Reading List

Comparative Effectiveness Research: Challenges for Medical Journals, by Harold C. Sox, Mark Helfand, Jeremy Grimshaw, Kay Dickersin, the PLoS Medicine Editors, David Tovey,J. André Knottnerus, and Peter Tugwell.

[R]ealiz[ing] the full potential of [comparative effectiveness] research … will require assessing a heterogeneous body of evidence consisting of prospective randomized trials—including pragmatic trials—and observational research using data obtained in the course of regular practice. (Bold mine.)

Regional Variations in Diagnostic Practices, by Yunjie Song, Jonathan Skinner, Julie Bynum, Jason Sutherland, John E. Wennberg, and Elliott S. Fisher. Jason Shafrin has a review. The following is an excerpt from the paper’s abstract.

Current methods of risk adjustment rely on diagnoses recorded in clinical and administrative records. Differences among providers in diagnostic practices could lead to bias. … We used Medicare claims data from 1999 through 2006 to measure trends in diagnostic practices for Medicare beneficiaries. Regions were grouped into five quintiles according to the intensity of hospital and physician services that beneficiaries in the region received.  … Beneficiaries within each quintile who moved during the study period to regions with a higher or lower intensity of practice had similar numbers of diagnoses and similar HCC risk scores (as derived from HCC coding algorithms) before their move. The number of diagnoses and the HCC measures increased as the cohort aged, but they increased to a greater extent among beneficiaries who moved to regions with a higher intensity of practice than among those who moved to regions with the same or lower intensity of practice. … Substantial differences in diagnostic practices that are unlikely to be related to patient characteristics are observed across U.S. regions. The use of clinical or claims-based diagnoses in risk adjustment may introduce important biases in comparative-effectiveness studies, public reporting, and payment reforms.

Implementing Accountable Care Organizations, by Stephen M. Shortell, Lawrence P. Casalino, and Elliot S. Fisher.

In the face of concerns over rising health care costs, the new health care reform law offers one answer: the Accountable Care Organization (ACO).  The health care reform law encourages fee-for-service Medicare providers to create ACOs and also sets up a pediatric demonstration project.  This brief provides guidance to the federal government, states, and health care providers engaged in the work of developing ACOs.

[Book] The Promise: President Obama, Year One, by Jonathan Alter. Perhaps this book will reveal something new about health reform. Below is an excerpt of a summary from the publisher.

The Promise is a fast-paced and incisive narrative of a young risk-taking president carving his own path amid sky-high expectations and surging joblessness. Alter reveals that it was Obama alone—“feeling lucky”—who insisted on pushing major health care reform over the objections of his vice president and top advisors, including his chief of staff, Rahm Emanuel, who admitted that “I begged him not to do this.”

Alter takes the reader inside the room as Obama prevents a fistfight involving a congressman, coldly reprimands the military brass for insubordination, crashes the key meeting at the Copenhagen Climate Change conference, and bounces back after a disastrous Massachusetts election to redeem a promise that had eluded presidents since FDR.

Taking Up or Turning Down: New Estimates of Household Demand for Employer-Sponsored Health Insurance, by Jean Marie Abraham and Roger Feldman

This study provides new estimates of demand for employer-sponsored health insurance, using the 1997–2001 linked Household Component-Insurance Component of the Medical Expenditure Panel Survey (MEPS). Our focus is on households’ decisions to take up coverage through a worker’s employer. We found a significant inverse relationship between the out-of-pocket premium and the probability of taking up coverage, with the price effect considerably larger when we used instrumental variables methods to account for endogenous out-of-pocket premiums. Additionally, workers in families with more children eligible for Medicaid were less likely to take up coverage.

Workers on the Margin: Who Drops Health Coverage when Prices Rise? by Edward N. Okeke, Richard A. Hirth, and Kyle Grazier

We revisit the question of price elasticity of employer-sponsored insurance (ESI) take-up by directly examining changes in the take-up of ESI at a large firm in response to exogenous changes in employee premium contributions. We find that, on average, a 10% increase in the employee’s out-of-pocket premium increases the probability of dropping coverage by approximately 1%. More importantly, we find heterogeneous impacts: married workers are much more price-sensitive than single employees, and lower-paid workers are disproportionately more likely to drop coverage than higher-paid workers. Elasticity estimates for employees below the 25th percentile of salary distribution in our sample are nearly twice the average.

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