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.
In 2019, Pennylvania established the first voluntary financial incentive program to improve ED treatment and follow-up for patients with opioid use disorder. We evaluated adoption of clinical pathways for care among hospitals in Pennsylvania in a recent publication in JAMA Network Open. Did this incentive work? The short answer – yes.
Happy New Year! As we enter the new year (and the new decade) we excited about what we have accomplished and even more excited and hopeful about what lies ahead. We are grateful to the community that we serve, and our position in leading the nation in research to improve the health system. But before we turn the page, we take a look back at what caught our readers’ attention last year. If there’s one theme that ties these articles together, it is about producing, parsing, and promoting evidence where it is needed the most. In 2019, people turned to LDI in record numbers, with more than 550,000 page views on our web site. Our most popular content reflects the depth and breadth of our fellows’ research, and their commitment to addressing the key health care challenges of our day. We can’t wait to see what 2020 brings.
For decades ever more patients have been arriving at emergency departments (EDs). As concern has mounted, and emergency department crowding – most evident in wait times – has increased, fingers have been pointed. Health systems, politicians and researchers have blamed the decline of primary care, “inappropriate” use of the ED, a fragmented health system, and more recently, social determinants of health.
The solutions offered follow from these diagnoses. Improve primary care access, encourage patients and their doctors to use more primary care, penalize patients who are deemed retrospectively by simple algorithms to have used the ED inappropriately, improve care coordination, and improve social determinants of health by actions like paying for housing or transportation.
In a recent New York Times article, “A Doctor’s Diary: the Overnight Shift in the ER,” a physician describes the tragic cases, frantic pace of work, and long delays of the ED. The article rings true to us: two economists, one an emergency physician and one a fairly frequent user of the ED.
However, the solutions enumerated in the article are unlikely to solve ED overcrowding overall. In an economic framework, they all address only one of the problems – the demand for ED visits.
It is hardly surprising that there’s a spike in the number of Medicare patients discharged from postacute care in a skilled nursing facility (SNF) the day before their copayment jumps from $0 to more than $150. However, the question remains whether this payment policy – which completely covers the first 20 days of a SNF stay – affects patient outcomes in any way. A recent study by Rachel Werner, Norma Coe, and colleagues now gives us some answers, and heightens concerns that Medicare’s SNF payment policy is having negative, unintended effects on patient outcomes.
The impact of childhood exposure to crime and violence is pervasive and longstanding. It might be tempting to assume that the economic losses, spread over a lifetime and across the country, cannot be calculated. But that’s just what LDI Associate Fellow Michal Gilad and co-author Abraham Gutman have done in a new working paper that attempts to calculate the consequences of such childhood exposure. The total? An annual cost to the country of $458 billion—greater than the entire share of the federal budget devoted to children in 2018—or a lifetime cost of $193,413 per child.
Americans pay about 14% of prescription drug costs out of pocket. Although there are exceptions in very high deductible plans, most of these payments are relatively modest compared to the incomes of middle-class people. In the New York Times, Aaron Carroll recently repeated the common criticism that such cost sharing is “often preventing people from getting necessary care.” So why do people end up with insurance that encourages them to ignore their doctors’ orders and fail to adhere to prescribed medications? Poor people are covered by Medicaid which has almost no cost sharing, so this is much more likely to be an issue for those who are not poor. Before blaming employers and bureaucrats, however, we should ask ourselves—what would we want?
What if someone told you that the nurse who would be your main caregiver throughout your labor routinely missed necessary nursing care activities, like comforting or teaching patients? In a recent study, my colleagues Eileen Lake, Sindhu Srinivas, Kathleen O’Rourke, Jordan Sanders and I found that half of nurses surveyed who worked in labor and delivery in 247 hospitals in four large U.S. states had missed one or more care activities on their last shift. Although labor and delivery nurses are the frontline providers during labor, hospital organizational factors often prevent them from having sufficient time or resources to provide the care that is needed.
[cross posted from the Health Cents blog on philly.com] Two models for redesigning our health insurance system both involve replacing private insurance and out-of-pocket payments with public insurance subsidized by tax collections. Whether the solution is Medicare for All (with no explicit premium or out-of-pocket payments) or a more heavily subsidized Medicare-like public option added to Obamacare, these plans promise the eventual replacement of all or a large part of current privately insured payments by public ones, immediately or sometime in the future.
“How long do I have?” It is the first question many patients ask after a cancer diagnosis. It is also among the hardest to answer. For decades, predicting cancer survival was more art than science. But now, unprecedented computing power and access to digital health information offer a tantalizing opportunity: can machine learning (ML) algorithms succeed where others fail? A new study from LDI Fellows Ravi Parikh, Christopher Manz, Amol Navathe, Mitesh Patel and colleagues tackles the question head on.
Outside of the brick and mortar walls of academic institutions – and conferences attended by researchers -- there is an invisible conversation happening. Academic Twitter, as it’s affectionately known, is a world unto itself. Yet, it turns out, there are ways in which it bears a striking resemblance to the familiar “old boys’ club.”
In a new article, University of Pennsylvania Law School Professor Allison Hoffman elucidates a fundamental problem afflicting health care in the United States: policymakers’ stubborn reliance on market-based theories and increased consumer choice to resolve the high spending and relatively poor health outcomes that have become endemic to the system. In “Health Care’s Market Bureaucracy,” forthcoming in the UCLA Law Review, Hoffman closely examines the economic theories underlying market-based health care policies, the empirical evidence demonstrating how such policies have failed in practice, and the regulatory infrastructure that has grown in an attempt to mitigate those failures.
Policies have reformed the health care system so that millions of Americans are able to access health coverage. However, for many, health coverage does not always translate to access to health care. The health care safety net plays a key role in filling coverage gaps that the traditional insurance system creates and ensures that health care is accessible and affordable for those who are uninsured or have high-deductible or high cost-sharing plans that leave them unable to access care. A new brief by Penn LDI and US of Care examines opportunities for the safety-net post-health reform.