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.
The White House has announced a series of Administration actions aimed at slowing the opioid epidemic, in addition to President Obama’s $1.1 billion budget request. This initiative comes amid a flurry of activity combating substance abuse. The Senate passed a bill targeting opioid abuse, the Centers for Disease Control and Prevention released its highly anticipated opioid prescribing guidelines for chronic pain, and the Food and Drug Administration announced it will require new warning labels on prescription opioids.
There are two opioid crises in the world today. One is the epidemic of abuse and misuse, present in many countries but rising at an alarming rate in the United States. The other crisis is older and affects many more people around the world each year: too few opioids. Hospitals in the U.S. and Europe routinely prescribe opioids for chronic cancer pain, end-of-life palliative care and some forms of acute pain, like bone fractures, sickle cell crises and burns. But patients with these conditions in much of Asia, Africa and Latin America often receive painkillers no stronger than acetaminophen.
This chart from Milliman shows that the individual market had losses of 3.9% of premiums in 2013, prior to the ACA. Theses losses would have been reduced to 2.1% of premiums in 2014 if the risk corridor program had been fully funded; instead, the losses increased to 6.1% because of significantly limited risk corridor payments.
The CDC’s new guideline on opioids focuses on managing chronic pain, but opioid use in postsurgical care may also be a problem. In a research letter in JAMA, LDI Senior Fellow Mark Neuman and colleagues document the rising use of opioids prescribed after low-risk surgical procedures in the US. They found an increase both in terms of the percentage of patients who received any opioid and the amount of opioid dispensed for each patient. The fact that this is occurring against a backdrop of increasing diversion, misuse, and abuse is particularly concerning, since it may be adding fuel to the fire.