UMBC Economics Department
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Item Leveraging the Medicaid Current Beneficiary Survey to Estimate Undercounting in Claims Data during the COVID-19 Public Health Emergency(2024-06-29) Gill, Christine; Blake, Elizabeth; Roll, MelissaItem Hilltop Hospital Pricing Work Featured in New State of Reform Article(The Hilltop Institute, 2022-09-23) The Hilltop Institute; Henderson, Morgan; Mouslim, MorganeHilltop抯 newly funded National Science Foundation (NSF) project on hospital pricing behavior is featured in a new article by State of Reform, an organization focused on conversations that bridge the gap between health care and the policy that governs it. Hilltop researchers Morgan Henderson, PhD, and Morgane Mouslim, DVM, ScM, will collect, clean, document, and synthesize a sample of pricing data posted by hospitals in response to a 2021 federal rule mandating that hospitals disclose previously confidential data on the prices they charge. The resulting data set and documentation will be made available to other researchers. Drs. Henderson and Mouslim will also conduct two studies on the relationship between payer mix and hospital pricing behavior.Item Healthcare Upside/Down: Pricing Impacting Financially Vulnerable Populations w/ Henderson & Mouslim(Healthcare NOW Radio Podcast Network, 2022-11-16) Henderson, Morgan; Mouslim, MorganeS2E2: Healthcare Cash Price Variability Impacting Financially Vulnerable Populations with Morgan Henderson, Principal Data Scientist and Morgane Mouslim, Health Policy Analyst at The Hilltop Institute at the University of Maryland, Baltimore County and host Dr. Nick. As we move clearly into a transparent and fair system of healthcare service that offers economic, affordable, and accessible healthcare to everyone it is important to take account of all the groups and find an appropriate path for every member of our community. Self-pay patients are an understudied yet important and financially vulnerable population of emergency room users and as you will hear the Emergency Room facility fees may be a key cost driver in patient ER bills. Depending on your facilities status it may be that the ER fee is tied to economic drivers and fixed costs and is hard to adjust. Your better pill to swallow is to consider alternative delivery options until health policy catches up and addresses these issues identifying alternative approaches for these groups that offer a lower cost more economic option would start to address the inequities and failures of our existing system.Item Cross-Validation of Insurer and Hospital Price Transparency Data(AJMC, 2024-08-06) Henderson, Morgan; Mouslim, MorganeGiven recent congressional interest in codifying price transparency regulations, it is important to understand the extent to which newly available price transparency data capture true underlying procedure-level prices. To that end, we compared the prices for maternity services negotiated between a large payer and 26 hospitals in Mississippi across 2 separate price transparency data sources: payer and hospital. The degree of file overlap is low, with only 16.3% of hospital朾illing code observations appearing in both data sources. However, for the observations that overlap, pricing concordance is high: Corresponding prices have a correlation coefficient of 0.975, 77.4% match to the penny, and 84.4% are within 10%. Exact price matching rates are greater than 90% for 3 of the 4 service lines included in this study. Taken together, these results suggest that although administrative misalignment exists between payers and hospitals, there is a measure of signal amid the price transparency noise.Item Comparison of Hospital Online Price and Telephone Price for Shoppable Services(American Medical Association, 2023-11-01) Thomas, Merina; Flaherty, James; Wang, Jiefei; Henderson, Morgan; Ho, Vivian; Cuban, Mark; Cram, PeterUS hospitals are required to publicly post their prices for specified shoppable services online. However, the extent to which a hospital抯 prices posted online correlate with the prices they give to a telephone caller is unknown.To compare hospitals� online cash prices for vaginal childbirth and brain magnetic resonance imaging (MRI) with prices offered to secret shopper callers requesting price estimates by telephone.This cross-sectional study included cash online prices from each hospital抯 website for vaginal childbirth and brain MRI collected from representative US hospitals between August and October 2022. Thereafter, again between August and October 2022, simulated secret shopper patients called each hospital requesting their lowest cash price for these procedures.We calculated the difference between each hospital抯 online and phone prices for vaginal childbirth and brain MRI, and the Pearson correlation coefficient (r) between the online and phone prices for each procedure, among hospitals able to provide both prices,A total of 60 representative US hospitals (20 top-ranked, 20 safety-net, and 20 non杢op-ranked, non杝afety-net hospitals) were included in the analysis. For vaginal childbirth, 63% (12 of 19) of top-ranked hospitals, 30% (6 of 20) of safety-net hospitals, and 21% (4 of 19) of non杢op-ranked, non杝afety-net hospitals provided both online and telephone prices. For brain MRI, 85% (17 of 20) of top-ranked hospitals, 50% (10 of 20) of safety-net hospitals, and 100% (20 of 20) of non杢op-ranked, non杝afety-net hospitals provided prices both online and via telephone. Online prices and telephone prices for both procedures varied widely. For example, online prices for vaginal childbirth posted by top-ranked hospitals ranged from $0 to $55?221 (mean, $23?040), from $4361 to $14?377 (mean $10?925) for safety-net hospitals, and from $1183 to $30?299 (mean $15?861) for non杢op-ranked, non杝afety-net hospitals. Among the 22 hospitals providing prices both online and by telephone for vaginal childbirth, prices were within 25% of each other for 45% (10) of hospitals, while 41% (9) of hospitals had differences of 50% or more (Pearson r?=?0.118). Among the 47 hospitals providing both online and phone prices for brain MRI, prices were within 25% of each other for 66% (31) of hospitals), while 26% (n?=?12) had differences of 50% or more (Pearson r?=??0.169). Among hospitals that provided prices both online and via telephone, there was a complete match between the online and telephone prices for vaginal childbirth in 14% (3 of 22) of hospitals and for brain MRI in 19% (9 of 47) of hospitals.Findings of this cross-sectional study suggest that there was poor correlation between hospitals� self-posted online prices and prices they offered by telephone to secret shoppers. These results demonstrate hospitals� continued problems in knowing and communicating their prices for specific services. The findings also highlight the continued challenges for uninsured patients and others who attempt to comparison shop for health care.Item Trends in Self-Pay Prices for Emergency Department Facility Fees (2021-2023)(2024-06-29) Mouslim, Morgane C.; Singh, Simone; Henderson, Morgan A.Item The Economic Impact of Medicaid Expansion in Mississippi(2024-02-20) Henderson, Morgan; Woodcock, CynthiaHilltop Principal Data Scientist Morgan Henderson, PhD, and Executive Director Cynthia Woodcock, MBA, presented Hilltop research to the Mississippi House Medicaid Committee. The research � a 2021 economic analysis of Medicaid expansion in Mississippi � was commissioned by the Center for Mississippi Health Policy, a nonprofit, non-partisan organization.Item Sole Community Hospitals and Affordable Rural Health(2024-06-29) Henderson, Morgan; Mouslim, MorganeItem Multiple Chronic Condition Patterns among Full-Benefit Maryland Medicaid Enrollees(2024-06-29) Han, Fei; Gill, Christine; Blake, Elizabeth; Stockwell, IanItem The Appropriate Division of Regulatory Labor(Springer, 2024-10-22) Brennan, TimothyShould national postal authorities or postal operators, experts in postal economics and policy, also become experts in estimating environmental costs and benefits? The alternative view is that there should be a “division of regulatory labor,” akin to the division of productive labor going back to Adam Smith. An environmental regulator can incorporate pollution and global warming costs across the economy, while postal authorities address postal policy goals taking the costs determined by environmental policy into account. A potential boundary between postal and environmental policy is pertinent also to national or transnational regulation of electric transmission and distribution grids. This issue has recently arisen in antitrust, as policymakers express greater sympathy for considerations beyond consumer benefit, including social equality and environmental sustainability. Employment and equity are arguably (and controversially) separable as well. However, there may be limits to the division of regulatory labor. Competition authorities in the USA have not been reluctant to expect other regulators in the USA to incorporate competitive effects in designing their regulations. Moreover, often sectoral regulators are expected to balance multiple policy considerations. One also needs to recognize that other regulations, such as climate-related carbon pricing, may not be in place.Item Slow convergence: Career impediments to interdisciplinary biomedical research(PNAS, 2024-07-29) Berkes, Enrico; Marion, Monica; Milojević, Staša; Weinberg, Bruce A.Despite the long-standing calls for increased levels of interdisciplinary research as a way to address society’s grand challenges, most science is still disciplinary. To understand the slow rate of convergence to more interdisciplinary research, we examine 154,021 researchers who received a PhD in a biomedical field between 1970 and 2013, measuring the interdisciplinarity of their articles using the disciplinary composition of references. We provide a range of evidence that interdisciplinary research is impactful, but that those who conduct it face early career impediments. The researchers who are initially the most interdisciplinary tend to stop publishing earlier in their careers—it takes about 8 y for half of the researchers in the top percentile in terms of initial interdisciplinarity to stop publishing, compared to more than 20 y for moderately interdisciplinary researchers (10th to 75th percentiles). Moreover, perhaps in response to career challenges, initially interdisciplinary researchers on average decrease their interdisciplinarity over time. These forces reduce the stock of interdisciplinary researchers who can train future cohorts. Indeed, new graduates tend to be less interdisciplinary than the stock of active researchers. We show that interdisciplinarity does increase over time despite these dampening forces because initially disciplinary researchers become more interdisciplinary as their careers progress.Item Predicting Hospitalization with the Hilltop Institute Analytics Research Team(UMBC Center for Social Science Research, 2024-02-12) Anson, Ian; Goetschius, Leigh; Han, Fei; Henderson, Morgan; Kim, Jean; Anson,Ian; Mallinson,Christine; Filomeno,Felipe; Kim,Jean; Moreland,D’Juan; Barnes,Amy; Ralston,MyriamOn today’s episode we hear from Dr. Leigh Goetschius, Data Scientist Advanced, Dr. Fei Han, Principal Data Scientist and Affiliate Assistant Professor in the UMBC Department of Computer Science and Electrical Engineering, and Dr. Morgan Henderson, Principal Data Scientist and Affiliate Assistant Professor in the UMBC Department of Economics. Together, these researchers form the UMBC Hilltop Institute Analytics Research team. Our conversation focuses on their work in creating predictive models in the field of healthcare.Item Home Economics and Women's Gateway to Science(2024-01-26) Andrews, Michael; Zhao, YilingWe propose that collegiate home economics programs in the early 20th century introduced a generation of women to science, especially biology and chemistry. Using college-level data from the 1910 Commissioner of Education report and a collection of historical college yearbooks spanning 1900-1940, we document that a 10 percentage points increase in the share of women in home economics led to a roughly 3 percentage points increase in the share of women majoring in science. We demonstrate that the result is driven by exposure to science in the historical home economics curricula rather than through selection bias or faculty role model effects. By linking colleges to recent educational data, we provide suggestive evidence for the persistent impact of historical curricula decisions on modern day gender gaps in STEM fields.Item Site Selection Decisions for U.S. Colleges(2022-05-13) Andrews, MichaelThis manuscript describes how locations were selected for a large sample of U.S. colleges and universities. It is designed to serve as an extended historical appendix to Andrews (2022) and describes how the sample was constructed for that project. My hope is that this historical narrative detail on college site selection processes will be of wider interest to historians, education researchers, and other scholars.Item In the Interest of Full Disclosure: Consequences of the Grand Bargain in Patenting(2023-08-25) Pease, Marilyn; Andrews, Michael; Vasu, RajkamalWe consider a model where an innovator chooses how much to disclose about their invention before Cournot competing. More disclosure lets the follower copy more, but also signals strength and increases the innovator's probability of winning an infringement suit. We find policies that increase damages due to copying lead to universally more disclosure, while policies that increase winning probabilities induce less disclosure from large inventions and more from small inventions. We validate our predictions using two court decisions; one increased damages, the other winning probabilities. We conclude that some pro-patent policies are counterproductive, reducing disclosure for the largest inventions.Item Do Local Conditions Determine the Direction of Science? Evidence from Land Grant Colleges(2023-10-31) Andrews, Michael; Smith, AlexaHow should research resources be allocated across space to have the most beneficial impact on society? Prior studies suggest that scientists are influenced by the local ideas they are exposed to, and hence local conditions shape the direction of science. We investigate this hypothesis in the context of agricultural research, constructing a measure that quantifies the extent to which land grant colleges are located in counties that grow different distributions of crops than the rest of their states, which we call agricultural unrepresentativeness. Consistent with the prior literature, land grant colleges in more agriculturally unrepresentative counties produce research focusing on unrepresentative crops and create more geographically limited productivity spillovers. Because college locations are not determined randomly, these results may reflect endogenous sorting by state policymakers rather than causal effects of local agricultural conditions. We isolate exogenous variation in land grant college’s agricultural unrepresentativeness using historical college site selection natural experiments. When using only this exogenous variation, we find no correlation between land grant counties’ unrepresentativeness and the unrepresentativeness of agricultural research. To understand this null result, we investigate actions land grant colleges can take to overcome the effects of local agricultural conditions and find that colleges exogenously placed in agriculturally unrepresentative counties invest more in extension services to interact with more distant constituents. We conclude that local agricultural conditions need not determine the direction of science so long as researchers can take actions to obtain non-local information.Item Jue Insight: Beyond Students: Effects of University Establishment on Local Economic Mobility(2023-12-06) Andrews, Michael; Russell, Lauren C.How does the presence of a university affect local economic mobility and inequality? Existing work on universities' role in economic mobility have focused on students but have not examined the effect on local communities. We exploit historical natural experiments to answer these questions, using "runner-up" counties that were strongly considered to become university sites but were not selected for as-good-as-random reasons as counterfactuals for university counties. We find that university establishment causes greater intergenerational income mobility but also increases cross-sectional income inequality. We highlight four channels through which these effects operate: universities "hollow-out" the local labor market and provide greater opportunities to achieve top incomes, both of which increase cross-sectional inequality, while at the same time increasing educational attainment across the income distribution and fostering social interactions to high-socioeconomic status individuals, which both prevent inequality from perpetuating into intergenerational immobility.Item Improving American Retirement Prospects(2024-06-01) Wilschke, Peter; Kuruvilla, Arvind; Dyson, MatthewItem Immigration Attitudes and Labor Market Conditions in the United States(2024-03-22) Ayromloo, Shalise S; Firsin, OlegItem Does Section 230 Provide Platforms Too Much or Too Little Immunity?(Techology Policy Institute, 2021-07-07) Brennan, TimRead the latest work published by the fellows of Technology Policy Institute.