Missing Pieces in Health Services Cost Analysis: Consensus on Modeling, Magnitude, and Micro-Costing
Date of Award
2021
Embargo Period
8-1-2024
Document Type
Dissertation
Degree Name
Doctor of Philosophy (PhD)
College
College of Health Professions
First Advisor
Kit N. Simpson
Second Advisor
Annie N. Simpson
Third Advisor
Paul J. Nietert
Fourth Advisor
J. Dunc Williams
Fifth Advisor
Zoher F. Kapasi
Abstract
Cost and cost savings have become an important focus for health policy administrators. However, there are missing pieces in our approach to cost analysis; there is no consensus on multivariable methods, no indicators of minimally acceptable values, and no specification of process costing. In this dissertation, I propose to fill the gaps in the literature by 1) identifying which methods are appropriate for large claims data, 2) examine existing methods to establish minimally important difference (MID) in health outcomes to identify MID in costs, and 3) determine differences in sick visit clinic costs using a modified micro-costing method. Most models that were compared to the generalized linear models Gamma distribution with log link found it to be the superior model in both simulated data and real administrative data. We recommend that in cases where acceptable anchors are not available to establish an MID, both the Delphi and the distribution-method of MID for costs be explored for convergence. Our micro-costing approach is feasible to use under virtual working conditions; requires minimal provider time; and generates detailed cost estimates that have “face validity” with providers and are relevant for economic evaluation.
Recommended Citation
Dooley, Mary Judith, "Missing Pieces in Health Services Cost Analysis: Consensus on Modeling, Magnitude, and Micro-Costing" (2021). MUSC Theses and Dissertations. 566.
https://medica-musc.researchcommons.org/theses/566
Rights
All rights reserved. Copyright is held by the author.