STUDYING THE IMPACT OF GOVERNMENT PROGRAMS ON HEALTHCARE EFFICIENCY USING ECONOMETRIC MODELS

Abstract

In this dissertation, we evaluate certain government interventions in several ways. We investigate the impact of the Global Budget Revenue (GBR) program on Length of Stay (LOS) for inpatients in emergency departments (EDs) in Maryland. The GBR program was announced on January 1, 2014 and, as a government mandate, all Maryland hospitals that were not covered by the Total Patient Revenue program were required to participate. Around the same time, many states, including Maryland, adopted Medicaid expansion. To estimate the effect of GBR on LOS in Maryland hospitals, we conduct a difference-in-differences (DID) analysis and consider the impact of Medicaid expansion by using hospitals from West Virginia, Delaware, and Rhode Island, which also adopted Medicaid expansion at the same time, as the control group.

We expand the GBR study by adding more controls and using a longer study period. We find that all results support the conclusion that GBR implementation has a negative impact on the time that Maryland inpatients spend in the ED and, the bigger the hospital, the longer the LOS.

We conduct a DID analysis and investigate the impact of the GBR program on the wait time for inpatients from admit decision to the time of departure from the ED in Maryland using four control groups based on different assumptions. Our estimates imply that GBR has a negative impact on the wait time of inpatients in the ED.

Finally, we provide a comprehensive literature review of articles that used a DID model and were published since 1990 in the top 30 emergency medicine journals listed by the Scimago Institutions Rankings. We show that the top journals in emergency medicine have become more likely to publish DID-related articles.

In the sixth chapter, we examine the changes in the number of fatality reports before and after the implementation of the Severe Injury Reporting Program (SIRP) using a DID model. Our study suggests the Occupational Safety and Health Administration (OSHA) should expand its approved state programs so as to increase implementation of the SIRP on the state level rather than the federal level. This could relieve pressure on OSHA’s limited resources while maintaining its commitment to national workplace safety.