Browsing by Author "Xu, Yingying"

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    Entry of Freestanding Emergency Departments in Texas – A series of Economic Studies
    (2019-07-19) Xu, Yingying; Ho, Vivian
    This dissertation consists of three essays which examine the location choice and emergency care market competition with the entry of freestanding emergency departments (FrEDs) in Texas, U.S.A. As the innovative health care facilities, Texas is the first state introducing the licensing act for FrEDs and has the highest number of FrEDs among all states by the end of 2018. The first paper investigates whether FrEDs open in areas of high need, or areas that yield high profit. Using logistic regressions, I find FrEDs in 2016 were more likely to be in high-income areas with high percentage of private insurers. The second paper explores whether the entry of FrEDs has been associated with less congestion in hospital-based emergency departments. By examining annual visits, wait time, length of visit and drop-out rate in hospital-based emergency departments from 2010 to 2016, the work concludes that the entry of FrEDs did not help relieve hospital congestion. The third paper examines visits in local markets and changes in patient casemix after the entry of FrEDs, to show market competition between different emergency care providers. I conclude that newly introduced FrEDs not only served as substitutes to hospital EDs, but also expanded the emergency services market. Low-acuity and well-insured patients were more likely to be diverted to nearby FrEDs from hospitals. Overall, this work helps understand the role of FrEDs in the healthcare market. Findings will guide future licensing requirements, state healthcare budget and potential customer protections in the United States.
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    Freestanding Emergency Department Entry and Market‐level Spending on Emergency Care
    (Wiley, 2019) Ho, Vivian; Xu, Yingying; Akhter, Murtaza; James A. Baker III Institute for Public Policy
    Background: Freestanding emergency departments (FrEDs) could reduce wait times in overcrowded emergency departments (EDs), but they might also increase usage and overall spending for emergency care. We investigate the relationship between the number of FrEDs entering a local market and overall spending on emergency care. Methods: We accessed data from Arizona, Florida, North Carolina, and Texas in Blue Cross Blue Shield Axis; a limited data set of deidentified insurance data claims that we linked to Public Use Microdata Area (PUMA) data from the American Community Survey; and lists of licensed FrEDs from state agencies. Regression analysis was used to estimate the association between changes in the number of FrEDs in 495 PUMAs and total spending on emergency care, out‐of‐pocket spending, utilization, and price per visit from January 2013 to December 2017. Final estimates came from a PUMA‐level fixed‐effects model, with controls for state, quarter, and PUMA‐level demographics. Results: Entry of an additional FrED in a PUMA was associated with a 3.6 percentage point (pp; CI = 2.4 to 4.9) increase in emergency provider reimbursement per insured beneficiary in Texas, Florida, and North Carolina. There was no change in spending (2.5 pp; CI = −8.2 to 3.1) associated with a FrED's entry in Arizona. Entry of an additional FrED was associated with a 0.18 (CI = 0.12 to 0.23) increase in the number of emergency care visits per 100 enrollees in Texas, Florida, and Arizona. In contrast, entry of another FrED was not associated with a change in utilization (−0.03; CI = −0.09 to 0.02) in North Carolina. Estimated out‐of‐pocket payments for emergency care increased 3.6 pp (CI = 2.5 to 4.8) with the entry of a FrED in Texas, Florida, and Arizona, but declined by 15.3 pp (CI = −26.8 to −3.7) in North Carolina. Conclusions: Rather than functioning as substitutes for hospital‐based EDs, FrEDs have increased local market spending on emergency care in three of four states’ markets where they have entered. State policy makers and researchers should carefully track spending and utilization of emergency care as FrEDs disseminate to better understand their potential health benefits and cost implications for patients.