What’s important and/or interesting in health care?

Every so often someone asks me one of the questions I hate: “What is the most important and under-discussed health policy issue right now?” or some variant thereof.

I hate it because of how I’m wired, not because it’s a bad question. The truth is, just about every health policy issue of import right now is a variant of an issue that has been important for decades and isn’t going away anytime soon either, whether under-discussed or not. My brain just isn’t as tuned to what’s hot and under-discussed as to what’s interesting (to me) or important (for one reason or another) all the time.

This got me thinking, just what is it that I find interesting and important all the time? These would naturally be the issues that attract me to whatever papers I pull from the dozens of journal tables of contents I receive each week. Some papers are must reads (to me). Others I pass up.These are also issues I’m very likely to write about again and again.

In no particular order, here’s the list I’ve been making on subject areas I almost always care about, with some notes on whether I think each is broadly important for policy or mostly just interesting to me (because I’m weird):

  • Medicaid access—important
  • Narrow networks—important
  • ACO performance—important
  • Effects of payments level and manner on health care quality and outcomes—important and basically a generalization of interest ACOs
  • Wellness programs, specifically how they affect health and spending—important. Many companies really are interested in or implementing these. They ought to really care what the impacts are.
  • Consolidation in the health care market (horizontal and vertical) and implications—important
  • Medicare advantage market, growth, value, costs, including premium support-like reforms—important
  • Part D market—important
  • Consumer decision-making in health insurance markets—interesting. I just don’t see results of work in this area binding on policy, but I could be wrong.
  • Cost shifting—interesting
  • Reference pricing—important
  • The opioid epidemic—important
  • Hospital or health sector productivity—interesting
  • Comparative effectiveness, cost effectiveness, and the management of health care technology—important
  • Observational methods for causal inference/big data—interesting
  • Labor market and health care (job lock, premium-wage trade-off)—interesting
  • Consumer directed health plans—important
  • Quality measurement and incentives—important
  • Management of and leadership in health care—interesting
  • Data access for research—important
  • Placebo effects—interesting
  • Any clinical area with which I have personal experience as a patient (insomnia, kidney stones, etc.)—interesting
  • Scientific communication—important

I probably forgot some things I’m actually interested, and have revealed as much in my posts. If you think so, remind me! Also, maybe you think I should find something not on this list to be important or interesting enough to pay close attention to. If so, what is it? Tell me on Twitter or by email.

@afrakt

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