Getting the Methods Right — The Foundation of Patient-Centered Outcomes Research, by Sherine E. Gabriel and Sharon-Lise T. Normand (The New England Journal of Medicine)
The Supreme Court and the Future of Medicaid, by Timothy Stoltzfus Jost and Sara Rosenbaum (The New England Journal of Medicine)
Value-Based Purchasing — National Programs to Move from Volume to Value, by Jordan M. VanLare and Patrick H. Conway (The New England Journal of Medicine)
The Cost-Effectiveness of Environmental Approaches to Disease Prevention, by Dave A. Chokshi and Thomas A. Farley (The New England Journal of Medicine)
Outcomes for Whites and Blacks at Hospitals That Disproportionately Care for Black Medicare Beneficiaries, by Lenny López and Ashish K. Jha (Health Services Research)
Objective. Hospital care for blacks is concentrated among a small number of hospitals and whether they have worse outcomes across common medical conditions is unknown.
Data Source. We used the 2007 100% Medicare file to calculate 30- and 90-day mortality rates for white and black patients admitted for acute myocardial infarction (AMI), congestive heart failure (CHF), or pneumonia.
Study Design. We ranked all hospitals in the country by their proportion of discharged black patients and identified the top 10 percent of these hospitals as black serving. We examined race-specific adjusted mortality rates and adjusted for differences in hospital characteristics.
Principal Findings. At 30 days, black-serving hospitals had, compared with nonblack-serving hospitals, similar mortality for AMI, lower mortality for CHF, and higher mortality for pneumonia. At 90 days, mortality was higher at black-serving hospitals for both AMI and pneumonia and comparable for CHF compared with nonblack-serving hospitals. White patients had worse outcomes at black-serving hospitals for two conditions at 30 days and all three conditions at 90 days. Blacks also had worse outcomes at black-serving hospitals.
Conclusions. Hospitals with a high proportion of black patients had worse outcomes than other hospitals for both their white and black elderly patients.
Does Seeing the Doctor More Often Keep You Out of the Hospital?, by Robert Kaestner and Anthony T. Lo Sasso (The National Bureau of Economic Research)
By exploiting a unique health insurance benefit design, we provide novel evidence on the causal association between outpatient and inpatient care. Our results indicate that greater outpatient spending was associated with more hospital admissions: a $100 increase in outpatient spending was associated with a 2.7% increase in the probability of having an inpatient event and a 4.6% increase in inpatient spending among enrollees in our sample. Moreover, we present evidence that the increase in hospital admissions associated with greater outpatient spending was for conditions in which it is plausible to argue that the physician and patient could exercise discretion.
The Role of Federal and State Dependent Coverage Eligibility Policies on the Health Insurance Status of Young Adults, by Joel C. Cantor, Alan C. Monheit, Derek DeLia and Kristen Lloyd (The National Bureau of Economic Research)
This paper evaluates one of the first implemented provisions of the Patient Protection and Affordable Care Act (ACA) which permits young adults up to age 26 to enroll as dependents on a parent’s private health plan. The paper also considers how the interaction between prior state laws expanding dependent coverage to young adults and the ACA affected young adult coverage. Using data from the Current Population Survey for calendar years 2004-2010, we apply a difference-in-differences framework to estimate how these provisions affected coverage of eligible young adults compared to slightly older adults. Our findings indicate that controlling for state laws, early implementation of the ACA increased young adult dependent coverage by 5.3 percentage points and resulted in a 3.5 percentage point decline in their uninsured rate. The interaction between state laws and the ACA suggests that the increase in dependent coverage and decline in the uninsured rate may have been greater among young adults who were targeted by both the ACA and state laws.
Estimating the Effects of Friendship Networks on Health Behaviors of Adolescents, by Jason M. Fletcher and Stephen L. Ross (The National Bureau of Economic Research)
This paper estimates the effects of friends’ health behaviors, smoking and drinking, on own health behaviors for adolescents while controlling for the effects of correlated unobservables between those friends. Specifically, the effect of friends’ health behaviors is identified by comparing similar individuals who have the same friendship opportunities because they attend the same school and make similar friendship choices, under the assumption that the friendship choice reveals information about an individual’s unobservables. We combine this identification strategy with a cross-cohort, within school design so that the model is identified based on across grade differences in the clustering of health behaviors within specific friendship patterns. Finally, we use the estimated information on correlated unobservables to examine longitudinal data on the on-set of health behaviors, where the opportunity for reverse causality should be minimal. Our estimates for both behavior and on-set are very robust to bias from correlated unobservables.
Potential Consequences of Reforming Medicare Into a Competitive Bidding System, by Zirui Song, David M. Cutler and Michael E. Chernew (The Journal of the American Medical Association)
Mandatory insurance coverage and hospital productivity in Massachusetts: bending the curve?, by Mark A. Thompson, Timothy R. Huerta and Eric W. Ford (Health Care Management Review)
Objective: The aim of this study was to examine whether universal insurance coverage mandates lead to a more productive use of hospital resources.
Data Sources: The American Hospital Association’s Annual Survey and the Centers for Medicare and Medicaid Services’ case mix index for fiscal years 2005 through 2008 were used.
Study Design: A Malmquist approach was used to assess hospitals’ productivity in the United States and Massachusetts over the sample period. Propensity score matching is used to “simulate” a randomized control group of hospitals from other markets to compare with Massachusetts. Comparisons are then made to examine if productivity differences are due to universal health insurance coverage mandate.
Principal Findings: In the early stages, Massachusetts’ coverage mandates lead to a significant drop in hospitals’ productivity relative to comparable facilities in other states. In 2008, Massachusetts functioned 3.53% below its 2005 level, whereas facilities across the United States have seen a 4.06% increase over the same period.
Conclusions: If the individual mandate is implemented nationwide, the Massachusetts’ experience indicates that a near-term decrease in overall hospital productivity will occur. As such, current cost estimates of the Patient Protection and Affordable Care Act’s impact on overall health spending are potentially understated.
Medicare and Medicaid Spending Trends and the Deficit Debate, by John Holahan and Stacey McMorrow (The New England Journal of Medicine)
Doctors, Patients, and Lawyers — Two Centuries of Health Law, by George J. Annas (The New England Journal of Medicine)
Care Redesign — A Path Forward for Providers, by Thomas H. Lee (The New England Journal of Medicine)
Identifying Research Needs for Improving Health Care, by Stephanie M. Chang, Timothy Carey, Elisabeth Uphoff Kato, Jeanne-Marie Guise and Gillian D. Sanders (Annals of Internal Medicine)