University of Maryland Global Campus

HMGT 400: Research and Data Analysis in Health- FINAL EXAM

Data File: HMGTFINALEXAM.csv (Request from Professor after you submit Group Assignment #3)

Software Tool: Analysis ToolPak, RegressItLogistic or XLMiner Analysis ToolPak

Question #1 (15 credits):

The FINAL EXAM data file provides data on hospitals in 2011 and 2012. Analyze the FINAL EXAM dataset. You may calculate the “Hospital Beds per Population (Per Capita)” variable by dividing “total_hospital_beds by tot_population. Use the analysis results to complete Table 1 (template) below. Net Hospital benefits = Hospital Revenues minus Hospital Costs.

Table 1. Comparing hospitals in 2011 with hospitals in 2012

2011

2012

t Value (Pr<|t|) N Mean St. Dev N Mean St. Dev Hospital Characteristics 1. Hospital beds 2. Number of paid Employee 3. Number of non-paid Employee 4. Internes and Residents 5. System Membership 6. Total hospital cost 7. Total hospital revenues 8. Net Hospital benefits 9. Available Medicare days 10. Available Medicaid days 11. Total Hospital Discharge 12. Medicare discharge 13. Medicaid discharge Socio-Economic Variables 14. Hospital Beds per Population (Per Capita) 15. Percent of population in poverty 16. Percent of Female population in poverty 17. Percent of Male population in poverty 18. Median Household Income Then please answer the following questions. A) What are the significant differences for each of the hospital characteristics between 2011 and 2012? B) What are the significant differences for each of the socio-economic variables between 2011 and 2012? C) Based on your findings did hospitals (in general) have a better performance in 2011 or 2012? Explain. D) How does hospital performance relate to the hospital characteristics and how does it relate to the socio-economic characteristics? Question #2 (15 credits): In the data file, create a new variable called “hospital net benefits”. Do this by subtracting “hospital costs” from “hospital revenues”. Analyze the dataset and then complete Table 2 (template). In the last column report the T-test results comparing hospital characteristics between 2 groups of hospitals “1. For-profit & Other ownership”, 2.“Non-profit & public” hospitals. Note in the data file: If own = 0 then the hospital is non-profit owned If own = 1 then the hospital is for-profit owned If own = 2 then the hospital is public (government) owned If own = 3 then the hospital is owned by some other organization Table 2. Comparing “For-profit & Other” hospital group to “Non-profit & Public” hospital group in two years (2011, 2012) For Profit & Other Non-Profit & Public t Value (Pr<|t|) N Mean St. Dev N Mean St. Dev Hospital Characteristics 1. Hospital beds 2. Number of paid Employee 3. Number of non-paid Employee 4. Internes and Residents 5. System Membership 6. Total hospital cost 7. Total hospital revenues 8. Net Hospital Benefits 9. Available Medicare days 10. Available Medicaid days 11. Total Hospital Discharge 12. Medicare discharge 13. Medicaid discharge Socio-Economic Variables 14. Per Capita Hospital Beds 15. % population in poverty 16. % Female population in poverty 17. % Male population in poverty 18. Median Household Income Then answer the following questions: 1) What are the main significant differences between the “For-profit & Other” hospital group and the “Non-profit & Public” hospital groups? Which test is the best fit test? Why? 2) Use a column plot or graph to compare “Net Hospital Benefits” between “for-profit & other” and “non-profit & public” hospitals. 3) Create a scatter plot with the correct variable and axes labels and legend. Use the plot to compare hospital cost (x-axes) and revenue (y-axes) and discuss your findings? 4) If we assume that hospital net-benefit is a good measure of hospital performance, which type of hospitals had the better performance between “for-profit & other” and “non-profit & public” hospitals? 5) Overall, what are the main statistically significant differences between “for-profit & other” and “non-profit & public” hospital groups? Question #3 (15 credits): Our data file provides the variable herf_ins called the Herfindahl–Hirschman Index which measures market concentration for the health insurance market. Please note that unlike the class exercise in which you used herf_cat, which measured market concentration for the hospital market, in this assignment you are using herf_ins which measures market concentration for the health insurance market. Analyze the data to complete Table 3 (template) below: Table 3. Comparing hospitals in High, Moderate, and Low Insurance Market Concentration in two years (2011, 2012) High Concentration Insurance Market Moderate Conc. Insurance Market Low Concentration Insurance Market ANOVA Count Mean STDev Count Mean STDev Count Mean STDev F Value (Pr<|F|) Hospital Characteristics 1. Hospital beds 2. No. of paid Employees 3. No. of non-paid Employees 4. Internes and Residents 5. System Membership 6. Total hospital cost 7. Total hospital revenues 8. Net Hospital benefits 9. Available Medicare days 10. Available Medicaid days 11. Total Hospital Discharges 12. Medicare discharge-ratio 13. Medicaid discharge-ratio Socio-Economic Variables 14. Per Capita Hospital Beds 15. Median Household Income Then answer the following questions: 1) In a short paragraph describe and explain what the Herfindahl index is. You can use the reference provided in the class exercise or any other citation. 2) Compare the following information between hospitals located in high, moderate, and low concentration health insurance markets? a) What are the main significant differences between hospitals in the different insurance markets? (use the ANOVA test) b) What is the impact of being in a high-concentration health insurance market on hospital revenues and costs? c) Does being in a high concentration market have a positive impact on net hospital benefits? d) What about the number of Medicare and Medicaid discharges? Are hospitals in high concentration insurance markets more likely to accept Medicare and Medicaid patients? e) What is the impact of other variables? (Note: to answer the last question, please compute Medicare-discharge ratios and Medicaid-discharge ratios first and then run two t-Tests (high concentration vs. moderate concentration, and high vs. low concentration market). Please support your findings with an illustrative graph. Question #4 (Credits 20) Regression Models Analyze the data by running a regression model with “Net Hospital Benefits” as the dependent variable and present your results using the Table 4 template below. Table 4 – Regression Model 1 Coefficient ST. ERR T Stats P-values Lower 95% Upper 95% Intercept/Constant Total Hospital beds Teaching Hospital Dummy Count (N) = R Square = a) Describe and discuss your findings. b) Do the number of hospital beds or whether a hospital is a teaching hospital or not have a positive or negative impact on hospital net-benefit. (Hospital Performance)? In answering this question, consider statistical significance. Regression Model 2: Analyze the data by running a linear regression model and present your results using the Table 5 template below. Table 5 – Regression Model 2 Coefficient ST. ERR T Stat P-values Lower 95% Upper 95% Intercept/Constant Total Hospital beds Non-Teaching Hospital Dummy Count (N) = R Square = a) Describe and discuss your findings. b) Do the number of hospital beds or whether a hospital is a non-teaching hospital or not have a positive or negative impact on hospital net-benefits. (hospital performance)? In answering this question, consider statistical significance. c) Use the results from your Regression model 1 and regression model 2 to comment on any differences or similarities in impact of teaching hospital status or non-teaching hospital status on hospital net-benefits. (hospital performance)? Regression Model 3: Analyze the data by running a linear regression model and present your results using the Table 6 template below. Table 6 – Regression Model 3 Coefficient ST. ERR T Stat P-values Lower 95% Upper 95% Intercept/Constant Total Hospital beds Teaching Hosp. Dummy Medicare discharge ratio Medicaid discharge ratio Count (N) = R Square = a) Describe and discuss your findings. b) Do the number of Medicare or Medicaid patients in a teaching hospital have a positive or negative impact on hospital net-benefits. (hospital performance)? In answering this question, consider statistical significance. Regression Model 4: Analyze the data by running a linear regression model and present your results using the Table 7 template below. Table 7 – Regression Model 4 Coefficient ST. ERR T Stat P-values Lower 95% Upper 95% Intercept/Constant Total Hospital beds Non-Teaching Hosp. Dummy Medicare discharge ratio Medicaid discharge ratio Count (N) = R Square = a) Describe and discuss your findings. b) Do the number of Medicare or Medicaid patients in a non-teaching hospital have a positive or negative impact on hospital net-benefit. (hospital performance)? In answering this question, consider statistical significance. c) Based on your findings please recommend three policies to improve hospital performance. Please make sure to use the final model for your recommendation Question #5 (Credits 20) Logistic Regression Models Analyze the data by running a linear regression model and present your results using the Table 8 template below. Use “being a member of a hospital network” (system_member) as the dependent variable. and the independent variables presented in Table 8 template below Table 8 – Logistic Model 1 Coefficient ST. ERR P-Value Exp (coeff) Exp (z SE) Exp (Std. Coeff.) Intercept/Constant Total Hospital costs Count (N) = R Square = a) Describe and discuss your findings. Logistic Model 2: Analyze the data by running a linear regression model and present your results using the Table 9 template below. Table 9 – Logistic Model 2 Coefficient ST. ERR P-Value Exp (coeff) Exp (z SE) Exp (Std. Coeff.) Intercept/Constant Total Hospital Costs Total Hospital Revenue Count (N) = R Square = a) Describe and discuss your findings. Logistic Model 3: Analyze the data by running a linear regression model and present your results using the Table 10 template below. Table 10 – Logistic Regression Model 3 Coefficient ST. ERR P-Value Exp (coeff) Exp (z SE) Exp (Std. Coeff.) Intercept/Constant Total Hospital Costs Total Hospital Revenue Medicare discharge ratio Medicaid discharge ratio Count (N) = R Square = a) Describe and discuss your findings. b) What is the impact of having more Medicare or more Medicaid patients in the hospitals, on membership in hospital systems? c) Based on your findings from Logistic Regression Model 3, please recommend three policies to justify whether hospitals will organize themselves into hospital systems or not. Question 6 (15 credits) 1. Please offer a research question for a study involving human subjects. 2. Explain the difference between the research process involving human subjects and the research process not involving human subjects. 3. Discuss ethical implications surrounding human subjects research studies. 4. Explain the governance of the human subjects research studies over the data and the process. 5. Provide examples of the consequences for not meeting IRB (Institutional Review Board) protocol requirements. 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