Featured Post
February 26, 2020
Last week LDI hosted a day-long conference on Medicare for All & Beyond. Our goal was to participate in one of today’s most pressing conversations in health care—how to expand health insurance to the 28 million people in the United States who are currently uninsured. We welcomed close to 300 people from across the spectrum to participate in this conversation, to consider the critical questions underlying today’s debate, and to look in depth at the challenges we face in expanding insurance coverage in our country. The conference gave us all plenty to mull over.
April 3, 2020
From March 10-March 16, 2020, people in the U.S. started to realize that the COVID-19 threat was real, according to a new working paper by LDI Senior Fellows Hans-Peter Kohler, Iliana V. Kohler, and colleagues at Penn’s Population Studies Center. More than 5,400 people answered an online survey about their perceptions of the risks and consequences of the pandemic, as well as any steps they were taking to distance themselves from others. As identified cases increased from 959 to 4,632, and reported COVID-19 deaths increased from 28 to 85, perceptions of risks and consequences increased dramatically.
Hospitalized patients with COVID-19 have high rates of acute respiratory distress syndrome (ARDS). In one case series from Wuhan, China, a third of hospitalized patients infected with SARS-CoV-2 developed ARDS, and over half of those patients died. A new study by LDI Associate Fellow Catherine Auriemma sheds light on the mortality attributable to ARDS in sepsis patients, and provides the mortality benchmark for future studies of patients with COVID-19.
March 22, 2020
As increasing numbers of people domestically and abroad face mandatory “lockdowns,” we have new evidence that these severe restrictions on movement are effective in containing the spread of the novel coronavirus. In a just-released working paper, LDI Senior Fellow Hanming Fang, PhD and colleagues Long Wang, PhD, of ShanghaiTech University, and Yang (Zoe) Yang, PhD, of Chinese University of Hong Kong, quantify the effects of the lockdown of the city of Wuhan on January 23, 2020, showing that it played a crucial role in reducing cases of COVID-19 in other Chinese cities and halting the spread of the virus.
March 10, 2020
Being a teen can be challenging under any circumstances, particularly in the context of the country’s increasing rates of opioid addiction and overdose. While many studies address adult and pediatric populations, less is known about how opioids are prescribed to adolescents in acute care settings. In a recent study in the Journal of Child & Adolescent Substance Abuse, my colleagues Jennifer Pinto-Martin, Nicholas Giordano, Catherine McDonald, and I explored the patient and clinical factors associated with adolescent receipt of an opioid prescription upon discharge from acute care.
March 4, 2020
[cross-posted from Health Affairs]
In previously published research in the Lancet Psychiatry and Psychiatric Services, I used cross-national data from the World Health Organization (WHO) and the Organization for Economic Cooperation and Development (OECD) to examine the economic assumptions that guide mental health policy making and found reason to doubt two common beliefs: one, about the importance of private payers, and the other, about the relationship between inpatient and outpatient care.
March 3, 2020
[cross-posted from The Philadelphia Inquirer]
An increasing source of public unhappiness with the private health insurance system in the U.S. involves the prevalence of large “surprise bills.” This happens when an out-of-network provider does not take your insurance company’s reimbursement as payment in full, and instead bills you extra. Politicians, ever eager to help, have proposed new regulatory legislation. But a key source of confusion about the phenomenon and the remedies is what causes it — who has allowed this to happen?
February 24, 2020
In our study of nearly a million patients with newly diagnosed breast, colon or lung cancer, the Affordable Care Act’s Medicaid expansion was associated with decreased rate of uninsurance and a shift toward earlier-stage cancer diagnosis. Despite concerns that coverage expansions would result in longer waits for treatment, my colleagues and I found no evidence that Medicaid expansion worsened access to timely cancer-directed therapies.
February 19, 2020
[cross-posted from Health Affairs]
Once a casualty of the battles to pass the Affordable Care Act (ACA), the “public option” has reappeared in the current health reform debate. This concept is not new; in some states, a public option for children has existed for decades. In this post, we examine the current status of buy-in programs that allow families whose income exceeds the eligibility limit for Medicaid or the Children’s Health Insurance Program (CHIP) to purchase public coverage for their children. Properly designed, targeted, and marketed, buy-in programs could be a cost-effective way of moving toward universal coverage for children.
February 17, 2020
Private equity acquisition of physician medical groups has come under increasing scrutiny for its potential role in expanding the use of “surprise” medical bills. Due to limited data availability, empirical study of private equity acquisition has been challenging, with most existing evidence coming from industry reports and a growing chorus of opinion articles in academic journals. In a new JAMA research letter, we describe acquisition of physician medical practices by private equity firms across specialties from 2013-2016.
February 13, 2020
[cross-posted from Health Affairs]
The phrase “social determinants of health”—long a concept among population health scientists—first caught fire in the health care community about five years ago. It signaled a newfound interest in the idea that health care ought to broaden its focus to include the social factors—homelessness, hunger, isolation—that lead to poor health and high health care costs. Despite hyper-partisan debates around health care, many agreed on the idea that if health care addressed upstream social problems—instead of just waiting for people to show up in the emergency department—Americans could live better and longer at lower cost.
February 11, 2020
Every year, about 500,000 patients present to emergency departments (EDs) across the country for deliberate self-harm, making the ED an important setting for suicide prevention services. Despite the need, less than 50% of hospitals offer certain evidence-based safety planning and other self-harm management practices. In a series of studies, my colleagues and I assessed the availability of key mental health services to ED patients after an episode of deliberate self-harm, and sought to understand how ED Directors perceived quality of care in the presence (or absence) of these practices.
February 4, 2020
After five years, a small experiment to improve care for frail elderly patients receiving primary care in the home has delivered some savings to Medicare—although it might be too small to know for sure. Authorized by the Affordable Care Act, the Independence at Home Demonstration (IAH) is part of a broader strategy of testing innovative ways to pay for value in health care—tying additional payment to higher quality care and cutting wasteful spending.