Unbiased Analysis of Today's Healthcare Issues
A recent paper in the Health Services Research journal (“Hospice…“) looks at whether hospice care reduces hospitalizations for elderly terminally ill patients in nursing homes. In the introduction, authors Pedro Gozalo and Susan Miller state that there are two main implications which result from end-of-life hospitalizations: “At the patient level, hospitalizations of frail NH [nursing…
Does health insurance increase utilization of medical services? Economic theory generally predicts that it will. Health insurance decreases the price individuals pay for medical care and thus the equilibrium quantity of medical care used will increase. A paper by Buchmueller, Grumbach, Kronick and Kahn (âEffect of Health Insurance on Medical Care Utilization…â?) examines this phenomenon…
Pay-for-performance or health care quality report cards are the latest fad in medicine. Different types of report cards, however, measure different things. Eve Kerr and co-authors investigate (‘Quality by any other name?’) how different quality measures compare against each other. The authors look at 3 types of physician review: Implicit Review: This involves using ‘subjective’…
To follow up on Monday’s post, I take a few quotations from Rachel Werner and David Asch’s paper (“The Unintended Consequences“) in the March 9, 2005 edition of JAMA. First, I look at the unintended consequence of coronary artery bypass graft (CABG) report cards in a number of U.S. states: In Pennsylvania, which also introduced…
Are quality based incentive programs the solution for improving physician quality without increasing cost? While I believe that measuring quality is an important avenue by which quality can be improved, it is not a magic bullet. A study by Gilmore, et al. (HSR 2007) looks at a pay-for-performance scheme developed in Hawaii. The authors look…
The RAND health insurance experiment (HIE) demonstrated that increasing coinsurance rates decreases medical care utilization. The HIE also found that health outcomes did not vary between individuals with high, low and zero coinsurance rates. A working paper by Chandra, Gruber and McKnight (“Patient Cost Sharing…“) re-examines whether or not this is the case using a…
When constructing policy, we are often faced by an equity-efficiency tradeoff. For instance, increasing welfare benefits will increase equity but may reduce a poor individual’s incentive to work if the welfare benefits are tied to having low income. A recent NBER working paper by the nobel laureate James Heckman and co-author Dimitriy Masterov (“…Investing in…
The National Committee for Quality Assurance (NCQA) is a “not-for-profit organization dedicated to improving health care quality.” One of their major initiatives is the Health Plan Employer Data and Information Set (HEDIS) which aims to evaluate the quality of care offered by various health plans. In a 2001 NBER working paper (“Learning…“), researchers Michael Chernew,…
America has been characterized as “the best poor man’s country.” In the nineteenth century land was cheap and available and farming provided relatively high living standards. During the twentieth century, however, change has come. By 1920, income equality had risen to all-time highs. Over the next century, income inequality and the returns to skill (i.e.:…
A recent Health Economics article by Adam Wagstaff gives a good comparison of five East Asian countries: Japan, Hong Kong, Korea, Singapore and Taiwan. While Japan (1961), Korea (1989) and Taiwan (1995) have introduced universal health insurance, Singapore and Honk Kong have not. Singapore began using medical savings account (MSAs) in 1984, but MSAs only…