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Can Oral Nutritional Supplements Improve Medicare Patient Outcomes in the Hospital? 口服营养补充剂能改善医院医疗保险患者的预后吗?
Forum for Health Economics and Policy Pub Date : 2014-09-01 DOI: 10.1515/fhep-2014-0011
D. Lakdawalla, J. Snider, D. Perlroth, C. LaVallee, M. Linthicum, T. Philipson, J. Partridge, P. Wischmeyer
{"title":"Can Oral Nutritional Supplements Improve Medicare Patient Outcomes in the Hospital?","authors":"D. Lakdawalla, J. Snider, D. Perlroth, C. LaVallee, M. Linthicum, T. Philipson, J. Partridge, P. Wischmeyer","doi":"10.1515/fhep-2014-0011","DOIUrl":"https://doi.org/10.1515/fhep-2014-0011","url":null,"abstract":"Abstract We analyzed the effect of oral nutritional supplement (ONS) use on 30-day readmission rates, length of stay (LOS), and episode costs in hospitalized Medicare patients (≥65), and subsets of patients diagnosed with acute myocardial infarction (AMI), congestive heart failure (CHF) or pneumonia (PNA). Propensity-score matching and instrumental variables were used to analyze ONS and non-ONS episodes from the Premier Research Database (2000–2010). ONS use was associated with reductions in probability of 30-day readmission by 12.0% in AMI and 10.1% in CHF. LOS decreases of 10.9% in AMI, 14.2% in CHF, and 8.5% in PNA were associated with ONS, as were decreases in episode costs in AMI, CHF and PNA of 5.1%, 7.8% and 10.6%, respectively. The effect on LOS and episode cost was greatest for the Any Diagnosis population, with decreases of 16.0% and 15.8%, respectively. ONS use in hospitalized Medicare patients ≥65 is associated with improved outcomes and decreased healthcare costs, and is therefore relevant to providers seeking an inexpensive, evidence-based approach for meeting Affordable Care Act quality targets.","PeriodicalId":38039,"journal":{"name":"Forum for Health Economics and Policy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2014-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79479196","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}
引用次数: 9
The Effects of Smoking Cessation on Weight Gain: New Evidence Using Workplace Smoking Bans 戒烟对体重增加的影响:工作场所禁烟的新证据
Forum for Health Economics and Policy Pub Date : 2014-09-01 DOI: 10.1515/fhep-2013-0004
Jason M. Fletcher
{"title":"The Effects of Smoking Cessation on Weight Gain: New Evidence Using Workplace Smoking Bans","authors":"Jason M. Fletcher","doi":"10.1515/fhep-2013-0004","DOIUrl":"https://doi.org/10.1515/fhep-2013-0004","url":null,"abstract":"Abstract Both tobacco use and obesity are among the most important and costly health challenges faced in developed countries. Unfortunately, they may be inversely linked. While policy interventions that have placed limits on tobacco use have increased substantially over time, one unintended consequence may be to increase obesity rates. Issues of selection and unobserved heterogeneity make it difficult to empirically assess the relationship between the two health outcomes. Additionally, there may be heterogeneous policy effects by cessation cause – smoking bans or medical treatments or tobacco prices. This paper focuses on the effects of a rapidly expanding policy by using within-individual differences in exposure to workplace smoking bans to estimate the impact of smoking cessation on weight gain using a large study of over 5000 White and Black respondents followed since 1986. Findings suggest that individuals affected by the smoking bans gained more weight in the short-term than suggested by OLS estimates.","PeriodicalId":38039,"journal":{"name":"Forum for Health Economics and Policy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2014-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80018539","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}
引用次数: 4
Patient Outcomes and Cost Effects of Medicaid Formulary Restrictions on Antidepressants 医疗补助限制抗抑郁药的患者结局和成本效应
Forum for Health Economics and Policy Pub Date : 2014-09-01 DOI: 10.1515/fhep-2014-0016
S. Seabury, D. Lakdawalla, D. Walter, J. Hayes, T. Gustafson, A. Shrestha, D. Goldman
{"title":"Patient Outcomes and Cost Effects of Medicaid Formulary Restrictions on Antidepressants","authors":"S. Seabury, D. Lakdawalla, D. Walter, J. Hayes, T. Gustafson, A. Shrestha, D. Goldman","doi":"10.1515/fhep-2014-0016","DOIUrl":"https://doi.org/10.1515/fhep-2014-0016","url":null,"abstract":"Abstract Many state Medicaid programs have implemented policies designed to reduce spending on prescription drugs by restricting access to branded products. For patients with major depressive disorder, formulary restrictions could severely limit access to antidepressant therapies and disrupt care. We linked data on patient outcomes and spending from 24 state Medicaid programs to information on formulary restrictions from 2001 to 2008. Outcomes included frequency of MDD-related hospitalizations and ER visits per patient and total healthcare spending. We estimated the effect of the policies on patient outcomes and spending using a difference-and-difference approach. We found that restricting access to antidepressants increased the probability of an MDD-related hospitalization by 1.7 percentage points (16.6%). Furthermore, we found no evidence that these restrictions resulted in any net savings for Medicaid.","PeriodicalId":38039,"journal":{"name":"Forum for Health Economics and Policy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2014-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89589914","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}
引用次数: 6
A Note on Income Effects and Health Care Cost Growth in Medicare 关于医疗保险的收入效应和医疗保健成本增长的说明
Forum for Health Economics and Policy Pub Date : 2014-02-01 DOI: 10.1515/fhep-2013-0001
T. Mcguire
{"title":"A Note on Income Effects and Health Care Cost Growth in Medicare","authors":"T. Mcguire","doi":"10.1515/fhep-2013-0001","DOIUrl":"https://doi.org/10.1515/fhep-2013-0001","url":null,"abstract":"Abstract This paper sets out a model of technical change and health care cost growth for a representative Medicare beneficiary facing a budget constraint. Derivation of an explicit expression for health care cost growth shows how technological change and preferences, including income effects, affect cost growth. The analysis highlights the role of the 76% subsidy from current taxpayers to Medicare beneficiaries for purchase of health insurance. This subsidy insulates beneficiaries from the income effects of cost growth by shifting the costs and income effects to taxpayers. Simulations show that over the next 10–20 years, income effects will have little effect on cost growth in Medicare.","PeriodicalId":38039,"journal":{"name":"Forum for Health Economics and Policy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2014-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85873619","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}
引用次数: 3
A Note on Income Effects and Health Care Cost Growth in Medicare. 关于医疗保险的收入效应和医疗保健成本增长的说明。
Forum for Health Economics and Policy Pub Date : 2014-02-01 DOI: 10.1515/fhep-2013-0
Thomas G McGuire
{"title":"A Note on Income Effects and Health Care Cost Growth in Medicare.","authors":"Thomas G McGuire","doi":"10.1515/fhep-2013-0","DOIUrl":"https://doi.org/10.1515/fhep-2013-0","url":null,"abstract":"<p><p>This paper sets out a model of technical change and health care cost growth for a representative Medicare beneficiary facing a budget constraint. Derivation of an explicit expression for health care cost growth shows how technological change and preferences, including income effects, affect cost growth. The analysis highlights the role of the 76% percent subsidy from current taxpayers to Medicare beneficiaries for purchase of health insurance. This subsidy insulates beneficiaries from the income effects of cost growth by shifting the costs and income effects to taxpayers. Simulations show that over the next 10-20 years, income effects will have little effect on cost growth in Medicare.</p>","PeriodicalId":38039,"journal":{"name":"Forum for Health Economics and Policy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2014-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4548929/pdf/nihms-713000.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34026350","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}
引用次数: 0
The Crowd, the Cloud and Improving the Future of Medical Device Innovation 人群、云与改善医疗器械创新的未来
Forum for Health Economics and Policy Pub Date : 2014-01-01 DOI: 10.1515/fhep-2012-0023
Marco D. Huesch, R. Szczerba
{"title":"The Crowd, the Cloud and Improving the Future of Medical Device Innovation","authors":"Marco D. Huesch, R. Szczerba","doi":"10.1515/fhep-2012-0023","DOIUrl":"https://doi.org/10.1515/fhep-2012-0023","url":null,"abstract":"Abstract Barriers and delays to medical device innovation are often solely attributable to the regulatory environment instead of both the current state of innovation practices and product development processes in the industry. Increasing the pace of innovation while reducing costs requires the creation of a new approach that fits both established medical device corporations as well as entrepreneurial start-ups. In this commentary we advance the concept of innovation platforms to facilitate ideation in the medical device space. Such platforms could also allow the full health benefits from individual medical devices to be reaped, by overcoming interoperability concerns through simulation and credentialing. Given the dramatic benefits of medical device success, such non-traditional business models for development may be potential solutions for industry, users and regulators.","PeriodicalId":38039,"journal":{"name":"Forum for Health Economics and Policy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2014-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89012401","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}
引用次数: 1
Medicare Reimbursement Reform for Provider Visits and Health Outcomes in Patients on Hemodialysis. 医疗保险报销改革对提供者访问和血液透析患者的健康结果。
Forum for Health Economics and Policy Pub Date : 2014-01-01 DOI: 10.1515/fhep-2012-0018
Kevin F Erickson, Wolfgang C Winkelmayer, Glenn M Chertow, Jay Bhattacharya
{"title":"Medicare Reimbursement Reform for Provider Visits and Health Outcomes in Patients on Hemodialysis.","authors":"Kevin F Erickson,&nbsp;Wolfgang C Winkelmayer,&nbsp;Glenn M Chertow,&nbsp;Jay Bhattacharya","doi":"10.1515/fhep-2012-0018","DOIUrl":"https://doi.org/10.1515/fhep-2012-0018","url":null,"abstract":"<p><p>The relation between the quantity of many healthcare services delivered and health outcomes is uncertain. In January 2004, the Centers for Medicare and Medicaid Services introduced a tiered fee-for-service system for patients on hemodialysis, creating an incentive for providers to see patients more frequently. We analyzed the effect of this change on patient mortality, transplant wait-listing, and costs. While mortality rates for Medicare beneficiaries on hemodialysis declined after reimbursement reform, mortality declined more - or was no different - among patients whose providers were not affected by the economic incentive. Similarly, improved placement of patients on the kidney transplant waitlist was no different among patients whose providers were not affected by the economic incentive; payments for dialysis visits increased 13.7% in the year following reform. The payment system designed to increase provider visits to hemodialysis patients increased Medicare costs with no evidence of a benefit on survival or kidney transplant listing.</p>","PeriodicalId":38039,"journal":{"name":"Forum for Health Economics and Policy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2014-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1515/fhep-2012-0018","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34293533","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}
引用次数: 12
A Cost-Benefit Analysis of Using Evidence of Effectiveness in Terms of Progression Free Survival in Making Reimbursement Decisions on New Cancer Therapies 使用无进展生存期的有效性证据来制定新的癌症治疗报销决策的成本-收益分析
Forum for Health Economics and Policy Pub Date : 2014-01-01 DOI: 10.1515/fhep-2013-0025
Warren Stevens, T. Philipson, Yanyu Wu, Connie Chen, D. Lakdawalla
{"title":"A Cost-Benefit Analysis of Using Evidence of Effectiveness in Terms of Progression Free Survival in Making Reimbursement Decisions on New Cancer Therapies","authors":"Warren Stevens, T. Philipson, Yanyu Wu, Connie Chen, D. Lakdawalla","doi":"10.1515/fhep-2013-0025","DOIUrl":"https://doi.org/10.1515/fhep-2013-0025","url":null,"abstract":"Abstract Payers increasingly require evidence of a statistically significant difference in overall survival (OS) for reimbursement of new cancer therapies. At the same time, it becomes increasingly costly to design clinical trials that measure OS endpoints instead of progression-free survival (PFS) endpoints. While PFS is often an imperfect proxy for OS effects, it is also faster and cheaper to measure accurately. This study develops a general cost-benefit framework that quantifies the competing trade-offs of the use of PFS versus that of OS in oncology reimbursement. We then apply this general framework to the illustrative case of metastatic renal cell carcinoma (mRCC). In the particular case of mRCC, the framework demonstrates that the net benefit to society from basing reimbursement decisions on PFS endpoints could be between $271 and $1271 million in the United States, or between €171 and €1128 million in Europe. In longevity terms, waiting for OS data in this case would result in a net loss of 3549–14,557 life-years among US patients, or 6785–27,993 life-years for European patients. While more stringent standards for medical evidence improve accuracy, they also impose countervailing costs on patients in terms of foregone health gains. These costs must be weighed against the benefits of greater accuracy. The magnitudes of the costs and benefits may vary across tumor types and need to be quantified systematically.","PeriodicalId":38039,"journal":{"name":"Forum for Health Economics and Policy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2014-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75709695","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}
引用次数: 5
Opportunities in the Economics of Personalized Health Care and Prevention 个性化卫生保健和预防经济学中的机遇
Forum for Health Economics and Policy Pub Date : 2013-09-01 DOI: 10.1515/fhep-2013-0012
D. Meltzer
{"title":"Opportunities in the Economics of Personalized Health Care and Prevention","authors":"D. Meltzer","doi":"10.1515/fhep-2013-0012","DOIUrl":"https://doi.org/10.1515/fhep-2013-0012","url":null,"abstract":"Abstract Personalized medicine is best viewed from a broad perspective of trying to use information about a patient to improve care. While “personalized medicine” often emphasizes the value of genetic information, traditional clinical approaches to personalizing care based on patient phenotype, provider and system-level factors should not be neglected. As these diverse approaches to personalization are examined, tools such as cost-effectiveness analysis can provide important insights into the value of these approaches, strategies for their implementation and dissemination, and priorities for future research. Such analyses are likely to be most insightful if they recognize that patient and provider behaviors are essential determinants of the value of treatments and that patient factors in particular may have large effects on the value of treatments and the need for interventions to improve decision making. These comments suggest three major areas of opportunity for economic analyses of personalized medicine: (1) traditional clinical approaches to personalized medicine, (2) multi-perspective studies of the benefits and costs of personalized medicine, and (3) the role of behavior in the value of personalized medicine.","PeriodicalId":38039,"journal":{"name":"Forum for Health Economics and Policy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2013-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83254126","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}
引用次数: 0
The Value of Diagnostic Testing in Personalized Medicine 诊断测试在个体化医疗中的价值
Forum for Health Economics and Policy Pub Date : 2013-09-01 DOI: 10.1515/fhep-2013-0023
D. Goldman, Charu N. Gupta, E. Vasudeva, K. Trakas, R. Riley, D. Lakdawalla, D. Agus, N. Sood, A. Jena, T. Philipson
{"title":"The Value of Diagnostic Testing in Personalized Medicine","authors":"D. Goldman, Charu N. Gupta, E. Vasudeva, K. Trakas, R. Riley, D. Lakdawalla, D. Agus, N. Sood, A. Jena, T. Philipson","doi":"10.1515/fhep-2013-0023","DOIUrl":"https://doi.org/10.1515/fhep-2013-0023","url":null,"abstract":"Abstract Personalized medicine – the targeting of therapies to individuals on the basis of their biological, clinical, or genetic characteristics – is thought to have the potential to transform health care. While much emphasis has been placed on the value of personalized therapies, less attention has been paid to the value generated by the diagnostic tests that direct patients to those targeted treatments. This paper presents a framework derived from information economics for assessing the value of diagnostics. We demonstrate, via a case study, that the social value of such diagnostics can be very large, both by avoiding unnecessary treatment and by identifying patients who otherwise would not get treated. Despite the potential social benefits, diagnostic development has been discouraged by cost-based, rather than value-based, reimbursement.","PeriodicalId":38039,"journal":{"name":"Forum for Health Economics and Policy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2013-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88608162","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}
引用次数: 21
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