• 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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