Building a Bridge to Somewhere Better: Linking Health Care Research and Health Policy, by Matthew M. Davis, Cary P. Gross and Carolyn M. Clancy (Health Services Research)
Of all the ways to influence health policy, using research to inform change has the dual appeal of sounding both straightforward and rigorous. However, reality intrudes in many forms to disrupt the otherwise common-sense connection between what we know, what we consider as policy and what we are doing. Different languages (academic versus political), disparate timeframes (deliberate versus opportunistic), and contrasting priorities (most rigorous versus good enough) often make translating research into policy an exercise in frustration. Just as basic scientists and clinical researchers grapple with the challenge of bringing innovations from bench to bedside, health services researchers must wrestle to make their work most relevant to policy realities in communities near and far.
From Research to Health Policy Impact, by Carolyn M. Clancy, Sherry A. Glied and Nicole Lurie (Health Services Research)
The opportunities for researchers to improve health and health care by contributing to the formulation and implementation of policy are almost unlimited. Indeed, the availability of these opportunities is a tribute to a generation of health services researchers questioning existing policies or studying essential “Why?” and “What if?” questions using rigorous analysis. Moreover, the steady albeit uneven transition of health care delivery from a paper-based cottage industry toward an enterprise that provides transparent information to clinicians, patients, policy makers and the public, and potentially vast amounts of data to policy researchers, combined with the expectations of an increasingly information-savvy public, have increased the focus on health care quality, access, and costs.
Our health care system, like those in other countries, confronts continued pressures from increasing costs; inconsistent quality; avoidable patient harms; pervasive disparities in health and health care associated with individual characteristics such as race, ethnicity, income, education and geography; and poor population health outcomes. The persistence of many of these challenges reflects, in part, a failure of science alone to improve heath. Strategies to address many of these challenges exist in the laboratory, but the contribution of this science to the health of the public is limited by a research enterprise that values discovery of new knowledge far more than its successful application.
Physician Social Networks and Variation in Prostate Cancer Treatment in Three Cities, by Craig Evan Pollack, Gary Weissman, Justin Bekelman, Kaijun Liao and Katrina Armstrong (Health Services Research)
Objective: To examine whether physician social networks are associated with variation in treatment for men with localized prostate cancer.
Data Sources: P 2004—“2005 Surveillance, Epidemiology and End Results-Medicare data from three cities.
Design Study: We identified the physicians who care for patients with prostate cancer and created physician networks for each city based on shared patients. Subgroups of urologists were defined as physicians with dense connections with one another via shared patients.
Principle Findings: Subgroups varied widely in their unadjusted rates of prostatectomy and the racial/ethnic and socioeconomic composition of their patients. There was an association between urologist subgroup and receipt of prostatectomy. In city A, four subgroups had significantly lower odds of prostatectomy compared with the subgroup with the highest rates of prostatectomy after adjusting for patient clinical and sociodemographic characteristics. Similarly, in cities B and C, subgroups had significantly lower odds of prostatectomy compared with the baseline.
Conclusions: Using claims data to identify physician networks may provide an insight into the observed variation in treatment patterns for men with prostate cancer.
Value-Based Insurance Design: More Health at Any Price, by A. Mark Fendrick, Jenifer J. Martin and Alison E. Weiss (Health Services Research)
When everyone is required to pay the same out-of-pocket amount for health care services regardless of clinical indication, there is evidence of underuse of high-value services and overuse of interventions of no or marginal clinical benefit. Unlike most current health plan designs, value-based insurance design (V-BID) acknowledges heterogeneity of clinical interventions and patient characteristics. It encourages the use of services with strong evidence of clinical benefit and likewise discourages the use of low-value services. Implementing this concept into the national policy debate required a strategy that included conceptual framework development, program implementation, rigorous evaluation, media outreach, and an advocacy plan. Upon completion of this strategy involving several colleagues from multiple disciplines, Congress included language specifically authorizing V-BID in the Patient Protection and Affordable Care Act. A wide-ranging approach, planned as early as possible, can lead to the successful translation of health services research to policy.
The Effect of HIFA Waiver Expansions on Uninsurance Rates in Adult Populations, by Adam Atherly, Bryan E. Dowd, Robert F. Coulam and Gery Guy (Health Services Research)
Research Objective: To evaluate the effect of the Health Insurance Flexibility and Accountability (HIFA) demonstrations on the rate of uninsured. The policy purpose of the HIFA demonstrations is to encourage “new comprehensive state approaches” that will increase the number of insured. HIFA interventions include changes in benefit packages, eligibility rules for public programs, and state subsidization of private health insurance premiums. Some states emphasized private insurance (premium assistance), whereas others placed greater emphasis on expanded eligibility for public insurance.
Data Sources/Study Setting: Data were drawn from the Current Population Survey from 2000 to 2007. The target populations for the HIFA waiver demonstrations consisted of individuals who were eligible for the HIFA waiver demonstrations in demonstration states.
Study Design: The estimation approach was a probit model using a difference-in-differences approach.
Principal Findings: In states that fully implemented their HIFA waiver, HIFA increased the rate of insurance coverage by 6.4 percentage points on average in the targeted adult population, suggesting that approximately 118,848 adults gained health insurance due to HIFA. Total HIFA adult enrollment in the six states studied was 280,739. The effect size varied by state, with Maine having the largest effect and Illinois the smallest. The results were robust to different specifications of the control group.
Conclusions: Our findings suggest that public insurance initiatives that provide states with flexibility regarding eligibility and plan design are a viable policy approach to reducing uninsurance rates.
The Harms of Screening: New Attention to an Old Concern, by Steven H. Woolf and Russell Harris (The Journal of the American Medicine Association)
Nocebo Effects, Patient-Clinician Communication, and Therapeutic Outcomes, by Luana Colloca and Damien Finniss Harris (The Journal of the American Medicine Association)
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