• Reading List

    Reading List is now a regular feature, with it’s own tag (click to see prior lists).

    Here’s some literature on topics of interest collected over the past few weeks. Whether and when I read these is an open question. As always, if anyone else digs into this stuff and wants to submit a guest post review of anything for consideration the door is open.

    Urban Institute has a mother load of papers on health reform in Massachusetts: (1) a bunch by Sharon Long, (2) from a general search of their site.

    [Book] The Theory of Taxation and Public Economics by Louis Kaplow looks interesting. In a forthcoming post I review his recent NBER paper (noted in a prior reading list). Note also he has a second book Fairness versus Welfare.

    Loyal reader Jacob Shmukler brought to my attention the Health Affairs paper Risk Pooling And Regulation: Policy And Reality In Today’s Individual Health Insurance Market by Mark V. Pauly and Bradley Herring. Here’s the abstract:

    Analysis of new data on the relationship between and premiums and coverage in the individual insurance market and health risk shows that actual premiums paid for individual insurance are much less than proportional to risk, and risk levels have a small effect on obtaining coverage. States limiting risk rating in individual insurance display lower premiums for high risks than other states, but such rate regulation leads to an increase in the total number of uninsured people. The effect on risk pooling is small because of the large amount of risk pooling in unregulated individual insurance.

    More recently in Health Affairs is a paper on the value of VA’s electronic medical record: The Value From Investments In Health Information Technology At The U.S. Department Of Veterans Affairs by  Colene M. Byrne, Lauren M. Mercincavage, Eric C. Pan, Adam G. Vincent, Douglas S. Johnston and Blackford Middleton.

    We compare health information technology (IT) in the Department of Veterans Affairs (VA) to norms in the private sector, and we estimate the costs and benefits of selected VA health IT systems. The VA spent proportionately more on IT than the private health care sector spent, but it achieved higher levels of IT adoption and quality of care. The potential value of the VA’s health IT investments is estimated at $3.09 billion in cumulative benefits net of investment costs. This study serves as a framework to inform efforts to measure and calculate the benefits of federal health IT stimulus programs.

    The  latest edition of Health Economics, P0licy and Law includes the following two articles. Given time constraints I am very unlikely to read them. But if I had an hour with nothing to do, I’d take a look.

    Individual responsibility for what? – A conceptual framework for exploring the suitability of private financing in a publicly funded health-care system by Gustav Tinghőga, Per Carlssona and Carl H. Lyttkensa

    Policymakers in publicly funded health-care systems are frequently required to make intricate decisions on which health-care services to include or exclude from the basic health-care package. Although it seems likely that the concept of individual responsibility is an essential feature of such decisions, it is rarely explicitly articulated or evaluated in health policy. This paper presents a tentative conceptual framework for exploring when health-care services contain characteristics that facilitate individual responsibility through private financing. Six attributes for exploring the suitability of private financing for specific health-care commodities are identified: (i) it should enable individuals to value the need and quality both before and after utilization; (ii) it should be targeted toward individuals with a reasonable level of individual autonomy; (iii) it should be associated with low levels of positive externalities; (iv) it should be associated with a demand sufficient to generate a private market; (v) it should be associated with payments affordable for most individuals; and finally, (vi) it should be associated with ‘lifestyle enhancements’ rather than ‘medical necessities’. The tentative framework enables exploration of individual responsibility connected to health care as a heterogeneous group of commodities, and allows policymakers to make decisions on rationing by design rather than default.

    Neo-liberal economic practices and population health: a cross-national analysis, 1980–2004 by Melissa Tracy, Margaret E. Kruka, Christine Harpera and Sandro Galea

    Although there has been substantial debate and research concerning the economic impact of neo-liberal practices, there is a paucity of research about the potential relation between neo-liberal economic practices and population health. We assessed the extent to which neo-liberal policies and practices are associated with population health at the national level. We collected data on 119 countries between 1980 and 2004. We measured neo-liberalism using the Fraser Institute’s Economic Freedom of the World (EFW) Index, which gives an overall score as well as a score for each of five different aspects of neo-liberal economic practices: (1) size of government, (2) legal structure and security of property rights, (3) access to sound money, (4) freedom to exchange with foreigners and (5) regulation of credit, labor and business. Our measure of population health was under-five mortality. We controlled for potential mediators (income distribution, social capital and openness of political institutions) and confounders (female literacy, total population, rural population, fertility, gross domestic product per capita and time period). In longitudinal multivariable analyses, we found that the EFW index did not have an effect on child mortality but that two of its components: improved security of property rights and access to sound money were associated with lower under-five mortality (p = 0.017 and p = 0.024, respectively). When stratifying the countries by level of income, less regulation of credit, labor and business was associated with lower under-five mortality in high-income countries (p = 0.001). None of the EFW components were significantly associated with under-five mortality in low-income countries. This analysis suggests that the concept of ‘neo-liberalism’ is not a monolithic entity in its relation to health and that some ‘neo-liberal’ policies are consistent with improved population health. Further work is needed to corroborate or refute these findings.

    A reader found interesting the OECD Health Working Paper “The Remuneration of General Practitioners and Specialists in 14 OECD Countries: What Are the Factors Influencing Variations Across Countries?” He wrote

    The dogma in USA, or at least what we say is, “we have too many specialists, and that is why costs are too high.”  Based on this paper however, that is clearly not the case.  My take: 1) ratio irrelevant and specialists may order too many tests in this country, 2) other OECD countries have a high value system with equal or more specialists with a FFS or capitation or salary system, and 3) need for ACOs/bundling, etc. in US, may be misguided–root cause is something else.

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