Fixing cracks in the US health system : addressing inefficiency and inequality with technology and transparency.

The United States (U.S.) healthcare system is the most expensive among developed countries, yet it faces persistent challenges. Primary issues include rising costs, inefficiencies, limited access to care, and pockets of poor-quality outcomes. This dissertation examines some critical cracks in the system and specifically evaluates the misuse of emergency room (ER) services for nonemergency matters, substantial pricing disparities among healthcare insurance companies and healthcare providers, and primary care shortages. The first chapter leverages a dataset of approximately 60 million ER outpatient visits in Texas from 2017 to 2022 to explore how many visits to the ER appear to be non-emergencies. A conservative definition of a nonemergency visit is taken by only considering patient visits to the ER for which the only procedure recorded for the visit is a consultation with a clinician. The COVID-19 pandemic is used as a natural experiment to analyze behavior shifts. The second chapter studies the lack of standardized pricing in healthcare, focusing on the variation in payments both across different providers for the same procedure and across different insurers for the same provider and procedure. Approximately 147 trillion data records of price information are collected to perform this analysis finding that larger healthcare provider practice sizes are associated with higher prices; providers in areas with poor population health tend to receive lower prices; higher quality services leads to higher prices; and prices are lower for healthcare providers where health insurance companies have strong market share. The third chapter addresses the shortage of primary care providers in the nation and investigates how technology can help tighten the gap between high demand and insufficient supply of primary care. Technologies such as telehealth and AI-powered virtual assistants appear to expand the supply of primary care without having to add more physicians. This dissertation offers a comprehensive view of some systemic weaknesses in U.S. healthcare and suggests solutions. It draws on significant data sets including some complete populations rather than samples and includes a large variety of tests combined to logically reach evidence-based conclusions aimed at improving efficiency, financial sustainability, and healthcare equity across the nation.

Name thesis:degree_name

Ph.D.

Level thesis:degree_level

Doctoral

Grantor

Baylor University.

Year dc:date.issued

2025

Author dc:creator

• Monger, Meade, 1965-

Advisor dc:contributor.advisor

• Pham, Van Hoang.

• Health care.
• Prices.
• Emergency.
• Primary care.

Statement dc:rights

• Baylor University works are protected by copyright. They may be viewed from this source for any purpose, but reproduction or distribution in any format is prohibited without written permission. Contact libraryquestions@baylor.edu for inquiries about permission.

Language dc:language.iso

en

Handle dc:identifier.uri

https://hdl.handle.net/2104/13998

OAI identifier oai:identifier

oai:baylor-ir.tdl.org:2104/13998