Moore Impact: The Darla Moore School of Business Podcast

Emergency Center Wait Times and SC Healthcare

Episode Summary

Dr. Orgul Ozturk helps unpack Dr. Lindsay Woodworth's research on hospital emergency room wait times in this episode.

Episode Notes

Season 2 Episode 11

Emergency Center Wait Times and Other BIG Healthcare Economy Questions

Dr. Orgul Demet Ozturk is the department chair and professor of economics in the Darla Moore School of Business at the University of South Carolina. Her academic research interests are in applied microeconomics fields, specifically labor economics and health economics. Dr. Ozturk was honored recently with the Endowed Chair James A. Morris Professor of Economics and her investiture was attended by over thirty colleagues glad to celebrate her accomplishments and share her celebration.

In this episode, Dr. Ozturk speaks a little about the investiture but mostly shares the EPiC monthly newsletter and in it, Dr. Lindsay Woodworth’s research on hospital emergency room overcrowding.

Topics include:

Learn more about Dr. Ozturk here

Learn more about Dr. Woodworth here

Learn more about EPiC here

Learn more about the Darla Moore School here

Episode Transcription

Kasie Whitener (00:04):

Tuesday morning, welcome into More Impact. It's Kasie Whitener here in the studio with my good friend, Dr. Orgul Ozturk from the Department of Economics at the University of South Carolina's Darland Morris School of Business. And we're here because I was able to rope you into coming here on a Tuesday morning. . Welcome Dr. Ozturk.

Orgul Ozturk (00:23):

Hello . Good to be here.

Kasie Whitener (00:24):

I'm glad you're here. So first of all, congratulations on Friday. We got together at the Russell Chapel on the University of South Carolina's Horseshoe, and we're able to spend time celebrating you as an instructor, as a professor, as the department chair, as a researcher in economics. And so first let me set this up as far as Moore Impact is concerned for those folks listening to us, really the goal of the Moore Impact Show is to bring what's happening on campus at the Darla Moore School of Business to our Columbia residents, our, you know, Lexington, Chapin, Richland County. All of our folks here who are listening in our listening audience also on Make the Point radio.com, so they can understand what's happening in the Darla Moore School of Business and how it contributes to the overall wellness in general of, of South Carolina as a state, Columbia as a city and of course the nation and, and the world in a much bigger market. And so, Dr. Ozturk, Orgul is on Friday, we named you the

Orgul Ozturk (01:27):

James A. Morris Professor of Economics

Kasie Whitener (01:30):

The James A. Morris Professor of Economics, which is what's called an endowed chair. And when we had our folks here for Give for Garnet two weeks ago, it was either last week or two weeks ago, they were here talking about fundraising. And they talked about endowed chairs, which is where a, an an individual donor decides they're going to support the university by supporting a particular position in the university. And in this case, this is now this endowed chair for you. And so that's, that's your official job. And you are the department chair of the Department of Economics. So you oversee all of these economics professors in that capacity, helping them with course assignments and research assignments and these kinds of things. And then on top of that, you are a researcher in you're own, right. And you're also teaching and you're also overseeing PhD students as they're nearing their dissertations and things like that. So you're a pretty busy gal.

Orgul Ozturk (02:17):

I am , I am pretty busy. , what was, and I am also the, you know, the director of Epic.

Kasie Whitener (02:24):

Oh, and Epic. The center, exactly right. So the economic policy research center. So let's, before we get to Epic, 'cause I think that the research we're gonna talk about is associated with that and that whole conversation we wanna have about emergency rooms and access to healthcare. That's the whole conversation for later on today. But what I wanna talk about first is what was Friday like for you?

Orgul Ozturk (02:42):

It was very special. You know, it's just the ultimate goal, I guess, of an academician. You are getting through the ranks, but then somebody saying, Hey, here is something named after someone who was quite important in our department. Is, is James A. Morris was a professor in 1970s. And James a Carhart named this position after his professor. He's one of our alums. So it feels special to be recognized given this title. It was nice to have all of my colleagues, including you Yes. Come and be with me to celebrate my family my husband's family, but also my family from Turkey. Not in person, but virtually join and see me celebrate. I guess. It was nice to have a party. I mean, I love a good party. Yeah.

Kasie Whitener (03:37):

, I'm with you. I love a good party too. Yes. So they had, the provost office was represented by Maryanne. Dean Verma was there. Audrey Korsgaard was there, who's our as Associate Dean. And then you mentioned all your colleagues. There were 24 of us there. And I only know that because Tina Poindexter, who's our events lady, was organizing us. And she said, we have three rows, eight people in each row, . So, so all of us were there too. And we were all in our regalia, our co I always call 'em my academic costume . But it, there's a level of formality to this. And it took place in the Russell Chapel. So there's this elevated stage that you got to stand on and they had a declaration that they read for you and all this.

Orgul Ozturk (04:13):

Yeah, it was, I mean I don't necessarily like formality like this, but everybody took the time and put that costume on, like you said, and there were actually 30 of us almost because my husband being faculty

Kasie Whitener (04:26):

Oh, right. He sat with the family. That's right. That's right.

Orgul Ozturk (04:28):

So anyways, it is nice to kind of see somebody talk about your career and you getting the opportunity to say thank you Yeah. To everyone that helped you build that career. Right. And we don't get to wear our costumes very often. It's

Kasie Whitener (04:48):

Only . It

Orgul Ozturk (04:50):

Was a good opportunity and weather was perfect, so, oh, it was nice. Usually they get really, really hot. So Yeah, it was a good one. Yeah.

Kasie Whitener (04:55):

It was nice and cool out. And we got to walk across the horseshoe. Yes. And, and have a nice reception over at the McCutchen house. And so when we think about these kinds of achievements, right one of the things that Dean Verma did was read off your list of publications and you were really kind of funny 'cause when you got up to give your speech, you're like, there are a few of those I would've rather not have been on there. Right. , tell us a little bit about this process of becoming a published researcher and what that looks like. Because I know before you and I talked about how, hey, we do the research and three years later it shows up in the academic journal that that gap between the time that you're doing the work and the time that it's recognized, share that just a little bit with our audience.

Orgul Ozturk (05:33):

Yeah. I mean, you know, we devote almost all of our days for a period of time to one idea. That is how we kind of nurture it. We try to find whatever the goal, the question that we are trying to answer. It's with data, it's with theory, it's with kind of trying to understand what else been done out there and see where we can fit, what gap we can fill. And then you go around, present the work to hear what others can see that you didn't. Right. 'cause sometimes you kind cannot see. You could have blind spots. Exactly. Yeah. So it's really nice to hear others contribute. At least that's how I see presentations. I go out there and say, Hey, this is what I'm trying to answer. This is the best answer I can come up with. These are the methods I'm trying to use.

Orgul Ozturk (06:15):

What am I doing wrong? Right. Am I doing anything wrong? So it's good to kind of get it foolproof, make sure that nothing is wrong, nothing is you are not, not missing anything. And then you send it to journals and it's sometimes years before it goes through that blind review process. And you hear back sometimes not nice things from you know, anonymous referees, , and it is sometimes about the fit Yeah. Of the research for the journalism questions, because we have a lot of journals. Right. covering many, many fields in economics. Right. So then you kind of find a good home for it, and that good home publishes it. And that in itself takes a year or two sometimes. Yeah. 'cause there is a queue of jo articles and they try to kind of arrange it in a way that's gonna make the most sense in the presence of others. Right. And then, you know, they send an email to people saying, Hey, latest issues here. Yeah. In these days in olden days it was a print copy will show up in your mailbox. Right. You'll open it up and say, oh,

Kasie Whitener (07:24):

And back in the 19 hundreds back in the 19 hundreds in the olden days. Yeah.

Orgul Ozturk (07:27):

Yeah. And and you know, if you, you're lucky, somebody will read it and then send you a note saying, Hey, I read your article. That's awesome. , you know, we are doing something similar, we wanna talk. Yeah. And that's how kind of academic knowledge is shared and kind of built on, I guess, right. And built up.

Kasie Whitener (07:46):

So I think too, to kind of put it in context for our listeners, that this is the knowledge that is then shared in the classroom. Exactly. Because this is the stuff that becomes textbooks. This is the stuff that is, hey, this is what we know to be true. Yeah. And that's where it, it's disseminated from there. So you're really creating new knowledge as a researcher and identifying things that people did not know the answer to these questions before. And then it gets disseminated out into the classroom. And that's what the people are learning in the classroom, is what the researchers have discovered. So I think it's the idea that like, hey, it, it, it's gonna sit and sort of wither away. That's that's not entirely true. No, it is. Eventually through you know, the channels it's gonna go through into our students, they're gonna understand

Orgul Ozturk (08:27):

It too. Yeah. Sometimes you know, it, it doesn't because it is not immediate. That is the part that we sometimes complain. Yeah. But yes, it makes it through the textbooks.

Kasie Whitener (08:36):

Dr. Orgul Ozturk here with me today on Moore Impact. We've got three more segments coming up. Don't go away.

Kasie Whitener (08:50):

Good Tuesday morning to you. Welcome back into Moore Impact, Kasie and Orgul here talking a little bit about Friday's ceremony where we called it the investiture ceremony. This is the highest level of achievement really for an academic based on your research, based on your service to the university, based on your work in the classroom rising through the ranks to department chair, and then being identified as somebody who's not only a, a leader in your field, but a leader in the school itself. And I just, I, I gotta say congratulations. I think it's so well deserved. And everybody who was there felt the same way. And I was telling Keven this on the morning show. I said, you know I feel like that she's my favorite colleague, but she makes me feel like I'm her favorite colleague. And like Donna Bobek and I were talking about it.

Kasie Whitener (09:36):

I was like, she makes me feel like I'm super special. And Donna goes, she makes me feel that way too. . And I thought, what a great gift for you as a colleague and as a professional to make the people around you feel so important and so appreciated. I just think you're amazing. And so it gave us all a chance to express that to you. And, and I, I know I don't wanna embarrass you anymore about it, but I just wanna say that and Dr. It makes me very happy. Dr. Verma was not wrong. Dean Verma was not wrong when he said that your everybody's favorite colleague, all of us are like, oh, of course. We love her. We're so glad to hear be here and celebrate her. So all that to say, your family was able to watch live. Right. Obviously your, your in-laws are here in Columbia. Yes. And so they were able to be there in person with your husband and your daughters, which is super cool. Your daughter and your son, right? Yes. And so that, that was super cool. It was fun to see them around. And then we recorded it so that your family and Turkey could watch. But you said they don't speak English?

Orgul Ozturk (10:28):

No. I mean, my brother does. And I shared it with him so that he can translate. And we actually thought about maybe having it live streamed mm-hmm . But my mom gets so stressed about these things, she gets so excited and it's gonna be past midnight in Turkey. So I'm like, let's not, and then I'll shared the video and of course she was in tears. But my brother did all the translations. Yes. And she wanted to know who everybody was. So I made sure to point out , this is our dean, our vice provost, I mean, you know she, it's good to make them proud. Yes,

Kasie Whitener (11:06):

Of course. It's always, you never get too old for your parents to be proud of you.

Orgul Ozturk (11:09):

No. It's kind of funny that, you know, even at age 48 now, it's kind of, she still treats me like I'm eight years old

Kasie Whitener (11:15):

. So I like, how are you able to do all this? You're like, well, mom, I'm 48 years old. So like, that's, that's gonna be a thing. Okay. So one more thing on this, on the on Friday and the investor and all that really about your family in Turkey, there's some disruption happening in Turkey. Right. Some political upheaval. What has been the challenge for you guys navigating conversations with them or understanding what's going on for them? Like, can you bring our, like, share with our listeners just a little bit about some of the, 'cause we know the former president has been arrested, is that right?

Orgul Ozturk (11:46):

No, not the former president, but his Istanbul municipality what do you call it? Like the Mayor. Mayor, okay. Yes. Yeah.

Kasie Whitener (11:55):

The mayor of Istanbul.

Orgul Ozturk (11:56):

Yeah. The mayor of the big mayor. There are many of municipal in you know, Istanbul, but he's the mayor of all mayors. Right. In Istanbul.

Kasie Whitener (12:04):

Okay. So pretty important guy.

Orgul Ozturk (12:05):

Oh yeah. Pretty important guy. And he is considered to be kind of leader in the oppositional side of things and potential, you know, future president at least he was, I think in many people's minds. Gotcha.

Kasie Whitener (12:17):

And now there's this, he's being accused of corruption, is that right? Yeah.

Orgul Ozturk (12:21):

Yeah.

Kasie Whitener (12:22):

Yeah. Wow. So, but you don't have anything else to add to that? Like, things are weird in Turkey, but I don't live there, there. I don't

Orgul Ozturk (12:28):

Think so things, no. The thing is you know, I grew up in that country and things have always been weird in my country in some way or another. And it's, I, the only thing that bothers me is the arresting of opposition leaders. I mean, these kind of events student protests, they should happen. Right. They are a sign of healthy you know Right. Country democracy. But when you try to put down with brute force or by arresting any dissident voice, that is where the problem is. Right. And that is one thing that really bothers me, embarrasses me about my country, is that we are up there with North Korea in terms of jailing journalists. Hmm. People who are just expressing opinions. Right. There shouldn't be a, a punishment for them for doing so. Right. Peacefully and even the protest. I mean they are not hurting anyone. They have the right to sit there and you know, voice their opinions. Right. And that is heartbreaking. It it kills you when it's your own country, even if you don't live there. Yeah. You'll still feel like you know, that's, that is me in some ways. Yeah. It's hard to see it even from a distance.

Kasie Whitener (13:43):

So that perspective, 'cause you've been here for a long time. Yeah. That perspective of having a right to protest, having the right to have your voices heard, like, is all of that, was that, is that in you as part of your, your code of ethics from the time you before you got here? Yeah. Or is that like American id? Is that Americanization ? I

Orgul Ozturk (14:02):

Mean, no, I think it's always been there. I mean, I'm not sure if it is a general public, you know, always a shared cultural thing. I think it is in some ways, in a different way though. I mean, Turkish how the government works is different. In Turkey, you have your states, we have essential government, and usually things happen kind of overnight. Right. So that kind of when the government changes, it is a pretty striking change, maybe, right. For a lot of us. So that was, you know, that's the way it is, kind of attitude was normal to that Right. Here, you don't see it. And here people have opinions about even the tiniest change, and as a result, change is not really easy in this country. Right. I mean, change happens over many years. And federalism is great for researchers. Right. But I kind of like that if something's gonna change, it's gonna change. Yeah. And from a researcher perspective, not necessarily, you know, as a citizen, but

Kasie Whitener (15:00):

Well in that case too, like there is, there's a sense maybe that it's not permanent. Right. Because the government's gonna flip over whatever the length of the term is. Right.

Orgul Ozturk (15:09):

This is what is kind of funny to me I've been in US for more than 20 years now, and when I left country Turkey that was more of the case. It was bunch of coalition governments all the time. Bunch of early elections all the time. Things changing all the time. Right. And it was like central Right, right. Central left to, we never far went too far away from that center. Right. In these days, I think it is a common you know trend everywhere you are going in the extremes. And that kind of distancing is hard. Yeah. Harder for the democracy, I think in general. Yeah. So that's what I'm seeing in Turkey now. This government has been in charge for so many years. It's, and it's been even when you see things not going well, it's been in charge for years.

Orgul Ozturk (16:04):

Right. That is hard to reconcile with my you know, childhood Turkey. Right. Where things weren't necessarily perfect. I mean, we were far from perfect, but at least things were kind of always changing. Right. There was always when you didn't see things being right. You just, through the garment new coalition formed, a new party was in charge again. Everybody was in some way or another similar Right. But still, I think it was leading to a better economy, better government, better governance, better policy. Right. Or shorter period of time. Now I feel like country's stuck. Right. It's 20 plus years with the same kind of ideology and it seems to be constantly trying to silence the opposition and things are going badly. And you're like, what is not why it's not changing. Right.

Kasie Whitener (16:54):

And ideology that's not working. Yeah. Right. That seems to not be effective as a governance. Yeah. I mean, and yet you're not getting rid of it.

Orgul Ozturk (17:00):

And when I graduated my PhD program, we actually thought about maybe potentially going back to Turkey. There were academic efforts be considered. Now I wouldn't consider going back. Yeah. 'cause the life, academic life especially is so different Yeah. Here versus anywhere else, but especially Turkey. Yeah.

Kasie Whitener (17:19):

It's interesting to me to think about the the silencing of the opposition, the limited scope, the limited viewpoint versus a place where there's just this miasma of voices and there's just a lot of opportunities for coalitions. And imagine if all those voices were being heard and we were really working on getting to the very best solution. And even if that solution doesn't work perfectly, then we'll try to fix it the next time around. Like, that sense of constant momentum toward a better nation, I think is what we strive for. For like, that's what we want. And so then to see something come in and seize the, the control, seize the reins. I

Orgul Ozturk (17:56):

Mean, I remember complaining about having too many parties in Turkey. Yeah. Because you know, when you have 20 parties or more, actually

Kasie Whitener (18:03):

Very fragmented. Yes, exactly.

Orgul Ozturk (18:05):

But I'm now we are going more onto that two party system and it is not, it's not working. Oh, yeah. It's not working in this country.

Kasie Whitener (18:14):

It's not working here either. Yeah. Yeah. , you're not wrong about that. . And at some point there's a blending where things seem to be, there's not a lot of difference between these two perspectives. And the government is moving with some momentum that isn't necessarily what's best for the people, isn't necessarily best for what, what the people the citizens are trying to serve. It's just this momentum. Yeah. It's like an unstoppable momentum. All right. So speaking of which, one of the areas of government influence, areas where the government does get engaged and try to organize markets and, and help people get access is in healthcare mm-hmm . And so we have this new research from one of our colleagues who has written about access to emergency rooms and the volume that these emergency rooms are experiencing. Tell us a little bit about this new paper and just give us the basic brief. We're gonna run to break at the bottom of the hour and we can really break it down on the other side. Sure.

Orgul Ozturk (19:08):

So this is Lindsay Woodworth's work. She's an associate professor in my department. She's a health economist. It's new published, but it's been, you know, on the works for a long, in the works for a long time. She basically tries to understand what's the effect of of crowding when somebody has to wait because of the crowding, how their outcomes are affected. You are not going to be just looking at the wait times and be able to get at that outcomes conclusion though, because obviously who is not waiting the most emergent, you know? Right, right. The serious cases. But she had a very clever way in this paper and in some others too, getting at that question. And then identifies causally what the effect will be if you were to have less crowded emergency rooms. You

Kasie Whitener (19:53):

Published this as the first EPIC policy brief. Mm-Hmm . And Epic is the economic policy center. Yes. At the University of South Carolina's Darla Moore School of Business. And the goal here with these policy briefs is to kind of disseminate this research that your colleagues are working on into talking points for our legislators and for our voters to understand really what's happening. And that new knowledge we were talking about before getting transferred, not just to our students in the classroom, but now out into the world to these epic policy briefs. Can anybody subscribe to these? Of course. Like anybody can get ahold of 'em.

Orgul Ozturk (20:27):

Yes. Yes. I mean, if you just go to our website, you can subscribe, you can follow us on LinkedIn, you can have access. I mean, the whole goal is to reach out to general public with these research briefs. Yeah. We wanna have it in the simplest language possible so everybody can understand. And don't go into this nitty gries of academic language, but make it so that you know you know, where what we are doing. You have the knowledge of who is doing what. So you can contact us about other things as well. And read some really cool research papers. Yeah.

Kasie Whitener (21:01):

Well, and some really cool research papers. , I know there's some people that came through their master's degree program that are like, yeah. Right. . Anyway, on the other side of the break. We're gonna talk more, we're gonna get into the weeds of this healthcare conversation based on Lindsay's research, it's Kasie and Orgul here for Moore Impact. Don't go away. All right. As promised, we're gonna get into this healthcare conversation. Welcome back to Moore Impact, Kasie and Orgul here talking about Lindsay's research, which is related to wait times in emergency rooms, and in this overall trying to get a sense of healthcare outcomes based on these particular metrics. So share just a little bit with us, like what the details of this research are.

Orgul Ozturk (21:47):

Sure. So Lindsay was, you know, we all here, emergency rooms are crowded. If we ever have to go there for a broken arm, we wait for a long time. So she's been quite interested in how the emergency rooms work. She has a lot of other papers on it too. And she wanted to answer, Hey, is this the wait time? Is it really an important you know, thing that we need to worry about? So then the obvious question is, if somebody's waiting for a long time, are they going to be worse off in terms of their health outcomes? So but of course, this is a hard question to question to answer why if you look at the data, you are going to see people who are not waiting are the ones who are potentially dying more. Why? Because who are not, who is not waiting in the emergency room, the ones who are coming there, you know, with very severe condition. Right.

Kasie Whitener (22:41):

Gunshot wounds. Exactly. Car accidents,

Orgul Ozturk (22:43):

Those take priority. They go in. So if you were to just look at the data in terms of wait times and outcomes, you're gonna see this really weird outcome. Right. So she wanted to get at it in a way that is having two comparable people, but one having to wait longer than the other. So how do you do this? Again, she has other papers that kind of get at this in clever ways, but this one, the latest paper of hers is looking at the entry of two new emergency rooms emergency departments to the market in South Carolina. Two new emergence rooms are open in 2004 to 2010. Mm-Hmm . So when they open up, what happens to the existing ones, suddenly those are emptier. Right. Right. And two people, one coming and the day before the opening, I mean, this is exaggeration obviously, but the day after with the same condition, a gunshots say, right. One has to wait less, even less than they normally would. Right. As a result, she was able to show when something like this happened, and in the way that she expresses it just imagine one out of 10 people just magically disappearing. That results in a huge amount of improvement in the rate of survival, about 25% change in the outcomes and the 30 day after dismiss sale from the hospital,

Kasie Whitener (24:05):

Which would indicate if we have more emergency rooms, there's more access to care, people wait less time, and they have better long-term outcomes.

Orgul Ozturk (24:14):

I mean, yeah. So that's one solution, obviously, but emergency rooms are expensive and they are you know, emergency rooms are expensive to staff, expensive to operate. So I mean, the idea is like, how can we reduce crowding of emergency room one is to have more of, but other is to how can we reduce the use of emergency rooms for non-emergency care? That is biggest problem. That is the biggest problem in us. Right. Emergency rooms are usually used, not usually, but also are used for in, for individuals who do not have access to regular healthcare. Right. They are used as a source of regular healthcare.

Kasie Whitener (24:52):

Right. As a primary care. Exactly.

Orgul Ozturk (24:54):

Mm-Hmm . Exactly. And if we can get those individuals out of the emergency room, and I'm not saying don't allow them to use, because that is their only source of emerge room is the only source of healthcare sometimes. Right. But how can we better care for them so they don't have to go to the emergency rooms? That's another way to, and probably a more efficient, effective overall way to improve access to emergency care.

Kasie Whitener (25:17):

And frequently the people that are using the emergency room for their primary care are our underinsured citizens. Exactly. The folks that don't necessarily have access to a primary care. And so they'll, they'll access the emergency room because the emergency room, and like this is sort of an air quotes, has to treat you, right? Yes. There's this, there's this compulsion that the emergency room will in fact treat you in some way. So you might be there for the sniffles for hay fever, you know, for whatever it is. But it is their only access to care because they don't have insurance or they're underinsured to enable them to go to a primary care physician in the doctor's office.

Orgul Ozturk (25:52):

Yeah. That, that has two sides, actually. One they don't have health insurance as a result. They don't get the regular care they need for chronic preventative, chronic preventative care Yeah. For chronic conditions that do lead to these very acute, severe outcomes if they are not taking care of. Right. and then there's also, of course, taking it, using it for just regular care. Right. But I think the first part is another major component that we are as a result of this lack of access to care turning something that is maybe cheap to regularly care for into something really expensive. Right. And that is much major. And again, crowding our emergency rooms. Well,

Kasie Whitener (26:34):

The condition worsens, it gets you know, un untenable. Right. Untenable into a place where the healthcare professionals have to enact these kinds of lifesaving things. Yes. Which they wouldn't have had to do otherwise. You

Orgul Ozturk (26:46):

Have health heart medicine, say you need to fill or get care for regularly get your medicine regularly. But if you cannot afford to do either of those or don't have access to either of those, you end up in the hospital with a heart condition. Right. You know, or asthmatics, you know, if they cannot regularly fill their inhalers Right. They end up in the emergency room for,

Kasie Whitener (27:07):

Oh, and we see this with diabetics too. Yes. Diabetics too, where they're not able to regulate their insulin, they end up Exactly. In a position where they're gonna have to have a foot amputated, these kinds of things. Exactly. Where I didn't necessarily have to get there if the care had been managed. Exactly. All right. So let's talk about whether or not that managed care piece is about the access to the payer system in terms of having our third party payers, which are our insurers, and then we have our healthcare providers, which are, these are these two things are decoupled in the United States healthcare system. It's, you've got the insurance companies that are doing the paying, and you've got the healthcare facilities that are doing the providing. And in our system, you've gotta have both, right? You've gotta have your care provider, you've gotta have your insurance to be able to cover the expenses, the care provider. But sometimes those things don't work together.

Orgul Ozturk (27:52):

No. I mean, everybody's maximizing their own profit functions. They on utility then resulting in this sometimes competing you know, incentives. And that leaves us with this ultra expensive, I mean, really good care, right? Still, but ultra expensive and sometimes unaccessible care, if you cannot access it, what does it mean to have a great healthcare system? Right. and I mean, one another part is you are the other weird thing or unusual thing in us is a lot of the healthcare is provided through employment, right? And it is one thing to have a University of South Carolina providing a health insurance for their employees. The other is this small pop and shop, right? Pop and, you know, mom shop, shop mom and pop. Yeah. And so, and that is quite expensive, especially with the rates, et cetera we're facing now. Right. Which then leaves even the people who maybe 20 years ago were able to access care, not able to access care.

Kasie Whitener (28:56):

It's so ridiculous. The idea that our gov that our healthcare is coupled to employment. This is, and this is something I think was really exposed during covid, is what a huge, huge mistake this is. Yes. and part of it is it came from way back in the, I I wanna say the 1920s or thirties might have been later than that where Congress decided to cap wages and say like, okay, well people can only make a certain amount of money. Right. You can only make a certain amount of money. Well, businesses wanted to compete for better employees. And so the thing they did Well, we can't pay you, you so we'll offer you health insurance. Right. That's, it's so benign. Like it seems like it's not even that big a deal, but that's where it came from. Yeah. And now you're a healthcare provider.

Kasie Whitener (29:36):

Well, you're a payer, right? You're United Healthcare, you know, insurance or whatever, and you realize it's a whole lot easier to sell insurance to a company that's got 500 employees than it is to sell to individuals ins, right. Individuals. Yes. So they're out there, you know, state Farm, progressive, our car insurance people are out there, slumming it one person at a time. Right. But United Healthcare is selling to Discount Tire company with a thousand stores nationwide. Right. And so for them, that sale is a whole lot easier. Yeah. And the two things become so tightly intertwined that it's just really difficult now to get them, you know, un unpacked, right? Yes, exactly. And that was part of the Obamacare thing was like, Hey, let's find a way to get affordable insurance made available. And, and even that's not working. The healthcare marketplace doesn't

Orgul Ozturk (30:19):

Work. And with all the with all the if you are not going to be able to say you have to buy it, and if you cannot afford it, we are going to give you subsidized, you know, insurance. Right. I mean, it's a marketplace and it is supposed to work, right. But with everything, I think that had to go into those legislative changes that they had to be made to make this possible. Right. It turned into something that is not sustainable and or really solving the problem. Well,

Kasie Whitener (30:51):

Businesses, businesses of a certain size have to offer healthcare. Yeah. And that by law, right? Yeah. So that's the kind of thing that it's like, well, now wait a second. If, if you didn't have to offer healthcare by law, couldn't people go and get their own healthcare on a free market?

Orgul Ozturk (31:05):

Yeah. I mean, also like this kind of size restrictions, thresholds, et cetera, is kind of sometimes excites the researcher because you see a lot of punching around those thresholds, right? I mean, if you are supposed to offer health insurance for your insur employees who are working more than 40 hours,

Kasie Whitener (31:25):

You'll work on 40 hours. You

Orgul Ozturk (31:26):

Hire a bunch of people for 39 hours. Yeah. I mean, that kind of, I mean, this is creating very I mean, it's creating incentives that is leading to very, a lot of bad behavior. Yeah. Leaving people you know without insurance. Right. And I mean, it is a struggle for the small shops to offer health insurance because it is with this setting of the market. Right. Extremely expensive to do so. Right. So yeah, we need a bigger, better solution. Universal healthcare needs to be part of the discussion. Yeah.

Kasie Whitener (31:59):

I mean, I think there's a lot of alternatives, right? Yes. There, and there's a lot of different models out there. The question is, of course, there are incentives for people who are benefiting from the current model, of course. And, you know, I, I don't mean to throw UnitedHealthcare outta the bus. They were a, a great insurance provider for us when we worked, when Charlie worked for Discount Tire Company. I mean, we had exceptional insurance or Discount Tire Company, but at the same time, that was because there was this economy of scale. They were insuring so many people that they could do it for an affordable amount, you know, with a, with a major insurance company. And you just don't necessarily have that same economy of scale. No. If you're a, you know, 45, 50 person shop, and you are required by law, but you're not a huge client for these big insurance companies, and so you're not necessarily getting the benefits of the the best deals. Yeah. The best deals. Yeah.

Orgul Ozturk (32:42):

And who's getting the best deals are already in a pretty good position to provide exceptional benefits to their employees,

Kasie Whitener (32:48):

And in the meantime, the people who are getting paid. Right. . Then we have our healthcare in, it's the hospital, the hospital systems, which now a lot of hospital systems have bought up, a lot of independent care providers people, the care providers want to be part of the system so that they can have easier bill processing, have easier collections and that kind of thing, and not have to run that part of their business themselves. And yet when they do that, they limit the, the people that are gonna have access to them because they're only able to take a certain types of care and that kind of thing. Yeah. Types

Orgul Ozturk (33:20):

Of payers. Yeah. I mean, consolidated care, monopolies forming, and a lot of smaller you know, care providers closing, especially in rural areas, that's a big problem in South Carolina. Mm-Hmm . Yeah. It's

Kasie Whitener (33:31):

Huge opportunities for entrepreneurs in this space. Perhaps we just would have to get, I think perhaps those legal the regulations, the restrictions that are benefiting the big massive conglomerates. We gotta get those things addressed in a way that would open up opportunity for competition and some smaller providers to come, come forward. We are seeing some independent healthcare clinics too. So to bring it back to Lindsay's research, and we're gonna go to break here in just about 30 seconds. I wanna talk about independent care providers. What are the alternatives to emergency rooms and sort of what are the different types of businesses that fit in that spectrum of care? Everything from the preventative stuff. Hey, we're gonna go see our, you know, pediatrician once a year, whatever, all the way up to acute care and emergency care. All right. This is Moore impact, Kasie and Orgul here unpacking Lindsay's research through our Epic policy brief. We'll be right back.

Kasie Whitener (34:27):

Welcome back to Moore Impact Kasie and Orgul here we are going through the March EPIC policy brief, which was a it's a PDF file. It's issued to anybody on your mailing list. And as EPIC, the Economic Policy Center at the Darla Moore School of Business is a relatively new center. Your email list probably has a couple hundred people on it, right? Yeah. So it's, it's kind of a small distribution right now, but if you wanna get access to it so that each month, you'll be able to see what is this research that is being highlighted by the center. You can go to the website sc.edu and just look for Economic Policy Center, and you'll find it at the Darla Moore School. You can also do sc.edu/moore, I think is our Moore school website. But don't quote me on that.

Kasie Whitener (35:11):

But if you get to our website and you find the Economic Policy Center, you can subscribe to this particular policy brief. It'll come by email. It's a PDF file, and it'll tell you what the researchers are working on. And in this case, it's Lindsay's work about emergency room wait times, and the outcomes that we can expect from these emergency room wait times. And we were talking about one of the ways to reduce them is to increase the number of emergency rooms, but emergency rooms are expensive. And our healthcare organizations in many cases are profit driven companies. When I was living up in Greenville, Greenville Health System was kind of like the last nonprofit in the area. And I think they, they might have they might have one or two there now anyway, but it's less, like, less common now to have a non-profit health organization because they're competing with these for-profit health organizations like Prisma like Lexington Medical Center and that kind of thing. And, and there's nothing wrong with being for-profit. We're in the business school. Like we, we love profit. We have no problem with profit. The question is, what are the incentives for that, for that organization to provide care to people who can't afford to pay for care?

Orgul Ozturk (36:16):

Yeah. I mean like you said and I think we shouldn't solve this problem by building more emergency rooms. That will be the I mean I think main focus should be the preventive care, right? And giving people access to healthcare at, before we'd reach to emergency conditions. Right? So we

Kasie Whitener (36:37):

Can't, but will they do it? I mean, that's the other thing. 'cause You can't force them to go into preventative care and to like, say, hey, every month. You know, it's not like, I would say like in the state of Virginia, you have to have your car inspected annually, and they'll figure out whether or not it, the emissions are okay. And if you've got bald tires, you have to get them replaced. And if you're windshield wipers or garbage, you have to replace those. Like in Virginia, you take your car to say, is it safe to be on the road? And this is like a level of regulation that South Carolinians absolutely hate. And it's not like you're gonna bring that to healthcare where it's like, Hey, your driver's license is about to expire, and in order to get a new one, you have to go get a vision test. You have to, I, I mean, they already do the vision test, but like, you have to go get a heart, you know, evaluation. We wanna know that you're in good health. And that's the only reason we're gonna give you back your driver's license. I mean,

Orgul Ozturk (37:24):

Yes, it is true. You are not going to be able to force people. You need to incentivize them. You need to every behavior can be changed. If you can show someone the benefit to that behavior is more than the cost of it, right? Right. So how can we make the cost slower? How can we make the benefits more salient? Right? I mean, if we were to make it first of all, knowledge is a big reason or lack of it, right? That people usually don't seek care. So we make the knowledge and knowledge is also cheap to distribute, right? So, and we have a lot of people who are dedicated to increasing awareness about health conditions. Let's make that, let's nudge people, right? So that they are, let's make the care default so they don't have to opt in. So if we can make it easy for them to have it, and I think it will solve a lot of our problems if we can see, hey, all I need to do is be here, and this is somebody's gonna come and pick me up and take me to my doctor if I cannot, or somebody's going to be in my neighborhood. These clinics, maybe we can have trucks that going around checking people's blood.

Kasie Whitener (38:36):

Mobile healthcare.

Orgul Ozturk (38:37):

Yes.

Kasie Whitener (38:37):

Mobile healthcare, I love it. But these are the opportunities for entrepreneurs is what I'm talking about. Like, if you are an entrepreneur thinking like, Hey, I wanna provide care to neighborhoods. I wanna go to where I know there's gonna be a lot of elderly people who live in this neighborhood. So I'm gonna, you know, drive my health van around and I'm gonna give them some basic tips, and I'm going to, you know, take their blood pressure and, and get some, you know, some real easy sort of preventative conversations.

Orgul Ozturk (39:01):

Yeah. And I would be happy to, if I was the owner of a, you know owner of a hospital, would be the wrong one to choose, in this case . But if I have this, if I was a health official in a state, I would be happy to invest in this entrepreneur, right. And try to deal with them at the emergency rooms, right? So I think that is definitely a cost efficient and economically beneficial way to approach the health problems that we are facing. We

Kasie Whitener (39:29):

Have this kind of, if I build it, they will come mentality about healthcare. Meaning like, if we hold a seminar at the library about better heart health, then people who are interested in better heart health, they're gonna show up at the library and learn more about it. But I don't think that, I mean, it might be true of things like real estate investing that people will show up there and learn about real estate investing, but I don't think they're gonna show up to learn about how I could, I need to lose 50 pounds. You know what I'm saying? Like, they're not gonna show up to get told, Hey, stop eating donuts, . Like, that's, that's not the, from a healthcare perspective, how do you get people interested in this topic about themselves, right? Other than this like overactive fitness, you know like whatever the, the fitness mafia telling all of us we're fat and, you know, whatever.

Orgul Ozturk (40:12):

That is the, the cost side of thing. Again, it's a very costly thing. Yeah. I mean, cost is not necessarily the money and what is, it's so much easier to sit down and eat a donut, right. Than exercise for two hours and I don't know, try to choose the apple when you can choose a donut, right. Donuts are also cheaper. Right? . So, I mean, these are all making it hard for us. Costly for us. Yeah. I actually have a friend in, in Arnold school, and she does great research, and some of her work is about teaching people how to cook the food they love. Yeah. Southern cooking in a, a healthier way. Yeah. in a vegan way in some cases. And it kind of sounds oxymoron, but a nice southern cooking

Kasie Whitener (40:57):

To not use bacon fat to flavor everything. Yeah, exactly.

Orgul Ozturk (41:01):

Yeah. And she sees a huge impact on their participant. I mean, they see a huge impact. And actually, I mean, she's great at her job, and this is a small scale, maybe intervention, but we have innovative ways to reaching to people who are struggling, right. Who are struggling to make, I mean, making healthy choices is a luxury. Right?

Kasie Whitener (41:20):

Right. It really is. Especially because he healthy food, not healthy, not cheap. No. Yeah. And even having access to fresh grown things. I mean, we have initiatives like certified se grown, we have farmer's markets, we have I know an entrepreneur up in the Rock Hill area who's built a com, a organization called Victory Gardens, where he teaches people how to plant gardens in their own backyard and how to care and maintain those gardens, right. So they can grow their own vegetables, like all of these kinds of initiatives. But again, you have to get people who are willing to come forward and go, I want to eat healthier. Teach me, help me learn how to do this.

Orgul Ozturk (41:57):

Yeah. I mean the Thomas Creek farms, you know Right. Farmers Exchange,

Kasie Whitener (42:01):

I'd love them out. Na yeah.

Orgul Ozturk (42:03):

Mm-Hmm . Yeah. So I mean, we need one incentives to be provided so we can have more initiatives like this, but also when somebody is willing to actually garden in their backyard, we need to be able to provide empty the hoe and the, you know, soil or whatever the seeds. Right. And I love actually Richland Library's library of things for this reason. Yeah. I, I was so thrilled to see bunch of seeds and drawers for me to go pick and, you know, grow heirloom tomatoes if I want to. Yeah.

Kasie Whitener (42:32):

Yeah. There are opportunities, I think, and and people just have to get excited about them. But I think all of this, and as an economist, it always goes back to incentives. What are the incentives for this? How do we and as a community, you know, we don't, nobody wants to go the negative, so it's about carrot or stick, right? Nobody wants to go the stick route where we're gonna punish you for not having good, healthy habits for not eating, you know, healthy. And, and you don't ever know looking at people's healthcare outcomes, like whether or not it is about choices that they've made individually, or whether these are just, I mean, hereditary diseases that they have cancer, these kinds of things that, like you, you didn't intentionally do this to yourself. Right? Yeah. And so from an overall healthcare system perspective, building in incentives to make sure that the providers want to do the work, right? That the organizations that employ those and providers are seeing a return on their investment, that the payers who are covering the cost of these things are seeing a return on their investment. How do you sort of satisfy everybody and make sure the, the patient outcomes are right?

Orgul Ozturk (43:35):

Yeah. I mean it is so true. The other thing I think is missing and all these things we can do better if everybody is more aware of the cost. And it's not only about the direct cost, but all the indirect cost of things, all the externalities that we create or things that we do not invest in creates. And then when you do not correctly calculate the cost of things and to not correct the calculate the benefits of things, I think we do less of the things that we should,

Kasie Whitener (44:06):

Right.

Orgul Ozturk (44:07):

And do more of the things we shouldn't. So that kind of underestimating the cost overestimating the, or overestimating the cost in some cases or underestimating the benefits is a big issue. And that is where I think economists can do a little bit more in communicating.

Kasie Whitener (44:23):

Well, and I think too, and, and help me, if you think there's a way for the economist to sort of fill the gap here, it's very difficult to prove what didn't happen, right? Oh, of course. We created this intervention, and then we didn't have this, and we talked, you and I talked about this with the long-term wages for students that have a certain type of teacher in their classroom. If, if things went very well for these students, right? Like, we don't necessarily know what didn't happen. We don't know how many people didn't get diabetes. We don't know how many. Although e economists could say, okay, well in previous years, under earlier conditions, these were the outcomes. And now in this year with these conditions, these are the outcomes. Is that sufficient data or knowledge to be able to say, we think these, these interventions may have helped.

Orgul Ozturk (45:09):

So that's actually the core of our research, trying to find these, what we call counterfactuals, what ifs of the world. And that's where a economists use a lot of these natural experiments, right? That creates these you know sliding door moments. I say it's a very bad movie, but it's gives, like the sliding door just keeps me from getting into the metro right. Whatever. And then suddenly I'm in a parallel universe. So we create, we find ways to kind of get at this counterfactual. And it is a very hard thing to do. But that's why I love economics, because when we get at causality, that's what we are looking at. We are trying to look at when things didn't work out, what would they have as their outcomes?

Kasie Whitener (45:56):

It's fascinating. You're fascinating. You're amazing. Thank you for being here. This has been Moore Impact. When you learn more, you know more. And when you know more, you do more. Thanks for listening.