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Unintended Consequences : the Financial Assumptions and Economic Theory of Obamacare : the Patient Protection and Affordable Care Act

100%
Thoene M.
Olsztyn Economic Journal
|
2014
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vol. 9
|
issue 3
251-263
EN
This article examines the Patient Protection and Affordable Care Act (ACA,) often referred to colloquially as Obamacare, from a financial and economic perspective in order to analyze the potential efficacy of the system. Research was gathered pertaining to the stated objectives of the program, and economic theory was applied in order to reveal if the aims of the program are congruent with economic theory. It was found that the authors of the ACA did not anticipate or under-anticipated several economic effects of the legislation, which will hamper the implementation and effectiveness of the program. Furthermore, the economic theories employed by the Obama administration relied heavily upon classical economic theory, with little or no attention given to Transaction Cost Economics (TCE). Moreover, the law itself is overly complex and controversial due to a myriad of provisions added through the intercession of lobbyists from the healthcare, insurance and special interest sectors. The end result is that Americans may obtain a slightly improved healthcare system, but the United States will most likely still lag behind the rest of the industrialized world in many key health statistics.
2
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Analysis of Total, Direct and Indirect Cost Outliers in a Polish Specialist Hospital

51%
Cygańska M., Thoene M., Silva A.
Olsztyn Economic Journal
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2017
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vol. 12
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issue 4
451-464
EN
The purpose of this study is to analyze the factors facilitating the identification of the three categories of cost outliers. They are known as total cost outliers (TCO), direct cost outliers (DCO), and indirect cost outliers (ICO). 4,570 patients have been analyzed. To evaluate the factors that influence the patient being a cost outlier in a hospital; age, length of stay, gender, type of admission, reason for discharge, and type of department were considered. Multivariable logistic regression was used in the study. In our research TCO comprised 9% of the study sample. The percentage of DCO was slightly higher (10%) and ICO was slightly lower (8%). Total cost outliers accounted for almost 37% of total hospital costs, 40% of direct costs, and 34% of indirect costs. The direct cost outliers accounted for 44.39% of direct costs, and indirect cost outliers accounted for 34.91% of indirect costs. It was discovered that, in terms of gender, men are positively correlated with higher cost utilization. The risk of being a cost outlier increases risk in terms of death and referral for further treatment. The type of admission factor can only be a predictor of being an ICO. The risk of a patient being a length of stay outlier increases far more for the ICO (more than 580 times) than in the case of a DCO (3.81 times) or a TCO (13.79 times). The analysis suggests that not only TCO, but also DCO and ICO, should have high priority for hospital managers concerned with variations in the costs of care.
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