Dartmouth Response to “Target Decision-makers, Not Geography” Report

The title of the Institute of Medicine’s recent report “Target Decision-makers, Not Geography” at first glance appears to be an indictment of the work of the Dartmouth Atlas, which largely claims that policymakers can reduce healthcare spending by targeting the highest spending geographic areas. A more detailed review shows that the empirical findings from IOM…

Regional Variation: Interpretation

The quality and efficiency of the care patients receive is often determined by the accident of where they live and seek care. – Dartmouth Atlas Brief Within-[region] variation in spending and utilization is significantly larger than the across [region] variation for both Medicare and Medicaid.” – Report for the Institute of Medicine. Which statement is…

IOM Final Report: Geographic Variation in Health Care Spending

The Institute of Medicine (IOM) was charged with answering two questions: How do health care spending, utilization, and quality vary across geographic regions? Should Medicare provider payments be adjusted for regionally-based measures of value? Based on research conducted by Precision Health Economics, Acumen, and other research firms, IOM reached the following conclusions: Geographic variation in…

Treatment Heterogeneity

The advent of treatment guidelines and pay-for-performance may be a good thing for the “average” patient.  However, not all patients respond the same way to given treatments.  Thus, just because a treatment benefits the average patient, does not mean that the treatment is beneficial for a given individual patient. This phenomenon is known as treatment…

CoR #188

Nina Kallen presents this week’s round-up of risky posts, with an emphasis on “their technical and detailed nature.” Have you ever wondered about health insurance in China? How about how to overcome pre-existing conditions when applying for insurance? All this – and more! – at this week’s Cav at Insurance Coverage Law in Massachusetts.

Use Of Comparative Effectiveness Research By Four European Health Authorities

How do different European health authorities use comparative effectiveness research (CER) to determine drug coverage and pricing?  A recent Health Affairs article by Cohen, Malins and Shahpurwala answer just this question.  Here is a table summarizing the mission and priorities of health authorities in England, France, Germany and the Netherlands.   Source: Joshua Cohen, Ashley…

IV or OLS?

When conducting a regression-based analysis, how can you determine whether an instrumental variables (IV) method is better than an ordinary least squares (OLS) method?  A paper by Basu and Chan (2013) describes one approach based on measuring which of the approaches most successfully reduces the mean square error (MSE) of the coefficient of interest.  IV…