Abstract The Health and Retirement Study (HRS) is a preeminent data source for research related to the experiences of workers nearing retirement, including the large share of those workers who experience a health shock or disability onset after age 50. In this article, we highlight key information collected from HRS respondents that benefits disability policy research and the body of knowledge that has resulted from this information. Our main goal is to identify from this research experience potential improvements in data collection and documentation that would further strengthen the HRS as a data source for disability policy researchers.
{"title":"Using the Health and Retirement Study for Disability Policy Research: A Review","authors":"Jody Schimmel Hyde, D. Stapleton","doi":"10.1515/fhep-2017-0002","DOIUrl":"https://doi.org/10.1515/fhep-2017-0002","url":null,"abstract":"Abstract The Health and Retirement Study (HRS) is a preeminent data source for research related to the experiences of workers nearing retirement, including the large share of those workers who experience a health shock or disability onset after age 50. In this article, we highlight key information collected from HRS respondents that benefits disability policy research and the body of knowledge that has resulted from this information. Our main goal is to identify from this research experience potential improvements in data collection and documentation that would further strengthen the HRS as a data source for disability policy researchers.","PeriodicalId":38039,"journal":{"name":"Forum for Health Economics and Policy","volume":"22 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85369773","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract Cancer mortality declined in Belgium during the period 2004–2012, but there was considerable variation in the rate of decline across cancer sites (breast, lung, etc.). I analyze the effect that pharmaceutical innovation had on cancer mortality in Belgium, by investigating whether the cancer sites that experienced more pharmaceutical innovation had larger subsequent declines in mortality, controlling for changes in cancer incidence. The measures of mortality analyzed – premature (before ages 75 and 65) mortality rates and mean age at death – are not subject to lead-time bias. Premature cancer mortality rates are significantly inversely related to the cumulative number of drugs registered 15–23 years earlier. Since mean utilization of drugs that have been marketed for less than 10 years is less than one fourth as great as mean utilization of drugs that have been marketed for at least a decade, it is not surprising that premature mortality is strongly inversely related only to the cumulative number of drugs that had been registered at least 10 years earlier. Drugs registered during the period 1987–1995 are estimated to have reduced the premature cancer mortality rate in 2012 by 20%. Mean age at death from cancer increased by 1.17 years between 2004 and 2012. The estimates indicate that drugs registered during the period 1987–1995 increased mean age at death from cancer in 2012 by 1.52 years. The estimates also suggest that drugs (chemical substances) within the same class (chemical subgroup) are not “therapeutically equivalent,” i.e. they do not have essentially the same effect in the treatment of a disease or condition. The estimates imply that the drugs registered during 1987–1995 reduced the number of life-years lost to cancer at all ages in 2012 by 41,207. The estimated cost per-life-year gained in 2012 from cancer drugs registered in Belgium during the period 1987–1995 was €1311. This estimate is well below even the lowest estimates from other studies of the value of a life-year saved. The largest reductions in premature mortality occur 15–23 years after drugs are registered, when their utilization increases significantly. This suggests that, if Belgium is to obtain substantial additional reductions in premature cancer mortality in the future (15 or more years from now) at a modest cost, pharmaceutical innovation (registration of new drugs) is needed today.
{"title":"The Impact of Pharmaceutical Innovation on Cancer Mortality in Belgium, 2004–2012","authors":"F. Lichtenberg","doi":"10.1515/fhep-2015-0042","DOIUrl":"https://doi.org/10.1515/fhep-2015-0042","url":null,"abstract":"Abstract Cancer mortality declined in Belgium during the period 2004–2012, but there was considerable variation in the rate of decline across cancer sites (breast, lung, etc.). I analyze the effect that pharmaceutical innovation had on cancer mortality in Belgium, by investigating whether the cancer sites that experienced more pharmaceutical innovation had larger subsequent declines in mortality, controlling for changes in cancer incidence. The measures of mortality analyzed – premature (before ages 75 and 65) mortality rates and mean age at death – are not subject to lead-time bias. Premature cancer mortality rates are significantly inversely related to the cumulative number of drugs registered 15–23 years earlier. Since mean utilization of drugs that have been marketed for less than 10 years is less than one fourth as great as mean utilization of drugs that have been marketed for at least a decade, it is not surprising that premature mortality is strongly inversely related only to the cumulative number of drugs that had been registered at least 10 years earlier. Drugs registered during the period 1987–1995 are estimated to have reduced the premature cancer mortality rate in 2012 by 20%. Mean age at death from cancer increased by 1.17 years between 2004 and 2012. The estimates indicate that drugs registered during the period 1987–1995 increased mean age at death from cancer in 2012 by 1.52 years. The estimates also suggest that drugs (chemical substances) within the same class (chemical subgroup) are not “therapeutically equivalent,” i.e. they do not have essentially the same effect in the treatment of a disease or condition. The estimates imply that the drugs registered during 1987–1995 reduced the number of life-years lost to cancer at all ages in 2012 by 41,207. The estimated cost per-life-year gained in 2012 from cancer drugs registered in Belgium during the period 1987–1995 was €1311. This estimate is well below even the lowest estimates from other studies of the value of a life-year saved. The largest reductions in premature mortality occur 15–23 years after drugs are registered, when their utilization increases significantly. This suggests that, if Belgium is to obtain substantial additional reductions in premature cancer mortality in the future (15 or more years from now) at a modest cost, pharmaceutical innovation (registration of new drugs) is needed today.","PeriodicalId":38039,"journal":{"name":"Forum for Health Economics and Policy","volume":"193 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73759537","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract We study how the announcement by CVS Health, a large US-based pharmacy chain, to stop selling tobacco products affected its share price and that of its close competitors, as well as major tobacco companies. Combining event study and synthetic control methodologies we compare measures of CVS’s stock market valuation with those of a peer group consisting of large publicly listed firms that are part of Standard & Poor’s S&P 500 stock market index. CVS’s announcement is associated with a short-term decrease in its share price, whereas close competitors have benefitted from CVS’ decision. We also find a negative share price effect for Altria, the largest US domestic tobacco firm. Overall our findings are consistent with markets expecting consumers to shift from CVS to alternative outlets in the short-run, and interpreting CVS’ decision to drop tobacco products as signal that other firms may follow suit.
{"title":"The Share Price Effect of CVS Health’s Announcement to Stop Selling Tobacco: A Comparative Case Study Using Synthetic Controls","authors":"M. Andersen, Sebastian Bauhoff","doi":"10.1515/fhep-2015-0045","DOIUrl":"https://doi.org/10.1515/fhep-2015-0045","url":null,"abstract":"Abstract We study how the announcement by CVS Health, a large US-based pharmacy chain, to stop selling tobacco products affected its share price and that of its close competitors, as well as major tobacco companies. Combining event study and synthetic control methodologies we compare measures of CVS’s stock market valuation with those of a peer group consisting of large publicly listed firms that are part of Standard & Poor’s S&P 500 stock market index. CVS’s announcement is associated with a short-term decrease in its share price, whereas close competitors have benefitted from CVS’ decision. We also find a negative share price effect for Altria, the largest US domestic tobacco firm. Overall our findings are consistent with markets expecting consumers to shift from CVS to alternative outlets in the short-run, and interpreting CVS’ decision to drop tobacco products as signal that other firms may follow suit.","PeriodicalId":38039,"journal":{"name":"Forum for Health Economics and Policy","volume":"75 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86380806","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract The primary goal of the federal dependent coverage mandate was to increase health insurance coverage among young adults, the group with the lowest prevalence of health insurance coverage. To understand the full impacts of the federal dependent coverage mandate, it is important to evaluate how the mandate affects labor market activities and time spent away from work among young adults. Using data from the Consumer Population Survey (CPS) and the American Time Use Survey (ATUS) and implementing a difference-in-differences framework, we find: (1) Young adults substitute employer sponsored insurance for dependent coverage, (2) Affected individuals reduce their work time and switch from full- to part-time employment, and (3) The additional time from reduced labor market activity is reallocated towards more time spent on leisure activities, mainly watching television. The effects of the mandate on labor market activities are stronger in later years. Furthermore, we show that young adults do not increase the time they spend on activities that could enhance their human capital such as education and health, which reemphasizes potential unintended consequences of the mandate. These findings suggest that future work is necessary to fully understand the overall welfare effects of the policy.
{"title":"The Effect of the Health Insurance Mandate on Labor Market Activity and Time Allocation: Evidence from the Federal Dependent Coverage Provision","authors":"Otto Lenhart, Vinish Shrestha","doi":"10.1515/fhep-2016-0006","DOIUrl":"https://doi.org/10.1515/fhep-2016-0006","url":null,"abstract":"Abstract The primary goal of the federal dependent coverage mandate was to increase health insurance coverage among young adults, the group with the lowest prevalence of health insurance coverage. To understand the full impacts of the federal dependent coverage mandate, it is important to evaluate how the mandate affects labor market activities and time spent away from work among young adults. Using data from the Consumer Population Survey (CPS) and the American Time Use Survey (ATUS) and implementing a difference-in-differences framework, we find: (1) Young adults substitute employer sponsored insurance for dependent coverage, (2) Affected individuals reduce their work time and switch from full- to part-time employment, and (3) The additional time from reduced labor market activity is reallocated towards more time spent on leisure activities, mainly watching television. The effects of the mandate on labor market activities are stronger in later years. Furthermore, we show that young adults do not increase the time they spend on activities that could enhance their human capital such as education and health, which reemphasizes potential unintended consequences of the mandate. These findings suggest that future work is necessary to fully understand the overall welfare effects of the policy.","PeriodicalId":38039,"journal":{"name":"Forum for Health Economics and Policy","volume":"78 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89416904","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Gigi Moreno, E. van Eijndhoven, J. Benner, J. Sullivan
Abstract Price controls for prescription drugs are once again at the forefront of policy discussions in the United States. Much of the focus has been on the potential short-term savings – in terms of lower spending – although evidence suggests price controls can dampen innovation and adversely affect long-term population health. This paper applies the Health Economics Medical Innovation Simulation, a microsimulation of older Americans, to estimate the long-term impacts of government price setting in Medicare Part D, using pricing in the Federal Veterans Health Administration program as a proxy. We find that VA-style pricing policies would save between $0.1 trillion and $0.3 trillion (US$2015) in lifetime drug spending for people born in 1949–2005. However, such savings come with social costs. After accounting for innovation spillovers, we find that price setting in Part D reduces the number of new drug introductions by as much as 25% relative to the status quo. As a result, life expectancy for the cohort born in 1991–1995 is reduced by almost 2 years relative to the status quo. Overall, we find that price controls would reduce lifetime welfare by $5.7 to $13.3 trillion (US$2015) for the US population born in 1949–2005.
{"title":"The Long-Term Impact of Price Controls in Medicare Part D","authors":"Gigi Moreno, E. van Eijndhoven, J. Benner, J. Sullivan","doi":"10.1515/fhep-2016-0011","DOIUrl":"https://doi.org/10.1515/fhep-2016-0011","url":null,"abstract":"Abstract Price controls for prescription drugs are once again at the forefront of policy discussions in the United States. Much of the focus has been on the potential short-term savings – in terms of lower spending – although evidence suggests price controls can dampen innovation and adversely affect long-term population health. This paper applies the Health Economics Medical Innovation Simulation, a microsimulation of older Americans, to estimate the long-term impacts of government price setting in Medicare Part D, using pricing in the Federal Veterans Health Administration program as a proxy. We find that VA-style pricing policies would save between $0.1 trillion and $0.3 trillion (US$2015) in lifetime drug spending for people born in 1949–2005. However, such savings come with social costs. After accounting for innovation spillovers, we find that price setting in Part D reduces the number of new drug introductions by as much as 25% relative to the status quo. As a result, life expectancy for the cohort born in 1991–1995 is reduced by almost 2 years relative to the status quo. Overall, we find that price controls would reduce lifetime welfare by $5.7 to $13.3 trillion (US$2015) for the US population born in 1949–2005.","PeriodicalId":38039,"journal":{"name":"Forum for Health Economics and Policy","volume":"22 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85609621","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-12-01Epub Date: 2016-05-31DOI: 10.1515/fhep-2015-0027
Maria Serakos, Barbara Wolfe
On March 23, 2010, President Barack Obama signed the Patient Protection and Affordable Care Act (ACA) into law. This comprehensive health care reform legislation sought to expand health care coverage to millions of Americans, control health care costs, and improve the overall quality of the health care system. The ACA required that all US citizens and legal residents have qualifying health insurance by 2014. In this paper we give readers a brief overview of the effects of the ACA based on recent research. We then turn our attention to the possibility of using the ACA expansion to answer important underlying questions, such as: To what extent does the holding of insurance lead to improvements in access to care? To what extent does the holding of coverage lead to improvements in health? In mental health? Are there likely general equilibrium effects on labor force participation, hours worked, employment setting, and indeed even the probability of marrying? By necessity, researchers' ability to answer these questions depends on the availability of data, so we discuss current and potential data sources relevant for answering these questions. We also look to what has been studied about the health reform in Massachusetts and early Medicaid expansions to speculate what we can expect to learn about the effects of the ACA on these outcomes in the future.
{"title":"The ACA: Impacts on Health, Access, and Employment.","authors":"Maria Serakos, Barbara Wolfe","doi":"10.1515/fhep-2015-0027","DOIUrl":"10.1515/fhep-2015-0027","url":null,"abstract":"<p><p>On March 23, 2010, President Barack Obama signed the Patient Protection and Affordable Care Act (ACA) into law. This comprehensive health care reform legislation sought to expand health care coverage to millions of Americans, control health care costs, and improve the overall quality of the health care system. The ACA required that all US citizens and legal residents have qualifying health insurance by 2014. In this paper we give readers a brief overview of the effects of the ACA based on recent research. We then turn our attention to the possibility of using the ACA expansion to answer important underlying questions, such as: To what extent does the holding of insurance lead to improvements in access to care? To what extent does the holding of coverage lead to improvements in health? In mental health? Are there likely general equilibrium effects on labor force participation, hours worked, employment setting, and indeed even the probability of marrying? By necessity, researchers' ability to answer these questions depends on the availability of data, so we discuss current and potential data sources relevant for answering these questions. We also look to what has been studied about the health reform in Massachusetts and early Medicaid expansions to speculate what we can expect to learn about the effects of the ACA on these outcomes in the future.</p>","PeriodicalId":38039,"journal":{"name":"Forum for Health Economics and Policy","volume":"19 2","pages":"201-259"},"PeriodicalIF":0.0,"publicationDate":"2016-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6097713/pdf/nihms-983987.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36408765","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract We study how the optimal public provision of health care depends on whether or not individuals have an option to seek publicly financed treatment in other regions. We find that, relative to the first-best solution, the government has an incentive to over-provide health care to low-income individuals. When cross-border health care takes place, this incentive is solely explained by that over-provision facilitates redistribution. The reason why more health care facilitates redistribution is that high-ability individuals mimicking low-ability individuals benefit the least from health care when health and labor supply are complements. Without cross-border health care, higher demand for health care among high-income individuals also contributes to the over-provision given that high-income individuals do not work considerably less than low-income individuals and that the government cannot discriminate between the income groups by giving them different access to health care.
{"title":"Public Provision and Cross-Border Health Care","authors":"David Granlund, Magnus Wikström","doi":"10.1515/fhep-2014-0024","DOIUrl":"https://doi.org/10.1515/fhep-2014-0024","url":null,"abstract":"Abstract We study how the optimal public provision of health care depends on whether or not individuals have an option to seek publicly financed treatment in other regions. We find that, relative to the first-best solution, the government has an incentive to over-provide health care to low-income individuals. When cross-border health care takes place, this incentive is solely explained by that over-provision facilitates redistribution. The reason why more health care facilitates redistribution is that high-ability individuals mimicking low-ability individuals benefit the least from health care when health and labor supply are complements. Without cross-border health care, higher demand for health care among high-income individuals also contributes to the over-provision given that high-income individuals do not work considerably less than low-income individuals and that the government cannot discriminate between the income groups by giving them different access to health care.","PeriodicalId":38039,"journal":{"name":"Forum for Health Economics and Policy","volume":"13 1","pages":"157 - 177"},"PeriodicalIF":0.0,"publicationDate":"2016-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88902849","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jean M. Mitchell, J. Reschovsky, L. Franzini, E. A. Reicherter
Abstract Prior research on treatment of low back pain has documented large increases in use of spinal surgery, MRIs and lumbosacral injections linked to physician self-referral arrangements. No recent research has examined whether physician ownership of physical therapy services results in greater use of physical therapy to treat low back pain. The objective of this study is to investigate whether physician ownership of physical therapy services affects frequency of use, visits and types of physical therapy services received by patients with low back pain. Using claims records from insured patients covered by Blue Cross Blue Shield of Texas (2008–2011) we compared several metrics of use of physical therapy services for low back pain episodes controlling for self-referral status. We identified 158,151 low back pain episodes, 27% met the criteria to be classified as “self-referral.” Only 10% of “non-self-referral” episodes received physical therapy compared to 26% of self-referral episodes (p<0.001). The unadjusted and regression adjusted self-referral effect was identical – about 16 percentage point difference (p<0.001). Among patients who received some physical therapy, self-referral episodes were comprised of 2.26 fewer visits and 11 fewer physical therapy service units (p<0.001). Non-self-referring episodes included a significantly higher proportion of “active” (hands on or patient engaged) as opposed to “passive” treatments (p<0.001). The regression-adjusted difference was 30 percentage points when measured as actual counts and 29 percentage points when measured in RVUs (p<0.001). Total spending on back-related care was 35% higher for self-referred episodes compared to their non-self-referred counterparts (p<0.001). Ownership of physical therapy services influence physicians’ referral to initiate a course of physical therapy to treat low back pain, but also affect the types of physical therapy services a patient receives.
先前对腰痛治疗的研究表明，与医生自我转诊安排相关的脊柱手术、核磁共振成像和腰骶注射的使用大幅增加。最近没有研究调查医生拥有物理治疗服务是否会导致更多地使用物理治疗来治疗腰痛。本研究的目的是调查医生对物理治疗服务的所有权是否影响下腰痛患者的使用频率、就诊次数和接受的物理治疗服务类型。使用来自德州蓝十字蓝盾保险公司(Blue Cross Blue Shield of Texas)的保险患者(2008-2011)的索赔记录，我们比较了几种使用物理治疗服务来控制腰痛发作的自我转诊状态的指标。我们确定了158,151次腰痛发作，27%符合“自我转诊”的标准。只有10%的“非自我转诊”患者接受了物理治疗，而26%的自我转诊患者接受了物理治疗(p<0.001)。未经调整和回归调整的自我推荐效应相同，相差约16个百分点(p<0.001)。在接受一些物理治疗的患者中，自我转诊次数减少2.26次，物理治疗服务单位减少11个(p<0.001)。与“被动”治疗相比，非自我指涉发作包括明显更高比例的“主动”治疗(动手或患者参与)(p<0.001)。当以实际计数测量时，经回归校正的差异为30个百分点，当以rvu测量时，差异为29个百分点(p<0.001)。与非自我提及的患者相比，自我提及的患者在背部相关护理方面的总支出高出35% (p<0.001)。物理治疗服务的所有权影响医生的转诊，以启动一个疗程的物理治疗治疗腰痛，但也影响物理治疗服务的类型，病人接受。
{"title":"Physician Self-Referral of Physical Therapy Services for Patients with Low Back Pain: Implications for Use, Types of Treatments Received and Expenditures","authors":"Jean M. Mitchell, J. Reschovsky, L. Franzini, E. A. Reicherter","doi":"10.1515/fhep-2015-0026","DOIUrl":"https://doi.org/10.1515/fhep-2015-0026","url":null,"abstract":"Abstract Prior research on treatment of low back pain has documented large increases in use of spinal surgery, MRIs and lumbosacral injections linked to physician self-referral arrangements. No recent research has examined whether physician ownership of physical therapy services results in greater use of physical therapy to treat low back pain. The objective of this study is to investigate whether physician ownership of physical therapy services affects frequency of use, visits and types of physical therapy services received by patients with low back pain. Using claims records from insured patients covered by Blue Cross Blue Shield of Texas (2008–2011) we compared several metrics of use of physical therapy services for low back pain episodes controlling for self-referral status. We identified 158,151 low back pain episodes, 27% met the criteria to be classified as “self-referral.” Only 10% of “non-self-referral” episodes received physical therapy compared to 26% of self-referral episodes (p<0.001). The unadjusted and regression adjusted self-referral effect was identical – about 16 percentage point difference (p<0.001). Among patients who received some physical therapy, self-referral episodes were comprised of 2.26 fewer visits and 11 fewer physical therapy service units (p<0.001). Non-self-referring episodes included a significantly higher proportion of “active” (hands on or patient engaged) as opposed to “passive” treatments (p<0.001). The regression-adjusted difference was 30 percentage points when measured as actual counts and 29 percentage points when measured in RVUs (p<0.001). Total spending on back-related care was 35% higher for self-referred episodes compared to their non-self-referred counterparts (p<0.001). Ownership of physical therapy services influence physicians’ referral to initiate a course of physical therapy to treat low back pain, but also affect the types of physical therapy services a patient receives.","PeriodicalId":38039,"journal":{"name":"Forum for Health Economics and Policy","volume":"30 1","pages":"179 - 199"},"PeriodicalIF":0.0,"publicationDate":"2016-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88955261","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract I construct a disease-based medical expenditure index for Medicare Advantage (private plan) enrollees using data from the Medicare Current Beneficiary Survey from 2001 to 2009. I create the indexes by modeling total health-care expenditure as a function of each respondent’s diagnoses. Total medical inflation for this population is found to be 5.7 percent annually. By comparison, medical inflation in the Medicare fee-for-service (FFS) population is 4.5 percent annually. The difference is partly due to differential reporting of drug and nondrug spending in the MCBS for FFS beneficiaries; once this is corrected for, inflation among FFS beneficiaries is 5.0 percent. The remaining difference results from drug spending increasingly more rapidly among Medicare Advantage enrollees. I show that the introduction of Part D accounts for much of, and possibly all the remaining gap in inflation.
{"title":"Estimating Regression-Based Medical Care Expenditure Indexes for Medicare Advantage Enrollees","authors":"A. Hall","doi":"10.1515/fhep-2015-0031","DOIUrl":"https://doi.org/10.1515/fhep-2015-0031","url":null,"abstract":"Abstract I construct a disease-based medical expenditure index for Medicare Advantage (private plan) enrollees using data from the Medicare Current Beneficiary Survey from 2001 to 2009. I create the indexes by modeling total health-care expenditure as a function of each respondent’s diagnoses. Total medical inflation for this population is found to be 5.7 percent annually. By comparison, medical inflation in the Medicare fee-for-service (FFS) population is 4.5 percent annually. The difference is partly due to differential reporting of drug and nondrug spending in the MCBS for FFS beneficiaries; once this is corrected for, inflation among FFS beneficiaries is 5.0 percent. The remaining difference results from drug spending increasingly more rapidly among Medicare Advantage enrollees. I show that the introduction of Part D accounts for much of, and possibly all the remaining gap in inflation.","PeriodicalId":38039,"journal":{"name":"Forum for Health Economics and Policy","volume":"2 1","pages":"261 - 297"},"PeriodicalIF":0.0,"publicationDate":"2016-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74898458","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract Several studies have explored the causes and magnitude of geographic variation in Medicare spending and service use, but most of these studies have not taken into account that pharmaceuticals may substitute for medical service use. We address this issue using Medicare medical and pharmaceutical administrative claims data to explore the correlation between medical and pharmaceutical spending and utilization; we also examine medical and pharmaceutical use for subsets of the Medicare population with certain chronic conditions often treated with drugs. Beneficiary-level regressions with controls for health status and demographics were used to construct standardized medical spending and pharmaceutical spending and utilization measures for each region and patient cohort. Areas with higher medical spending tend to have higher pharmaceutical spending in general. However, areas with higher medical spending also tend to have lower pharmaceutical spending for conditions for which prescription drugs may substitute for additional medical care. Both of these patterns are consistent with less efficient medical practices in higher-spending areas. Likewise, more expensive drugs and more broad-spectrum antibiotics, which are often considered discretionary and overused, are more likely to be prescribed in higher-spending areas. Our results suggest that care may be provided more efficiently in some regions than in others. However, additional research is needed to investigate relationships between spending and health care outcomes, and what types of policies may create incentives for higher-spending regions to reduce spending without a loss in quality.
{"title":"Evidence of Inefficiencies in Practice Patterns: Regional Variation in Medicare Medical and Drug Spending","authors":"Melinda Buntin, T. Hayford","doi":"10.1515/fhep-2015-0034","DOIUrl":"https://doi.org/10.1515/fhep-2015-0034","url":null,"abstract":"Abstract Several studies have explored the causes and magnitude of geographic variation in Medicare spending and service use, but most of these studies have not taken into account that pharmaceuticals may substitute for medical service use. We address this issue using Medicare medical and pharmaceutical administrative claims data to explore the correlation between medical and pharmaceutical spending and utilization; we also examine medical and pharmaceutical use for subsets of the Medicare population with certain chronic conditions often treated with drugs. Beneficiary-level regressions with controls for health status and demographics were used to construct standardized medical spending and pharmaceutical spending and utilization measures for each region and patient cohort. Areas with higher medical spending tend to have higher pharmaceutical spending in general. However, areas with higher medical spending also tend to have lower pharmaceutical spending for conditions for which prescription drugs may substitute for additional medical care. Both of these patterns are consistent with less efficient medical practices in higher-spending areas. Likewise, more expensive drugs and more broad-spectrum antibiotics, which are often considered discretionary and overused, are more likely to be prescribed in higher-spending areas. Our results suggest that care may be provided more efficiently in some regions than in others. However, additional research is needed to investigate relationships between spending and health care outcomes, and what types of policies may create incentives for higher-spending regions to reduce spending without a loss in quality.","PeriodicalId":38039,"journal":{"name":"Forum for Health Economics and Policy","volume":"42 1","pages":"299 - 331"},"PeriodicalIF":0.0,"publicationDate":"2016-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75570006","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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