Reading list

The Elusive Path to Health Care Sustainability by John C. Lewin, G. Lawrence Atkins, and Larry McNeely (JAMA)

Despite the recent slowdown in health care inflation, particularly in Medicare and Medicaid, increases in health care costs threaten to exceed the nation’s capacity to pay. Medicare’s accountable care, medical home, and bundled payment initiatives, along with parallel private marketplace innovations, could help curb costs over time. However, it is uncertain which models will prove effective, and their effect will be limited until the most successful efforts are identified and scaled nationally. Even if per-capita health spending slows to the same rate as overall economic growth, increasing numbers of aging beneficiaries will alone double Medicare spending in 10 years while increasing private sector prices increase the burden on businesses and families.

Physician Trainees’ Decision Making and Information Processing: Choice Size and Medicare Part D by Andrew J. Barnes and others (PLOS One)

Many patients expect their doctor to help them choose a Medicare prescription drug plan. Whether the size of the choice set affects clinicians’ decision processes and strategy selection, and the quality of their choice, as it does their older patients, is an important question with serious financial consequences. Seventy medical students and internal medicine residents completed a within-subject design using Mouselab, a computer program that allows the information-acquisition process to be examined. We examined highly numerate physician trainees’ decision processes, strategy, and their ability to pick the cheapest drug plan—as price was deemed the most important factor in Medicare beneficiaries’ plan choice—from either 3 or 9 drug plans. Before adjustment, participants were significantly more likely to identify the lowest cost plan when facing three versus nine choices (67.3% vs. 32.8%, p<0.01) and paid significantly less in excess premiums ($60.00 vs. $128.51, p<0.01). Compared to the three-plan condition, in the nine-plan condition participants spent significantly less time acquiring information on each attribute (p<0.05) and were more likely to employ decision strategies focusing on comparing alternate plans across a single attribute (search pattern, p<0.05). After adjusting for decision process and strategy, numeracy, and amount of medical training, the odds were 10.75 times higher that trainees would choose the lowest cost Medicare Part D drug plan when facing 3 versus 9 drug plans (p<0.05). Although employing more efficient search strategies in the complex choice environment, physician trainees experienced similar difficulty in choosing the lowest cost prescription drug plans as older patients do. Our results add further evidence that simplifications to the Medicare Part D decision environment are needed and suggest physicians’ role in their patients’ Part D choices may be most productive when assisting seniors with forecasting their expected medication needs and then referring them to the Medicare website or helpline.

Dead Man Walking by Michael Stillman, and Monalisa Tailor (New England Journal of Medicine)

“Shocked” wouldn’t be accurate, since we were accustomed to our uninsured patients’ receiving inadequate medical care. “Saddened” wasn’t right, either, only pecking at the edge of our response. And “disheartened” just smacked of victimhood. After hearing this story, we were neither shocked nor saddened nor disheartened. We were simply appalled.

Access to Patient-Level Trial Data — A Boon to Drug Developers by Hans-Georg Eichler, Frank Pétavy, Francesco Pignatti, and Guido Rasi (New England Journal of Medicine)

The provision of access to clinical trial results that include patient-level data is generating much debate. A growing chorus of transparency advocates is pushing for open access to these data, making a case on the basis of respect for patients’ altruism, the need to safeguard public health, and distrust in the integrity and completeness of published trial information.1 We at the European Medicines Agency (EMA) have been actively engaged in this debate, and the EMA has recently published a draft of a policy that would make patient-level data in its possession publicly accessible. The principle of privacy protection will inform the EMA’s policy and activities; robust and proportionate measures will be adopted to safeguard patients’ privacy, in compliance with applicable data-protection legislation.

Adrianna (@onceuponA)

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