertion(2013) Lillie, Edwin Thomas; Sandborn, Peter; Mechanical Engineering; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Adoption and insertion of new technologies and processes into systems is inherently risky. A cost model that forecasts the cost of risk associated with inserting new technology into a system has been developed. The model projects the cost of inserting new processes, projects the impact of the processes on the cost of risk for the system, and performs a cost-benefit analysis on the adoption of proposed new processes. The projected cost of failure consequences (PCFC) is defined as the cost of all failure events (of varying severity) that are expected to occur over the service life of the system. The PCFC is uncertain, and the potential positive impact of adopting new technologies into the system is to reduce the cost of risk and/or reduce its uncertainty. A case study that assesses the adoption of a lead-free solder control plan into systems that previously used tin-lead solder has been performed.Item The Full Marginal Cost of Vehicle Travel on US Roadways(2011) Ferrari, Nicholas Joseph; Zhang, Lei; Civil Engineering; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)In this research, models primarily based on the Highway Economic Requirements System (HERS) are retrofitted to calculate six component marginal costs: Safety, Travel Time, Vehicle Operations, Agency, Emissions, and Noise. Each of these marginal costs is separately obtained for both peak and off-peak periods for seven different vehicle types. By combining these component costs, the true marginal cost to society of each vehicle is obtained for each roadway segment reported in the Highway Performance Monitoring System. This full marginal cost can be applied in future policy analysis in defining appropriate vehicle miles traveled (VMT) fee structures. In addition to calculating segment marginal costs, this report conducts a section level revenue analysis that compares the revenue generated by the current gas tax system employed by the United States versus a revenue system based on vehicle mile fees developed from marginal vehicle cost analyses.