Essay on Kidney Transplant and Performance Scores
Open Access
- Author:
- Ng, Han Loong
- Graduate Program:
- Economics
- Degree:
- Doctor of Philosophy
- Document Type:
- Dissertation
- Date of Defense:
- April 19, 2024
- Committee Members:
- Marc Henry, Professor in Charge/Director of Graduate Studies
Mark Roberts, Major Field Member
John Moran, Outside Unit & Field Member
Paul Grieco, Chair & Dissertation Advisor
Conor Ryan, Major Field Member - Keywords:
- quality regulation
kidney transplant
mortality rates
nonprofit policy
medicare - Abstract:
- I empirically investigate the effects of performance scores on the behavior of healthcare providers in the context of the Conditions of Participation (CoP) program implemented by Center of Medicare and Medicaid Services (CMS) in the US deceased donor kidney transplant program. In Chapter 1, I use a sharp regression discontinuity design to study the effects of being flagged by CMS for poor performance on transplant centers' behavior. Contrary to the existing literature, I find no evidence to suggest that flagged centers reduce (increase) the transplant of high (low) risk kidneys or waitlist younger, less obese, or non-diabetic patients. In Chapter 2, I study the threat of punishment on the strategic incentives of transplant centers and how it affects patient mortality. Using variation in distance to the CoP threshold, I show that the CoP reform reduced the probability of transplanting a patient-kidney pair. The reduction is more significant for riskier operations and low-volume centers. I find little change in aggregate patient mortality. My results suggest that centers avoid transplants for performance gains and that the reform's effect is mainly redistributive. In Chapter 3, I present a two-period model of transplant center behavior with risk-adjusted performance scores. I show that risk adjustment incentivizes centers to accept high-risk patient-kidney pairs compared to a model without risk adjustment. Furthermore, I illustrate how performance threshold and center size can affect the center's incentives to accept high-risk patient-kidney pairs. Finally, I discuss how the nonlinear incentive scheme incentivizes centers to reject patient-kidney pairs with high variance death probability.