Browsing by Author "Ku-Goto, Meei-Hsiang"
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Item Certificate of Need for Cardiac Care: Controversy Over the Contributions of CON(James A. Baker III Institute for Public Policy) Ho, Vivian; Ku-Goto, Meei-Hsiang; Jollis, James; James A. Baker III Institute for Public PolicyObjective: To test whether state Certificate of Need (CON) regulations influence procedural mortality or the provision of coronary artery bypass graft surgery (CABG) and percutaneous coronary interventions (PCI). Data Sources: Medicare inpatient claims obtained for 1989-2002 for patients age 65+ who received CABG or PCI. Study Design: We used differences-in-differences regression analysis to compare states that dropped CON during the sample period, versus states that kept the regulations. We examined procedural mortality, the number of hospitals in the state performing CABG or PCI, mean hospital volume, and statewide procedure volume for CABG and PCI. Principal Findings: States that dropped CON experienced lower CABG mortality rates relative to states that kept CON, although the differential is not permanent. No such mortality difference is found for PCI. Dropping CON is associated with more providers statewide and lower mean hospital volume for both CABG and PCI. However, statewide procedure counts remain the same. Conclusions: We find no evidence that CON regulations are associated with higher quality CABG or PCI. The regulations may limit the number of facilities performing these procedures, and the potential cost savings from this restriction should be investigated.Item Does state deregulation raise the costs of open-heart surgery?(James A. Baker III Institute for Public Policy;Baylor College of Medicine) Ho, Vivian; Ku-Goto, Meei-Hsiang; James A. Baker III Institute for Public PolicyItem A Nationwide Assessment of the Association of Smoking Bans and Cigarette Taxes With Hospitalizations for Acute Myocardial Infarction, Heart Failure, and Pneumonia(Sage, 2016) Ho, Vivian; Ross, Joseph S.; Steiner, Claudia A.; Mandawat, Aditya; Short, Marah; Ku-Goto, Meei-Hsiang; Krumholz, Harlan M.Multiple studies claim that public place smoking bans are associated with reductions in smoking-related hospitalization rates. No national study using complete hospitalization counts by area that accounts for contemporaneous controls including state cigarette taxes has been conducted. We examine the association between county-level smoking-related hospitalization rates and comprehensive smoking bans in 28 states from 2001 to 2008. Differences-in-differences analysis measures changes in hospitalization rates before versus after introducing bans in bars, restaurants, and workplaces, controlling for cigarette taxes, adjusting for local health and provider characteristics. Smoking bans were not associated with acute myocardial infarction or heart failure hospitalizations, but lowered pneumonia hospitalization rates for persons ages 60 to 74 years. Higher cigarette taxes were associated with lower heart failure hospitalizations for all ages and fewer pneumonia hospitalizations for adults aged 60 to 74. Previous studies may have overestimated the relation between smoking bans and hospitalizations and underestimated the effects of cigarette taxes.Item Regional differences in recommended cancer treatment for the elderlyHo, Vivian; Ku-Goto, Meei-Hsiang; Zhao, Hui; Hoffman, Karen E.; Smith, Benjamin D.; Giordano, Sharon H.; James A. Baker III Institute for Public PolicyAbstract Background Little is known about regional variation in cancer treatment and its determinants. We compare rates of adherence to treatment guidelines for elderly patients across Texas and whether local specialist supply is an important determinant of treatment variation. Methods Previous literature reviewed indicated 7 recommended courses of treatment for colorectal, pancreatic, and prostate cancer. We analyzed Texas Cancer Registry data linked with Medicare claims for the years 2004 to 2007 to study patients with these cancers. We tested for unadjusted and adjusted differences in treatment rates across 22 hospital referral regions (HRR). We tested whether variation in the local supply of specialists treating each cancer was an important determinant of treatment. Results We found significant differences in adjusted treatment rates across regions. For removal and examination of 12+ lymph nodes with colon cancer resection, 13 of 22 HRRs had rates significantly different from the median region. For adjuvant chemotherapy for regional colon cancer, five HRRs significantly differed from the median. For prostate cancer treatment with a favorable diagnosis, nine HRRs differed from the median HRR. Of the 7 treatments, only the local availability of surgeons was an important determinant for excision of lymph nodes for colon cancer patients. Conclusions There are significant variations across Texas for seven recommended cancer treatments. No one region has consistently higher or lower treatments than other regions, and local specialist supply is not an important predictor of treatment. Different factors may be determining regional variation in treatment rates across cancer types and treatment options.Item Why Are Hospital Prices Rising?Ho, Vivian; Dugan, Jerome; Ku-Goto, Meei-Hsiang; James A. Baker III Institute for Public PolicyThe substantial rise in health care expenditures that has occurred in the U.S. has been accompanied by rapid increases in the prices that hospitals receive for treating privately insured patients. We use data on revenues by payer type to identify the determinants of rising hospital prices in Texas between 2000 and 2007. Approximately two-thirds of the increase in prices can be explained by increases in the costs of care, which may reflect technology growth. Part of this cost increase could also be attributable to sicker patient populations, as patients with less severe conditions are increasingly treated in freestanding facilities. We find little evidence that rising hospital prices are attributable to increased hospital market competition, and no firm evidence that hospitals are raising prices in response to lower reimbursement from Medicare, Medicaid, or uninsured/selfpay patients. We can explain more than half of the observed price increase with hospital, patient, and market characteristics, but a sizable portion remains unexplained. Finding the optimal policies for controlling hospital price increases will require additional research to identify all of the underlying factors determining prices in this market.