Does physician knowledge of patient non-compliance change prescribing behavior in the real world?

This is the topic of a recent publication with co-authors Kata Bognar, Katie Everson, Michelle Brauer, Darius Lakdawalla and Felicia Forma.  The full title is Does knowledge of patient non-compliance change prescribing behavior in the real world? A claims-based analysis of patients with serious mental illness.  The abstract is below, but do read the whole thing…

Market consolidation in California

Yesterday, I discussed the idea of managed competition in California.  One of the original tenets of managed competition was insurers having integrated, mutually exclusive provider networks.  This would mean much more consolidation on the provider side.  While this could improve quality, there is also a risk that prices could rise.  In fact, this is what…

Patient care under uncertainty: Or why I learned to stop loving clinical practice guidelines

The National Cancer Institute defines personalized medicine as “uses information about a person’s genes, proteins, and environment to prevent, diagnose, and treat disease”. In practice, however, patient treatment is rarely personalized by individual since evidence to support complete personalization is rarely available. Personalization in practice more often means care that varies with some individual characteristics.…

When is physician failure a good thing?

How do physicians learn?  A paper by Van Gestel, Muller, and Bosmans (2018) claims that the answer is through cumulative experience, economies of scale, or human capital depreciation. Learning from cumulative experience refers to the idea that treating an additional patient generally improves physician (or team) performance. When referring to economies of scale, we capture…

Do hospital purchases of physician practices increase or decrease prices?

The effect of health care industry consolidation on prices is a question argued about by many including researchers, economists, anti-trust, lawyers, regulators and more.  There is evidence that health plan consolidation increases premiums, and hospital consolidation increases price. For instance, Dafny et al. 2015 writes: The harsh reality is that it’s difficult to find well-documented…

The downside of medical homes

Integrated delivery networks (IDNs) and medical homes are all the rage among health wonks.  The ability for patients to receive holistic are from multispecialty practice teams seems like it would be beneficial.  While quality of care may (or may not) improve with more integrated care, provider consolidation may have one downside: higher prices.  An NBER…