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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    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.
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    PUBLIC-PRIVATE PARTNERSHIP FOR NATURAL HAZARD MITIGATION INVOLVING RETROFIT AND INSURANCE
    (2015) YAO, XIJUN; Skibniewski, Miroslaw J; Civil Engineering; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
    Public-private Partnerships (PPP) involving governments and insurers have been used globally in natural hazard mitigation. Yet high expense on building retrofit and catastrophe insurance still prevents government from providing effective mitigations. This thesis introduces a new framework that governments can utilize to motivate insurers to insure property owners with an affordable premium and receive a high proportion of reimbursement on retrofit investment. Two case studies in the thesis show a high feasibility of this partnership on hazard-prone areas and a higher total benefit than similar methods. The case study result indicates a wide feasibility of the proposed framework in risk mitigation of various natural hazards by providing building retrofit and catastrophe insurance incentive to property owners. This solution is likely to provide policymakers with a PPP program as a new tool for motivating the insurers and the property owners to undertake building retrofit and mitigation of natural disasters.