scholarly journals Spending and quality after three years of Medicare’s bundled payments for medical conditions: quasi-experimental difference-in-differences study

BMJ ◽  
2020 ◽  
pp. m1780 ◽  
Author(s):  
Joshua A Rolnick ◽  
Joshua M Liao ◽  
Ezekiel J Emanuel ◽  
Qian Huang ◽  
Xinshuo Ma ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Service Use ◽  
The United States ◽  
Chronic Obstructive ◽  
Medical Conditions ◽  
Difference In Differences ◽  
Bundled Payments ◽  
Percentage Points ◽  
Quasi Experimental ◽  
Experimental Difference

AbstractObjectiveTo evaluate whether longer term participation in the bundled payments for care initiative (BPCI) for medical conditions in the United States, which held hospitals financially accountable for all spending during an episode of care from hospital admission to 90 days after discharge, was associated with changes in spending, mortality, or health service use.DesignQuasi-experimental difference-in-differences analysis.SettingUS hospitals participating in bundled payments for acute myocardial infarction, congestive heart failure, chronic obstructive pulmonary disease (COPD), or pneumonia, and propensity score matched to non-participating hospitals.Participants238 hospitals participating in the Bundled Payments for Care Improvement initiative (BPCI) and 1415 non-BPCI hospitals. 226 BPCI hospitals were matched to 700 non-BPCI hospitals.Main outcome measuresPrimary outcomes were total spending on episodes and death 90 days after discharge. Secondary outcomes included spending and use by type of post-acute care. BPCI and non-BPCI hospitals were compared by patient, hospital, and hospital market characteristics. Market characteristics included population size, competitiveness, and post-acute bed supply.ResultsIn the 226 BPCI hospitals, episodes of care totaled 261 163 in the baseline period and 93 562 in the treatment period compared with 211 208 and 78 643 in the 700 matched non-BPCI hospitals, respectively, with small differences in hospital and market characteristics after matching. Differing trends were seen for some patient characteristics (eg, mean age change −0.3 years at BPCI hospitals v non- BPCI hospitals, P<0.001). In the adjusted analysis, participation in BPCI was associated with a decrease in total episode spending (−1.2%, 95% confidence interval −2.3% to −0.2%). Spending on care at skilled nursing facilities decreased (−6.3%, −10.0% to −2.5%) owing to a reduced number of facility days (−6.2%, −9.8% to −2.6%), and home health spending increased (4.4%, 1.4% to 7.5%). Mortality at 90 days did not change (−0.1 percentage points, 95% confidence interval −0.5 to 0.2 percentage points).ConclusionsIn this longer term evaluation of a large national programme on medical bundled payments in the US, participation in bundles for four common medical conditions was associated with savings at three years. The savings were generated by practice changes that decreased use of high intensity care after hospital discharge without affecting quality, which also suggests that bundles for medical conditions could require multiple years before changes in savings and practice emerge.

The Effects of Parental and Sibling Incarceration: Evidence from Ohio

2021 ◽  
Vol 111 (9) ◽  
pp. 2926-2963
Author(s):  
Samuel Norris ◽  
Matthew Pecenco ◽  
Jeffrey Weaver
Keyword(s):  
United States ◽  
Criminal Activity ◽  
The United States ◽  
Parental Incarceration ◽  
Negative Effects ◽  
Beneficial Effects ◽  
Teen Parenthood ◽  
Percentage Points ◽  
Quasi Experimental ◽  
Outcomes For Children

Every year, millions of Americans experience the incarceration of a family member. Using 30 years of administrative data from Ohio and exploiting differing incarceration propensities of randomly assigned judges, this paper provides the first quasi-experimental estimates of the effects of parental and sibling incarceration in the United States. Parental incarceration has beneficial effects on some important outcomes for children, reducing their likelihood of incarceration by 4.9 percentage points and improving their adult neighborhood quality. While estimates on academic performance and teen parenthood are imprecise, we reject large positive or negative effects. Sibling incarceration leads to similar reductions in criminal activity. (JEL H76, J13, K42)

Improving Access to Delivery Care and Reducing the Equity Gap Through Voucher Program in Bangladesh: Evidence From Difference-in-Differences Analysis

2018 ◽  
Vol 38 (2) ◽  
pp. 137-145
Author(s):  
Kaji Tamanna Keya ◽  
Benjamin Bellows ◽  
Ubaidur Rob ◽  
Charlotte Warren
Keyword(s):  
Population Based ◽  
Public Health Facility ◽  
Difference In Differences ◽  
Voucher Program ◽  
Percentage Points ◽  
Null Effect ◽  
Demand Side Financing ◽  
Quasi Experimental ◽  
And Control

To test a statistically significant change in delivery by medically trained providers following introduction of a demand-side financing voucher, a population-based quasi-experimental study was undertaken, with 3,300 mothers in 2010 and 3,334 mothers at follow-up in 2012 in government-implemented voucher program and control areas. Results found that voucher program was significantly associated with increased public health facility use (difference-in-differences (DID) 13.9) and significantly increased delivery complication management care (DID 13.2) at facility although a null effect was found in facility-based delivery increase. A subset analysis of the five well-functioning facilities showed that facility deliveries increased DID 5.3 percentage points. Quintile-based analysis of all facilities showed that facility delivery increased more than threefold in lower quintile households comparing to twofold in control sites. The program needs better targeting to the beneficiaries, ensuring available gynecologist–anesthetist pair and midwives, effective monitoring, and timely fund reimbursements to facilities.

scholarly journals Extended Unemployment Insurance and Job Search: Evidence from Time Use Data

2015 ◽  
Vol 15 (2) ◽  
pp. 653-683 ◽  
Author(s):  
Krishna Regmi
Keyword(s):  
Unemployment Insurance ◽  
Time Use ◽  
Job Search ◽  
The United States ◽  
Average Effect ◽  
Difference In Differences ◽  
American Time Use Survey ◽  
Percentage Points ◽  
Time Use Survey ◽  
The U.S

Abstract In this paper, I investigate the effect of extended unemployment insurance (UI) coverage in the United States in recent years on job search. The U.S. government extended UI benefits in several phases in 2008–2009, increasing the duration of the benefits to a maximum of 99 weeks, up from the regular 26 weeks. Using the American Time Use Survey (ATUS) data, I find that women are more sensitive to the extended UI benefits than men. Difference-in-differences estimation shows that the average effect of the UI extensions for women is over a 10 percentage points decline in the probability of job search. However, I do not find any statistically significant effect on men.

scholarly journals Relationship between changing malaria burden and low birth weight in sub-Saharan Africa: A difference-in-differences study via a pair-of-pairs approach

eLife ◽  
2021 ◽  
Vol 10 ◽  
Author(s):  
Siyu Heng ◽  
Wendy P O'Meara ◽  
Ryan A Simmons ◽  
Dylan S Small
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Confidence Interval ◽  
Malaria Prevalence ◽  
Sub Saharan Africa ◽  
World Health ◽  
Difference In Differences ◽  
Malaria Burden ◽  
Percentage Points ◽  
Sub Saharan

Background:According to the World Health Organization (WHO), in 2018, an estimated 228 million malaria cases occurred worldwide with most cases occurring in sub-Saharan Africa. Scale-up of vector control tools coupled with increased access to diagnosis and effective treatment has resulted in a large decline in malaria prevalence in some areas, but other areas have seen little change. Although interventional studies demonstrate that preventing malaria during pregnancy can reduce the rate of low birth weight (i.e. child’s birth weight <2500 g), it remains unknown whether natural changes in parasite transmission and malaria burden can improve birth outcomes.Methods:We conducted an observational study of the effect of changing malaria burden on low birth weight using data from 18,112 births in 19 countries in sub-Saharan African countries during the years 2000–2015. Specifically, we conducted a difference-in-differences study via a pair-of-pairs matching approach using the fact that some sub-Saharan areas experienced sharp drops in malaria prevalence and some experienced little change.Results:A malaria prevalence decline from a high rate (Plasmodium falciparum parasite rate in children aged 2-up-to-10 (i.e. PfPR2-10) > 0.4) to a low rate (PfPR2-10 < 0.2) is estimated to reduce the rate of low birth weight by 1.48 percentage points (95% confidence interval: 3.70 percentage points reduction, 0.74 percentage points increase), which is a 17% reduction in the low birth weight rate compared to the average (8.6%) in our study population with observed birth weight records (1.48/8.6 ≈ 17%). When focusing on first pregnancies, a decline in malaria prevalence from high to low is estimated to have a greater impact on the low birth weight rate than for all births: 3.73 percentage points (95% confidence interval: 9.11 percentage points reduction, 1.64 percentage points increase).Conclusions:Although the confidence intervals cannot rule out the possibility of no effect at the 95% confidence level, the concurrence between our primary analysis, secondary analyses, and sensitivity analyses, and the magnitude of the effect size, contribute to the weight of the evidence suggesting that declining malaria burden can potentially substantially reduce the low birth weight rate at the community level in sub-Saharan Africa, particularly among firstborns. The novel statistical methodology developed in this article–a pair-of-pairs approach to a difference-in-differences study–could be useful for many settings in which different units are observed at different times.Funding:Ryan A. Simmons is supported by National Center for Advancing Translational Sciences (UL1TR002553). The funder had no role in study design, data collection and interpretation, or the decision to submit the work for publication.

Effectiveness of Penalties for Lockdown Violations During the COVID-19 Pandemic in Germany

2020 ◽  
Vol 110 (12) ◽  
pp. 1844-1849 ◽  
Author(s):  
Seung Hoon Chae ◽  
Hyung Jun Park
Keyword(s):  
Time Dependent ◽  
Control Group ◽  
Difference In Difference ◽  
Robert Koch Institute ◽  
Federal States ◽  
Percentage Points ◽  
Reproduction Numbers ◽  
Quasi Experimental ◽  
Using Data ◽  
Experimental Difference

Objectives. To investigate whether the imposition of fines can mitigate the spread of COVID-19. Methods. We used quasi-experimental difference-in-difference models. On March 20, 2020, Bavaria introduced fines as high as €25 000 (US $28 186) against citizens in violation of the Bundesland’s (federal state’s) lockdown policy. Its neighboring Bundesländer (federal states), on the other hand, were slow to impose such clear restrictions. By comparing 38 Landkreise (counties) alongside Bavaria’s border from March 15 to May 11 using data from the Robert Koch Institute, we produced for each Landkreis its (1) time-dependent reproduction numbers (Rt) and (2) growth rates in confirmed cases. Results. The demographics of the Landkreise were similar enough to allow for difference-in-difference analyses. Landkreise that introduced fines on March 20 reduced the Rt by a further 0.32 (95% confidence interval [CI] = −0.46, −0.18; P < .001) and decreased the growth rate in confirmed cases by an additional 6 percentage points (95% CI = −0.11, −0.02; P = .005) compared with the control group. Conclusions. Imposing fines may slow down the spread of COVID-19. Public Health Implications. Lockdowns may work better when governments introduce penalties against those who ignore them.

scholarly journals A Quasi-Experimental Study of the Effects of Pre-Kindergarten Education on Pediatric Asthma

2021 ◽  
Vol 18 (19) ◽  
pp. 10461
Author(s):  
Rie Masuda ◽  
Paul Lanier ◽  
Ellen Peisner-Feinberg ◽  
Hideki Hashimoto
Keyword(s):  
Service Use ◽  
Policy Issue ◽  
Pediatric Asthma ◽  
The United States ◽  
Asthma Diagnosis ◽  
Post Intervention ◽  
Explanatory Variables ◽  
Positive Effects ◽  
Interaction Terms ◽  
Quasi Experimental

Ensuring access to pre-kindergarten (Pre-K) education remains a pressing policy issue in the United States. Prior research has shown the positive effects that Pre-K has on children’s cognitive development. However, studies on its effects on children’s health outcomes are scarce. This study aimed to investigate the effects of the Pre-K program on pediatric asthma. Children’s individual data from existing research conducted in North Carolina were linked with state Medicaid claims data from 2011–2017. There were 51,408 observations (person-month unit) of 279 children enrolled in Pre-K and 333 unenrolled children. Asthma was identified using the ICD 9/10 codes. A difference-in-differences model was adopted using a panel analysis with three time periods: before, during, and after Pre-K. The explanatory variables were interaction terms between Pre-K enrollment and (a) before vs. during period and (b) during vs. after period. The results indicated that children enrolled in Pre-K had a greater risk of asthma diagnosis during Pre-K (b = 0.0145, p = 0.058). Conversely, in the post-intervention period, the enrolled children had a lower of receiving an asthma diagnosis (b = −0.0216, p = 0.002). These findings indicate that Pre-K may increase the use of asthma-related health services in the short term and decrease the service use after participants leave the program.

scholarly journals The impact of a Solar Market Garden programme on dietary diversity, women’s nutritional status and micronutrient levels in Kalalé district of northern Benin

2019 ◽  
Vol 22 (14) ◽  
pp. 2670-2681 ◽  
Author(s):  
Halimatou Alaofè ◽  
Jennifer Burney ◽  
Rosamond Naylor ◽  
Douglas Taren
Keyword(s):  
Nutritional Status ◽  
Dietary Diversity ◽  
Nutrition And Health ◽  
Difference In Differences ◽  
Percentage Points ◽  
Quasi Experimental ◽  
Gender Based ◽  
Solar Powered ◽  
The Impact ◽  
Health Programmes

AbstractObjective:To examine the impacts of a Solar Market Garden 1-year solar-powered drip irrigation (SMG) programme in Kalalé district of northern Benin on mothers’ nutritional status and micronutrient levels.Design:Using a quasi-experimental design, sixteen villages were assigned to four groups: (i) SMG women’s groups (WG); (ii) comparison WG; (iii) SMG non-WG (NWG); and (iv) comparison NWG. Difference-in-differences (DID) estimates were used to assess impacts on mothers’ food consumption, diversity, BMI, prevalence of underweight (BMI &lt; 18·5 kg/m2) and anaemia, and deficiencies of iron (ID) and vitamin A (VAD).Setting:Kalalé district, northern Benin.Participants:Non-pregnant mothers aged 15–49 years (n 1737).Results:The SMG programme significantly increased mothers’ intake of vegetables (DID = 25·31 percentage points (pp); P &lt; 0·01), dietary diversity (DID = 0·74; P &lt; 0·01) and marginally increased their intake of flesh foods (DID = 10·14 pp; P &lt; 0·1). Mean BMI was significantly increased among SMG WG compared with the other three groups (DID = 0·44 kg/m2; P &lt; 0·05). The SMG programme also significantly decreased the prevalence of anaemia (DID = 12·86 pp; P &lt; 0·01) but no impacts were found for the prevalence of underweight, ID and VAD.Conclusions:Improving mothers’ dietary intake and anaemia prevalence supports the need to integrate gender-based agriculture to improve nutritional status. However, it may take more than a year, and additional nutrition and health programmes, to impact the prevalence of maternal underweight, ID and VAD.

Lame Ducks and Local Fiscal Policy: Quasi-Experimental Evidence from Portugal

2019 ◽  
Author(s):  
Mariana Lopes da Fonseca
Keyword(s):  
Fiscal Policy ◽  
Term Limits ◽  
Fiscal Policies ◽  
Difference In Differences ◽  
Heterogeneous Effects ◽  
Quasi Experimental ◽  
Good Reputation ◽  
Local Fiscal Policy ◽  
Experimental Difference ◽  
True Preferences

Abstract I use the introduction of mayoral term limits in Portugal to identify how an exogenous variation in eligibility for office affects policy decisions. Relying on a quasi-experimental difference-in-differences approach, I find that term-limited incumbents pursue more conservative fiscal policies than those who are eligible for re-election. Heterogeneous effects show that the treatment effects primarily reflect the behaviour of right-leaning, term-limited incumbents. Results are in line with a model in which right-leaning officeholders try to maintain a good reputation by pleasing an electorate prone to redistribution while they are eligible, but adopt policies closer to their true preferences when term-limited.

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