• Reading list

    Bridging the gap: health equality and the deficit framing of health, by Alec Morton

    The analyst tasked with measuring population health, with appraising healthcare investments, or allocating healthcare resources, may frame their task in one of two possible ways: either as being concerned with health assets (e.g. health expectancy or stock of QALYs), or with health deficits (a ‘health gap’, analogous to the poverty gap). In this paper, we discuss the consequences of taking the asset or the deficit concept as one’s basic building block in developing a health measurement system when one has concerns about equitable distribution. We conclude that building metrics from a primitive health gap concept is possible and indeed may offer insights not otherwise easily accessible.

    Are cardiovascular diseases bad for economic growth? by Marc Suhrcke, Dieter Urban

    We assess the impact of cardiovascular disease (CVD) mortality on economic growth, using a dynamic panel growth regression framework taking into account potential endogeneity problems. In the worldwide sample we detect a non-linear influence of working age CVD mortality rates on growth across the per capita income scale. Splitting the sample (according to the resulting income threshold) into low- and middle-income countries, and high-income countries, we find a robust negative contribution of increasing CVD mortality rates on subsequent five-year growth rates in the latter sample. Not too surprisingly, we find no significant impact in the low- and middle-income country sample.

    Health expenditure and income in the United States, by F. Moscone and E. Tosetti

    This paper investigates the long-run economic relationship between health care expenditure and income in the US at a State level. Using a panel of 49 US States over the period 1980–2004, we study the non-stationarity and co-integration between health spending and income, ultimately measuring income elasticity of health care. The tests we adopt allow us to explicitly control for cross-section dependence and unobserved heterogeneity. Specifically, in our regression equations we assume that the error has a multifactor structure, which may capture global shocks and local spill overs in health expenditure. Our results suggest that health care is a necessity rather than a luxury, with an elasticity much smaller than that estimated in other US studies. Further, we detect significant spatial concentration in US health spending. Our broad perspective of cross-section dependence as well as the methods used to capture it give new insights on the debate over the relationship between health spending and income.

    Physicians versus Hospitals as Leaders of Accountable Care Organizations, by Robert Kocher and Nikhil R. Sahni

    Four-Dollar Generics — Increased Accessibility, Impaired Quality Assurance, by Niteesh K. Choudhry and William H. Shrank

    Health Care in the 2010 Congressional Election, by Robert J. Blendon and John M. Benson

    Systematic Review: Comparison of the Quality of Medical Care in Veterans Affairs and Non-Veterans Affairs Settings, by Trivedi AN, Matula S, Miake-Lye I, Glassman PA, Shekelle P, Asch S.

    Background: The Veterans Health Administration, the nation’s largest integrated delivery system, launched an organizational transformation in the mid 1990s to improve the quality of its care.

    Purpose: To synthesize the evidence comparing the quality of medical and other nonsurgical care in Veterans Affairs (VA) and non-VA settings.

    Data Sources: MEDLINE database and bibliographies of retrieved studies.

    Study Selection: Studies comparing the technical quality of nonsurgical care in VA and US non-VA settings published between 1990 and August 2009.

    Data Extraction: Two physicians independently reviewed 175 unique studies identified using the search strategy and abstracted data related to 6 domains of study quality.

    Data Synthesis: Thirty-six studies met the inclusion criteria. All 9 general comparative studies showed greater adherence to accepted processes of care or better health outcomes in the VA compared with care delivered outside the VA. Five studies of mortality following an acute coronary event found no clear survival differences between VA and non-VA settings. Three studies of care processes after an acute myocardial infarction found greater rates of evidence-based drug therapy in VA, and 1 found lower use of clinically-appropriate angiography in the VA. Three studies of diabetes care processes demonstrated a performance advantage for the VA. Studies of hospital mortality found similar risk-adjusted mortality rates in VA and non-VA hospitals.

    Limitations: Most studies used decade-old data, assessed selfreported service use, or included only a few VA or non-VA sites.

    Conclusions: Studies that assessed recommended processes of care almost always demonstrated that the VA performed better than non-VA comparison groups. Studies that assessed risk-adjusted mortality generally found similar rates for patients in VA and non-VA settings.

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    • 1) In reference to the Moscone paper, I had a recent meeting with our billing people, a large national organization. We all commented upon the fact that health care spending had not dropped as much as some of us expected. I have always thought that a lot of health care is not needed, and when faced with tough economic times, the marginal services would show big drops. While there have been decreases, it has not been of the size I expected.

      2) In my quixotic quest to get other physicians more interested in health reform issues, I have gotten few interested in ACOs. The NEJM article hit home for several guys I work with. Consensus seems to favor the hospitals winning out just because of resources. Most physician groups are not willing to sacrifice a doc to administrative causes of this sort. Hospitals have the admin people and tend to be more forward looking.

      Steve