Many physician and consumer groups cheered when the Obama administration proposed network adequacy standards for health insurance plans sold on state and federal marketplaces. They will be disappointed that many of these standards did not make it into the Final Rule published in early March in the Federal Register. CMS has backed away from quantitative network standards, opting instead to give states time to implement adequacy reforms through the National Association of Insurance Commissioners (NAIC) model law. This is a win for the insurance industry and state regulators, while consumer advocates arguably lost this round.
Can insights from behavioral economics inform creative approaches to increasing vaccination rates, and help prevent outbreaks of vaccine-preventable diseases? In a JAMA Pediatrics Viewpoint, LDI Senior Fellows Alison Buttenheim and David Asch suggest how to apply behavioral economic principles to the thorny issue of vaccine acceptance, and discuss the challenges in doing so.
Newly published research from the Center for Health Outcomes & Policy Research at the University of Pennsylvania School of Nursing supports the removal of collaborative agreement requirements. This study, partially funded by the Robert Wood Johnson Foundation, found that NPs were 13% more likely to work in primary care in states that required no collaborative agreements for practice or prescribing. For Pennsylvania, removing the requirement for collaborative agreements could increase the number of NPs by 13% and lower health care costs by $6.4 billion over the next ten years.
In a new study, LDI Senior Fellow Jalpa Doshi and colleagues document numerous direct and indirect hurdles to the use of publicly-funded health care datasets, including complex application procedures, high user fees, and prolonged wait times for data delivery. They reviewed data access policies to analyze how privacy policies promote or limit research, and discuss the variations across policies, agencies, and datasets. An infographic tells the story.
Price transparency—the ability to know the price of something before buying—is a mainstay of most markets. It has been touted as a way to reduce health care spending by enabling a new breed of cost-conscious consumers to comparison shop for care. A new JAMAstudy suggests that it might not be that simple.
April 22, 2016 [cross-posted from the Health Cents blog on Philly.com]
In the US, medical students graduate with an average of $176,00 in loans, not including the cost of their 4 years of undergraduate education. However, in the UK, India and most European countries, students can enroll directly into medical programs after high school and complete their program in five to six years. Shortening the education period in the US would help reduce the debt burden carried by graduates and might encourage more young doctors to pursue primary care.
In JAMA Internal Medicine, Renee Hsia, LDI Fellow Ari Friedman, and Matthew Niedzwiecki report that many patients triaged as “nonurgent” in the emergency department may still have urgent medical care needs. These patients sometimes arrive by ambulance, receive diagnostic tests and procedures, and may be admitted to the hospital. In an analysis of emergency department visits in the National Hospital Ambulatory Care Survey, the authors find that 5.7% of “nonurgent" ED visits resulted in admission or transfer, compared to 14.9% of "urgent" visits. The results illustrate that nonurgent does not necessarily connote inappropriate use of the emergency department. Academic Life in Emergency Medicine (ALiEM), an educational organization, developed this excellent infographic.
Until recently, we knew very little about the prices that insurers pay providers for services. In fact, with a few exceptions, almost everything we knew about health care spending came from analyzing Medicare data, a setting in which prices are administratively set. My recent NBER Working Paper with co-authors Zack Cooper, Marty Gaynor, and John Van Reenen, fills this gap by using a big dataset containing all of the claims from three large health insurers to provide a first look into the market for privately insured hospital care.
Martin Gaynor, PhD recently visited Penn and presented his new paper, “The Price Ain’t Right? Hospital Prices and Health Spending on the Privately Insured” (co-authored by Zack Cooper, Stuart Craig, and John Van Reenen). The national study was the first to analyze health care spending and hospital transaction prices among the privately insured—an analysis made possible by the availability of data from three of the largest private insurers in the U.S. For more detail, see blog post by co-author Stuart Craig. I spoke with Dr. Gaynor before his visit about some of the policy implications of this work. What follows is an excerpt from our conversation.
Penn Medicine recently sponsored a week-long series of events challenging all of us to address health equity in our work. One of these events was a 'story slam' in which a series of speakers told stories that testified to the impact of health inequities, here and abroad. This is one of those stories, by former LDI SUMR Scholar Karole Collier.
April 14, 2016 [This blog originally appeared on the PolicyLab at The Children’s Hospital of Philadelphia blog. View the original blog post here]
Secondhand smoke exposure is a significant public health problem. More than 40% of U.S. children are exposed to secondhand smoke, increasing their risk of respiratory infections, asthma flare-ups and premature death. When parents quit smoking, they not only increase their own life expectancy by an average of 10 years and eliminate the majority of their child’s secondhand smoke exposure, they also decrease the risk of their children becoming smokers later in life.
Some hospital leaders have complained that quality metrics like hospital readmissions unfairly penalize provider organizations for serving vulnerable, high-risk populations. Should Medicare readmission penalties be adjusted for patients’ socioeconomic risk factors? The specific issue of adjustment – and the larger issue of how socioeconomic status (SES) influences care quality and utilization – has drawn attention from federal policymakers and many hospitals leaders around the country. In particular, it is the subject of a series of reports by the National Academies of Sciences, Engineering, and Medicine, the second of which was released this week.
A recent Institute of Medicine (IOM) report, written by an expert committee that included Antonia Villarruel, PhD, RN, FAAN, Dean of Penn Nursing and an LDI Senior Fellow, examines the current approach to educating health professionals about social determinants of health.