Reading list

The Impact of Education on Health Knowledge, by Duha Tore Altindag, Colin Cannonier, Naci H. Mocan

The theory on the demand for health suggests that schooling causes health because schooling increases the efficiency of health production. Alternatively, the allocative efficiency hypothesis argues that schooling alters the input mix chosen to produce health. This suggests that the more educated have more knowledge about the health production function and they have more health knowledge. This paper uses data from the 1997 and 2002 waves of the NLSY97 to conduct an investigation of the allocative efficiency hypothesis by analyzing whether education improves health knowledge. The survey design allows us to observe the increase in health knowledge of young adults after their level of schooling is increased by differential and plausibly exogenous amounts. Using nine different questions measuring health knowledge, we find weak evidence that an increase in education generates an improvement in health knowledge for those who ultimately attend college. For those with high school as the terminal degree, no relationship is found between education and health knowledge. These results imply that the allocative efficiency hypothesis may not be the primary reason for why schooling impacts health outcomes.

Does a mandatory telemedicine call prior to visiting a physician reduce costs or simply attract good risks? by Chantal Grandchamp, Lucien Gardiol

This paper aims to estimate empirically the efficiency of a Swiss telemedicine service introduced in 2003. We used claims’ data gathered by a major Swiss health insurer, over a period of 6 years and involving 160 000 insured adults.

In Switzerland, health insurance is mandatory, but everyone has the option of choosing between a managed care plan and a fee-for-service plan. This paper focuses on a conventional fee-for-service plan including a mandatory access to a telemedicine service; the insured are obliged to phone this medical call centre before visiting a physician. This type of plan generates much lower average health expenditures than a conventional insurance plan. Reasons for this may include selection, incentive effects or efficiency.

In our sample, about 90% of the difference in health expenditure can be explained by selection and incentive effects. The remaining 10% of savings due to the efficiency of the telemedicine service amount to about SFr 150 per year per insured, of which approximately 60% is saved by the insurer and 40% by the insured. Although the efficiency effect is greater than the cost of the plan, the big winners are the insured who not only save monetary and non-monetary costs but also benefit from reduced premiums

The Critical Role Of Observational Evidence In Comparative Effectiveness Research, by Rachael L. Fleurence1, Huseyin Naci and Jeroen P. Jansen

Although not the gold standard of clinical research, observational studies can play a central role as the nation’s health care system embraces comparative effectiveness research. Investigators generally prefer randomized trials to observational studies because the former are less subject to bias. Randomized studies, however, often don’t represent real-world patient populations, while observational studies can offer quicker results and the opportunity to investigate large numbers of interventions and outcomes among diverse populations—sometimes at lower costs. But some decisions based on observational studies have turned out to be wrong. We recommend that researchers adopt a “body of evidence” approach that includes both randomized and observational evidence.

The Veterans Affairs Experience: Comparative Effectiveness Research In A Large Health System, by David Atkins, Joel Kupersmith and Seth Eisen

Comparative effectiveness research is a tool to use in achieving patient-centered, high-value health care. However, applying the results to individual patients and health systems raises unique issues. Here, we review lessons learned by the Veterans Health Administration (VHA) in developing and implementing the research in a large integrated health system. Decision makers should examine whether individual studies apply to diverse populations, align tools and incentives to adopt evidence-based practices, and consider both the patient and population perspectives. A key challenge remains how to incorporate comparative evidence and patient values into busy clinical practices.

Why Observational Studies Should Be Among The Tools Used In Comparative Effectiveness Research, by Nancy A. Dreyer, Sean R. Tunis, Marc Berger, Dan Ollendorf, Pattra Mattox and Richard Gliklich

Doctors, patients, and other decision makers need access to the best available clinical evidence, which can come from systematic reviews, experimental trials, and observational research. Despite methodological challenges, high-quality observational studies have an important role in comparative effectiveness research because they can address issues that are otherwise difficult or impossible to study. In addition, many clinical and policy decisions do not require the very high levels of certainty provided by large, rigorous randomized trials. This paper provides insights and a framework to guide good decision making that involves the full range of high-quality comparative effectiveness research techniques, including observational research.

The Midterm Elections — High Stakes for Health Policy, by Henry J. Aaron

Becoming Accountable — Opportunities and Obstacles for ACOs, by Harold S. Luft

The Effects of the Affordable Care Act on Workers’ Health Insurance Coverage, by Christine Eibner

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