The Supreme Court’s Historic Ruling on the Affordable Care Act: : Economic Sustainability and Universal Coverage, by Lawrence O. Gostin (The Journal of American Medical Association)
The Need for (long) Chains in Kidney Exchange, by Itai Ashlagi, David Gamarnik, Michael A. Rees and Alvin E. Roth (The National Bureau of Economic Research)
It has been previously shown that for sufficiently large pools of patient-donor pairs, (almost) efficient kidney exchange can be achieved by using at most 3-way cycles, i.e. by using cycles among no more than 3 patient-donor pairs. However, as kidney exchange has grown in practice, cycles among n>3 pairs have proved useful, and long chains initiated by non-directed, altruistic donors have proven to be very effective. We explore why this is the case, both empirically and theoretically.
We provide an analytical model of exchange when there are many highly sensitized patients, and show that large cycles of exchange or long chains can significantly increase efficiency when the opportunities for exchange are sparse. As very large cycles of exchange cannot be used in practice, long non-simultaneous chains initiated by non-directed donors significantly increase efficiency in patient pools of the size and composition that presently exist. Most importantly, long chains benefit highly sensitized patients without harming low-sensitized patients.
Income, the Earned Income Tax Credit, and Infant Health, by Hilary W. Hoynes, Douglas L. Miller and David Simon (The National Bureau of Economic Research)
This paper evaluates the health impact of a central piece in the U.S. safety net for families with children: the Earned Income Tax Credit. Using tax-reform induced variation in the federal EITC, we examine the impact of the credit on infant health outcomes. We find that increased EITC income reduces the incidence of low birth weight and increases mean birth weight. For single low education (<= 12 years) mothers, a policy-induced treatment on the treated increase of $1000 in EITC income is associated with 6.7 to 10.8% reduction in the low birth weight rate, with larger impacts for births to African American mothers. These impacts are evident with difference-in-difference models and event study analyses. Our results suggest that part of the mechanism for this improvement in birth outcomes is the result of more prenatal care and less negative health behaviors (smoking). We find little role for changes in health insurance. We contribute to the literature by establishing that an exogenous increase in income can improve health, and illustrating a health impact of a non-health program. More generally, we demonstrate the potential for positive external benefits of the social safety net.
The Impact of Hospital Consolidation — June 2012 Update, by Gaynor M and Town R (The Synthesis Project, Robert Wood Johnson Foundation)
This brief is an update of the 2006 synthesis examining the impact of hospital mergers on prices, costs, and quality of care. In addition to examining the literature on hospital consolidation since the 2006 synthesis was published, this update reviews the evidence on physician-hospital consolidation. The Patient Protection and Affordable Care Act (ACA) promotes Accountable Care Organizations (ACOs) and the bundling of payments across providers for an episode of care (“bundled payments”), both of which encourage consolidation between hospitals and physician practices.
- Hospital consolidation generally results in higher prices. This is true across geographic markets and different data sources. When hospitals merge in already concentrated markets, the price increase can be dramatic, often exceeding 20 percent.
- Hospital competition improves quality of care. This is true under both administered price systems, such as Medicare and the English National Health Service, and market determined pricing such as the private health insurance market. The evidence is more mixed from studies of market determined systems, however.
- Physician-hospital consolidation has not led to either improved quality or reduced costs. Studies find that consolidation was primarily for the purpose of enhanced bargaining power with payers, and hence did not lead to true integration. Consolidation without integration does not lead to enhanced performance.
Communicating With Physicians About Medical Decisions: A Reluctance to Disagree, by Jared R. Adams, Glyn Elwyn, France Légaré and Dominick L. Frosch (Archives of Internal Medicine)
The Moral Duty to Buy Health Insurance, by Tina Rulli, Ezekiel J. Emanuel and David Wendler (The Journal of American Medical Association)