UMBC Economics Department

Permanent URI for this collectionhttp://hdl.handle.net/11603/35

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Reporting Requirements Matter (A Lot): Evidence From Arkansas's Medicaid Work Requirements
(Health Affairs, 2025-03-03) Henderson, Morgan; Spicer, Laura; Middleton, Alice
We reexamine enrollment data from Arkansas Works, the state’s Medicaid work requirement program. As the only real-world instance of the implementation of Medicaid work requirements in a preexisting Medicaid expansion population, it is a valuable source of data for understanding the impacts of reporting requirements on enrollment.
Nonlinearities and Heterogeneity in Firms Response to Aggregate Fluctuations: What Can We Learn From Machine Learning?
(2025-02-09) Errico, Marco; Pesce, Simone; Pollio, Luigi
Firms respond heterogeneously to aggregate fluctuations, yet standard linear models impose restrictive assumptions on firm sensitivities. Applying the Generalized Random Forest to U.S. firm-level data, we document strong nonlinearities in how firm characteristics shape responses to macroeconomic shocks. We show that nonlinearities significantly lower aggregate responses, leading linear models to overestimate the economy's sensitivity to shocks by up to 1.7 percentage points. We also find that larger firms, which carry disproportionate economic weight, exhibit lower sensitivities, leading to a median reduction in aggregate economic sensitivity of 52%. Our results highlight the importance of accounting for nonlinearities and firm heterogeneity when analyzing macroeconomic fluctuations and the transmission of aggregate shocks.
Behavioral, Cognitive, and Functional Risk Factors for Repeat Hospital Episodes Among Medicare-Medicaid Dually Eligible Adults Receiving Long-Term Services and Supports
(Sage, 2024-09-26) Fakeye, Oludolapo; Rana, Prashant; Han, Fei; Henderson, Morgan; Stockwell, Ian
Repeat hospitalizations adversely impact the well-being of adults dually eligible for Medicare and Medicaid in the United States. This study aimed to identify behavioral, cognitive, and functional characteristics associated with the risk of a repeat hospital episode (HE) among the statewide population of dually eligible adults in Maryland receiving long-term services and supports prior to an HE between July 2018 and May 2020. The odds of experiencing a repeat HE within 30 days after an initial HE were positively associated with reporting difficulty with hearing (adjusted odds ratio, AOR: 1.10 [95% confidence interval: 1.02-1.19]), being easily distractible (AOR: 1.09 [1.00-1.18]), being self-injurious (AOR: 1.33 [1.09-1.63]), and exhibiting verbal abuse (AOR: 1.15 [1.02-1.30]). Conversely, displaying inappropriate public behavior (AOR: 0.62 [0.42-0.92]) and being dependent for eating (AOR: 0.91 [0.83-0.99]) or bathing (AOR: 0.79 [0.67-0.92]) were associated with reduced odds of a repeat HE. We also observed differences in the magnitude and direction of these associations among adults 65 years of age or older relative to younger counterparts.
Behind the Curtain: Comparing Predictive Models Performance in 2 Publicly Insured Populations
(Wolters Kluwer Health, 2024-11) Sun, Ruichen; Henderson, Morgan; Goetschius, Leigh; Han, Fei; Stockwell, Ian
Introduction: Predictive models have proliferated in the health system in recent years and have been used to predict both health services utilization and medical outcomes. Less is known, however, on how these models function and how they might adapt to different contexts. The purpose of the current study is to shed light on the inner workings of a large-scale predictive model deployed in 2 distinct populations, with a particular emphasis on adaptability issues. Methods: We compared the performance and functioning of a predictive model of avoidable hospitalization in 2 very different populations: Medicaid and Medicare enrollees in Maryland. Specifically, we assessed characteristics of the risk scores from March 2022 for the 2 populations, the predictive ability of the scores, and the driving risk factors behind the scores. In addition, we created and assessed the performance of an “unadapted” model by applying coefficients from the Medicare model to the Medicaid population. Results: The model adapted to, and performed well in, both populations, despite demographic differences in these 2 groups. However, the most salient risk factors and their relative weightings differed, sometimes dramatically, across the 2 populations. The unadapted Medicaid model displayed poor performance relative to the adapted model. Conclusions: Our findings speak to the need to “peek behind the curtain” of predictive models that may be applied to different populations, and we caution that risk prediction is not “one size fits all”: for optimal performance, models should be adapted to, and trained on, the target population.
On Balance: Efficiency without Apology: Consideration of the Marginal Excess Tax Burden and Distributional Impacts in Benefit–Cost Analysis
(Society for Benefit-Cost Analysis, 2021-03-21 ) Greenberg, David
Comments on Alexander Field: The Economic Consequences of Mobilization for the Second World War
(Cambridge University Press, 2025-01-23) Mitch, David
Field’s excellent book provides an impressive blend of careful quantification through total factor productivity analysis with a well developed and documented narrative account of key episodes of U.S. mobilization during the second world war. Field’s basic thrust of the book challenging the common view that U.S. mobilization for war constituted an economic miracle or at least a major economic policy success and arguing instead that the U.S. faced major production challenges and inefficiencies is quite convincing. One important issue to consider regards the relevant counterfactuals. Mobilization as such is not a very clearly defined treatment effect. Field’s assessment is appropriately on actual mobilization efforts as conducted. But that assessment poses the question of whether there were better alternatives and if so what were the margins of choice? One issue of interpretation and context concerns the relationship between mobilization for the "hot" second world war and the subsequent deterrence and containment effort of the “cold” war. A more general counterfactual issue concerns alternative forms for mobilization. U.S mobilization involved some mix of private enterprise, civilian government and military officials. Here comparative analysis with how mobilization worked elsewhere both for allied and axis powers would be informative. A final topic raised by Field’s book that warrants further consideration is is the implications of the war effort for profile of both corporate R&D and Federal government R&D. Field’s book deserves a wide readership well beyond specialists in the history of the second world war.
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, Melissa
Hilltop Hospital Pricing Work Featured in New State of Reform Article
(The Hilltop Institute, 2022-09-23) The Hilltop Institute; Henderson, Morgan; Mouslim, Morgane
Hilltop’s 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.
Healthcare Upside/Down: Pricing Impacting Financially Vulnerable Populations w/ Henderson & Mouslim
(Healthcare NOW Radio Podcast Network, 2022-11-16) Henderson, Morgan; Mouslim, Morgane
S2E2: 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.
Cross-Validation of Insurer and Hospital Price Transparency Data
(AJMC, 2024-08-06) Henderson, Morgan; Mouslim, Morgane
Given 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–billing 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.
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, Peter
Importance US hospitals are required to publicly post their prices for specified shoppable services online. However, the extent to which a hospital’s prices posted online correlate with the prices they give to a telephone caller is unknown. Objective 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. Design, Setting, and Participants This cross-sectional study included cash online prices from each hospital’s 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. Main Outcomes and Measures We calculated the difference between each hospital’s 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, Results A total of 60 representative US hospitals (20 top-ranked, 20 safety-net, and 20 non–top-ranked, non–safety-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–top-ranked, non–safety-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–top-ranked, non–safety-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–top-ranked, non–safety-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. Conclusions and Relevance 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.
Trends in Self-Pay Prices for Emergency Department Facility Fees (2021-2023)
(2024-06-29) Mouslim, Morgane C.; Singh, Simone; Henderson, Morgan A.
The Economic Impact of Medicaid Expansion in Mississippi
(2024-02-20) Henderson, Morgan; Woodcock, Cynthia
Hilltop 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.
Sole Community Hospitals and Affordable Rural Health
(2024-06-29) Henderson, Morgan; Mouslim, Morgane
Multiple Chronic Condition Patterns among Full-Benefit Maryland Medicaid Enrollees
(2024-06-29) Han, Fei; Gill, Christine; Blake, Elizabeth; Stockwell, Ian
The Appropriate Division of Regulatory Labor
(Springer, 2024-10-22) Brennan, Timothy
Should 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.
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.
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,Myriam
On 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.
Home Economics and Women's Gateway to Science
(2024-01-26) Andrews, Michael; Zhao, Yiling
We 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.
Site Selection Decisions for U.S. Colleges
(2022-05-13) Andrews, Michael
This 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.

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