Category Archives: BUHealth

Lisa Iezzoni’s new book on Risk Adjustment****

BU, BUHealth, EC 581, EC 782

I just received and have scanned through Lisa Iezzoni’s fourth book (as editor and major contributor) entitled

Risk Adjustment for Measuring Health Care Outcomes (Fourth Edition), Lisa I Iezzoni (ed) (2013)

Even though Lisa is a physician, not an economist or statistician, this book provides an excellent overview of risk adjustment (population-based), and severity or case mix adjustment (episode or event based), and includes discussion of available datasets, model comparisons, propensity score matching, lists of information potentially useful, clinical classification, variables  clinical, social and statistical issues. Contributions on statistical methodology by Michael Swartz and Arlene Ash, as well as separate chapters on mental health, long term care, managing healthcare organizations, and provider profiling are excellent. Its main weakness is in not capturing international developments at all, not discussing the commercial market for risk adjustment models, and not covering most nonlinear and econometric (as distinct from statistical) issues well. Still, it should be required reading for anyone planning to do work in this area.

I have put it on my list of all time favorite books, but acknowledge that only a limited subset of people will be interested in it.

 

Comprehensive Primary Care Initiative, by CMS, Overview

BUHealth, EC 581, EC 782

CMS posted in late August an interesting site that provides lots of information about the seven demonstrations going on for Comprehensive Primary Care Payment.

http://innovations.cms.gov/initiatives/Comprehensive-Primary-Care-Initiative/index.html
Each site includes a list of participating PCPs. with specific clinic names, zip codes and addresses. Could be interesting to examine how severe a selection problem there is.

Five Questions for Health Economists

BU, BUHealth, Conferences, EC 581, EC 782

My presidential address to the American Society of Health Economists is now available to download and scheduled for publication in the International Journal of Health Care Finance and Economics. Here is the link.

Five questions for health economists

Randall P. Ellis

Online First™, 3 September 2012

Here is the direct link to the pdf file.

http://www.springerlink.com/content/7m2668027362x52r/fulltext.pdf

 

Stirring but informative Clinton nomination speech for Barack Obama

BUHealth, Politics

I highly recommend to you the YouTube link to Bill Clinton's 49 minute Nominating Speech for Barack Obama.
Of particular use to health economists are his comments on the implications of the Romney-Ryan discussion of Medicare and Medicaid, I recommend that you watch the segment from 28:10 to 36:10.

http://www.youtube.com/watch?v=JeqNmaawCVw

Watch 28:10 to 36:10 to understand the health care discussion and why this issue is so important.
If you prefer text, you can read his speech as transcribed in the NYTimes.

The prepared text is linked here.

http://www.huffingtonpost.com/2012/09/05/bill-clinton-speech-text-_n_1850531.html?utm_hp_ref=elections-2012

The health discussion text from the speech follows. Note that his actual speech deviated from the prepared text in a few key places. Hence I am using the transcript.

...

Now, that brings me to health care. (Cheers, applause.) And the Republicans call it, derisively, “Obamacare.” They say it’s a government takeover, a disaster, and that if we’ll just elect them, they’ll repeal it. Well, are they right?

AUDIENCE MEMBERS: No!

PRESIDENT CLINTON: Let’s take a look at what’s actually happened so far.

First, individuals and businesses have already gotten more than a billion dollars in refunds from insurance companies because the new law requires 80 (percent) to 85 percent of your premium to go to your health care, not profits or promotion. (Cheers, applause.) And the gains are even greater than that because a bunch of insurance companies have applied to lower their rates to comply with the requirement.

Second, more than 3 million young people between 19 and 25 are insured for the first time because their parents’ policies can cover them.

(Cheers, applause.)

Millions of seniors are receiving preventive care, all the way from breast cancer screenings to tests for heart problems and scores of other things. And younger people are getting them, too.

Fourth, soon the insurance companies — not the government, the insurance companies — will have millions of new customers, many of them middle-class people with pre-existing conditions who never could get insurance before. (Cheers, applause.)

Now, finally, listen to this. For the last two years — after going up at three times the rate of inflation for a decade, for the last two years health care costs have been under 4 percent in both years for the first time in 50 years. (Cheers, applause.)

So let me ask you something. Are we better off because President Obama fought for health care reform? (Cheers, applause.) You bet we are.

Now, there were two other attacks on the president in Tampa I think deserve an answer. First, both Governor Romney and Congressman Ryan attacked the president for allegedly robbing Medicare of $716 billion. That’s the same attack they leveled against the Congress in 2010, and they got a lot of votes on it. But it’s not true. (Applause.)

Look, here’s what really happened. You be the judge. Here’s what really happened. There were no cuts to benefits at all. None. What the president did was to save money by taking the recommendations of a commission of professionals to cut unwarranted subsidies to providers and insurance companies that were not making people healthier and were not necessary to get the providers to provide the service.

And instead of raiding Medicare, he used the savings to close the doughnut hole in the Medicare drug program — (cheers, applause) — and — you all got to listen carefully to this; this is really important — and to add eight years to the life of the Medicare trust fund so it is solvent till 2024. (Cheers, applause.)

So — (chuckles) — so President Obama and the Democrats didn’t weaken Medicare; they strengthened Medicare. Now, when Congressman Ryan looked into that TV camera and attacked President Obama’s Medicare savings as, quote, the biggest, coldest power play, I didn’t know whether to laugh or cry — (laughter) — because that $716 billion is exactly, to the dollar, the same amount of Medicare savings that he has in his own budget. (Cheers, applause.) You got to get one thing — it takes some brass to attack a guy for doing what you did. (Laughter, cheers, applause.)

So — (inaudible) — (sustained cheers, applause) — now, you’re having a good time, but this is getting serious, and I want you to listen.

(Laughter.) It’s important, because a lot of people believe this stuff.

Now, at least on this issue, on this one issue, Governor Romney has been consistent. (Laughter.) He attacked President Obama too, but he actually wants to repeal those savings and give the money back to the insurance company. (Laughter, boos.)

He wants to go back to the old system, which means we’ll reopen the doughnut hole and force seniors to pay more for drugs, and we’ll reduce the life of the Medicare trust fund by eight full years. (Boos.)

So if he’s elected, and if he does what he promised to do, Medicare will now grow (sic/go) broke in 2016. (Boos.) Think about that. That means, after all, we won’t have to wait until their voucher program kicks in 2023 — (laughter) — to see the end of Medicare as we know it. (Applause.) They’re going to do it to us sooner than we thought. (Applause.)

Now, folks, this is serious, because it gets worse. (Laughter.) And you won’t be laughing when I finish telling you this. They also want to block-grant Medicaid, and cut it by a third over the coming 10 years.

AUDIENCE MEMBER: No!

PRESIDENT CLINTON: Of course, that’s going to really hurt a lot of poor kids. But that’s not all. Lot of folks don’t know it, but nearly two-thirds of Medicaid is spent on nursing home care for Medicare seniors — (applause) — who are eligible for Medicaid.

(Cheers, applause.) It’s going to end Medicare as we know it. And a lot of that money is also spent to help people with disabilities, including — (cheers, applause) — a lot of middle-class families whose kids have Down’s syndrome or autism or other severe conditions. (Applause.) And honestly, let’s think about it, if that happens, I don’t know what those families are going to do.

So I know what I’m going to do. I’m going to do everything I can to see that it doesn’t happen. We can’t let it happen. (Cheers, applause.) We can’t. (Cheers, applause.)

 

Congrats to BU faculty on prominent role at ASSA 2013!

BU, BUHealth, Conferences, General Economics

Congratulations!

BU faculty, graduate students and alumni appear prominently in the program of the Allied Social Sciences Association (ASSA) meetings (aka the AEA meetings), scheduled to be held in San Diego January 4-6, 2013. Altogether their names appear as presenters, authors, chairs or discussants at least 73 times. Seventeen different economics faculty are listed as participants (up from 12 in 2012). I see many colleagues from SMG and SPH as well.

Names of BU faculty, graduate students and alumni on the preliminary program of the ASSA are shown on the extract below in Bold. (Also shown are the times and rooms in case you have not looked yet.) My apologies for the incompleteness of this listing, since finding alumni in particular is challenging. I am sure I missed many more alumni.

Well done colleagues!

The full ASSA preliminary program is listed here. http://www.aeaweb.org/aea/2013conference/program/preliminary.php

(Also, not too early to begin planning for your presentation at ASSA 2014, which will be in Philadelphia Jan 3-5, 2014, or for 2015 in Boston!)

Be sure to plan on attending the BU reception at the ASSA which will be
Saturday, January 5, 6:00-8:00 pm, Manchester Grand Hyatt-Gregory A & B

Here is the full roster of BU participants/coauthors

Jan 04, 2013 8:00 am, Manchester Grand Hyatt, Molly A & B
American Economic Association
The Market for Medicines in Developing Countries (O1)
Drug Quality and the Development of Private Retail Pharmacy Markets
Wesley Yin (Boston University)
Dan Bennett (University of Chicago)

Jan 04, 2013 8:00 am, Manchester Grand Hyatt, Gibbons
Econometric Society
Product Markets (D4)
Durable Goods Monopoly with Stochastic Costs
Juan Matias Ortner (Princeton University)
Discussants:
Juan Matias Ortner (Princeton University)

Jan 04, 2013 8:00 am, Manchester Grand Hyatt, Elizabeth Ballroom A
American Economic Association
The Organizational Economics of Multinational Firms (F2)
Discussants:
Andrew Newman (Boston University)
Stefania Garetto (Boston University)

Jan 04, 2013 10:15 am, Manchester Grand Hyatt, Manchester D
American Economic Association
Finance (G1) (Poster Session)
Do Humans Perceive Temporal Order in Asset Returns?
Jasmina Hasanhodzic (Boston University)
Andrew Lo (Massachusetts Institute of Technology)
Emanuele Viola (Northeastern University)

Jan 04, 2013 10:15 am, Manchester Grand Hyatt, Gregory A & B
American Economic Association
Financial Intermediation and Financial Crisis (E5)
Presiding: Jianjun Miao (Boston University)
Banking Bubbles and Financial Crisis
Jianjun Miao (Boston University)
Pengfei Wang (Hong Kong University of Science and Technology)
Demand Creates its Own Supply
Christophe Chamley (Boston University)
Discussants:
Simon Gilchrist (Boston University)

Jan 04, 2013 10:15 am, Manchester Grand Hyatt, Edward A
American Economic Association
Global Production Chains (F1)
Do Prices Determine Vertical Integration? Evidence from Trade Policy
Laura Alfaro (Harvard Business School)
Paola Conconi (Universite Libre de Bruxelles)
Harald Hadinger (University of Vienna)
Andrew Newman (Boston University)

Jan 04, 2013 10:15 am, Manchester Grand Hyatt, Elizabeth Ballroom G
American Economic Association
Work on Women's Work is Never Done (J2)
Shocking Female Labor Supply: A Reassessment of the Impact of World War II on U.S. Women's Labor Supply
Claudia Goldin (Harvard University)
Claudia Olivetti (Boston University)

Jan 04, 2013 10:15 am, Manchester Grand Hyatt, Ford B
International Health Economics Association
Health Insurance Market Innovations (I1)
Presiding: Wesley Yin (Boston University and NBER)
Discussants:
Dara Lee (University of Missouri)

Jan 04, 2013 10:15 am, Manchester Grand Hyatt, Ford C
National Tax Association
Health Care Cost Containment (I1)
Age-Based Heterogeneity and Pricing Regulation on the Massachusetts Health Insurance Exchange
Keith Marzilli Ericson (Boston University and NBER)

Jan 04, 2013 2:30 pm, Manchester Grand Hyatt, Elizabeth Ballroom C
American Economic Association
Markups, Customer Base and Business cycles (E2)
Presiding: Leena Rudanko (Boston University)
Inflation Dynamics during the Financial Crisis: Microeconomic Evidence on the Linkages between Price-Setting and Balance Sheet Conditions
Simon Gilchrist (Boston University)
Egon Zakrajsek (Federal Reserve Board)
Raphael Schoenle (Brandeis University)
Customer Capital and Business Cycles
Francois Gourio (Boston University)
Leena Rudanko (Boston University)
Discussants:
Christopher House (University of Michigan)

Jan 04, 2013 2:30 pm, Manchester Grand Hyatt, Cunningham A & B
Econometric Society
Nature of Labor Income Risk (E2)
Reconciling Estimates of Income Processes in Growth Rates and Levels
Moira Daly (Copenhagen Business School)
Dmytro Hryshko (University of Alberta)
Iourii Manovskii (University of Pennsylvania)

Jan 04, 2013 2:30 pm, Manchester Grand Hyatt, Manchester F
American Economic Association
The Political Economics of Momentum, Persistence and Information (D8)
The Persistence of Political Partisanship: Evidence from 9/11
Sharun Mukand (University of Warwick)
Ethan Kaplan (University of Maryland)

Jan 04, 2013 2:30 pm, Manchester Grand Hyatt, Randle B
American Economic Association
Developments in Health and Population Economics (I1)
Explaining the Birth Order Effect: The Role of Prenatal and Early Postnatal Conditions
Jee-Yeon K. Lehmann (University of Houston)
Ana Nuevo-Chiquero (University of Barcelona)
Marian Vidal-Fernandez (University of New South Wales)
The Impact of Childhood Health on Adult Educational Attainment: Evidence from Mandatory School Vaccination Laws
Dara N. Lee (University of Missouri)

Jan 04, 2013 2:30 pm, Manchester Grand Hyatt, Edward C
American Economic Association
Medical Treatment (I1)
Presiding: Kathleen Carey (Boston University)
Technology Diffusion and Learning Spillovers in Health Care: Evidence from New Cancer Drugs
Leila Agha (Boston University)
David Molitor (Massachusetts Institute of Technology)
Negative Tests and the Efficiency of Medical Care: Investigating the Determinants of Imaging Overuse
Jason Abaluck (Yale University)
Leila Agha (Boston University)

Jan 05, 2013 7:45 am, Marriott Marquis & Marina, Santa Rosa
Association for Social Economics
Presidential Breakfast
Martha Starr (President, ASE) (American University) The Social Responsibility of Business Through a Social-Economics Lens

Jan 05, 2013 8:00 am, Manchester Grand Hyatt, Ford A
American Economic Association
Economic History (N0)
The Persistence of the Inquisitorial Mind: Long-Run Effects of the Spanish Inquisition
Jordi Vidal-Robert (Boston University)

Jan 05, 2013 8:00 am, Manchester Grand Hyatt, Molly A & B
American Economic Association
Discussants:
Daniele Paserman (Boston University)

Jan 05, 2013 8:00 am, Manchester Grand Hyatt, Edward C
American Economic Association
Recent Developments in Consumer Bankruptcy Research (K3)
Social Networks and Personal Bankruptcy
Michelle Miller (Rutgers University)

Jan 05, 2013 8:00 am, Manchester Grand Hyatt, Cunningham C
Econometric Society
Incentive Pay and Competition (G3)
Rising Through the Ranks: The Evolution of the Market for Corporate Executives, 1936-2003
Carola Frydman (Boston University)

Jan 05, 2013 10:15 am, Manchester Grand Hyatt, Elizabeth Ballroom B
American Economic Association
Default Risk and Aggregate Fluctuations (E3)
Presiding: Francois Gourio (Boston University)
Default Risk Premia and Investment in a DSGE model
Francois Gourio (Boston University)

Jan 05, 2013 10:15 am, Manchester Grand Hyatt, Edward A & B
American Economic Association
Youth Behavior (J1)
No Pass No Drive: Education and Allocation of Time
Rashmi Barua (Singapore Management University)
Marian Vidal Fernandez (UNSW)

Jan 05, 2013 10:15 am, Manchester Grand Hyatt, Randle D
American Economic Association
Economic Analysis of Environmental Policy (Q5)
Climate Change and U.S. Electric Power
Ian Sue Wing (Boston University)
Karina Veliz Roja (Boston University)
Tim Fuerst (University of Notre Dame)

Jan 05, 2013 10:15 am, Manchester Grand Hyatt, Manchester F
American Economic Association
Financial Policies: Lessons from Historical and Long Run Perspectives (G1)
Economic Effects of Runs on Early "Shadow Banks": Trust Companies and the Impact of the Panic of 1907
Carola Frydman (Boston University)
Eric Hilt (Wellesley College)
Lily Zhou (Federal Reserve Bank of New York)

Jan 05, 2013 10:15 am, Manchester Grand Hyatt, Edward C
American Economic Association
Gender, Trade and Productivity Shocks (J1)
Presiding: Claudia Olivetti (Boston University)
Discussants:
Claudia Olivetti (Boston University)

Jan 05, 2013 10:15 am, Manchester Grand Hyatt, Gibbons
Econometric Society
Testing (C1)
Discussants:
Hiroaki Kaido (Boston University)

Jan 05, 2013 10:15 am, Marriott Marquis & Marina, La Costa
Health Economics Research Organization
Medical Interventions and Patient Offsetting Behavior (I1)
Does Statin Use Adversely Affect Health Behaviors?
Robert Kaestner (University of Illinois and NBER)
Michael Darden (Tulane University)
Darius Lakdawalla (University of Southern California and NBER)
Wesley Yin (Boston University and NBER)

Jan 05, 2013 2:30 pm, Manchester Grand Hyatt, Randle D
American Economic Association
Intangible Capital and Asset Prices (G1)
Customer Capital
Francois Gourio (Boston University)
Leena Rudanko (Boston University)

Jan 05, 2013 2:30 pm, Manchester Grand Hyatt, Molly A & B
American Economic Association
Plan Choice and Switching Costs in Health Insurance Market (I1)
Dynamic Plan Choice in Medicare Part D - Quantifying Switching Costs
Chao Zhou (University of Pittsburgh)
Yuting Zhang (University of Pittsburgh)

Jan 05, 2013 2:30 pm, Manchester Grand Hyatt, Manchester A
American Economic Association
Labor Market Networks (J2)
Discussants:
Kevin Lang (Boston University)

Jan 05, 2013 2:30 pm, Manchester Grand Hyatt, Emma A & B
American Economic Association
The Impacts of Great Society Programs (N3)
Discussants:
Robert Margo (Boston University)

Jan 05, 2013 2:30 pm, Manchester Grand Hyatt, Cunningham C
Econometric Society
New Developments in Empirical Modeling of Games (C5)
Random Coefficients in Static Games of Complete Information
fabian dunker (University of Goettingen)
Stefan Hoderlein (Boston College)
Hiroaki Kaido (Boston University)

Jan 05, 2013 2:30 pm, Marriott Marquis & Marina, Torrey Pines 1
Society for Computational Economics
Inference in DSGE-type models (C3)
Frequency Domain Analysis of Medium Scale DSGE Models with Application to Smets and Wouters (2007)
Zhongjun Qu (Boston University)
Denis Tkachenko (Boston University)

Jan 06, 2013 8:00 am, Manchester Grand Hyatt, Windsor B & C
American Economic Association
Family Formation (J1)
Why Have Divorce Rates Fallen? The Role of Women's Age at Marriage
Dana Rotz (Mathematica Policy Research)

Jan 06, 2013 8:00 am, Manchester Grand Hyatt, Molly A & B
American Economic Association
Health Care Labor Markets (J4)
Presiding: Patricia Cortes (Boston University)
The Relative Quality of Foreign Nurses in the US
Patricia Cortes (Boston University)
Jessica Pan (National University of Singapore)
Discussants:
Wes Yin (Boston University)

Jan 06, 2013 8:00 am, Manchester Grand Hyatt, Manchester G
American Economic Association
Woman and Labor Markets (J1)
Sexual Violence against Women and Labor Market Outcomes
Joseph J. Sabia (San Diego State University)
Angela Dills (Providence College)
Jeffrey DeSimone (University of Maryland)
Discussants:
Kevin Lang (Boston University)

Jan 06, 2013 10:15 am, Manchester Grand Hyatt, Gregory A & B
American Economic Association
Assessing the Impacts of Job Loss (J6)
The Long-Term Impact of Job Displacement in Germany during the 1982 Recession on Earnings, Income, and Employment
Johannes Schmieder (Boston University)
Till Von Wachter (Columbia University)
Stefan Bender (Institute for Employment Research)

Jan 06, 2013 10:15 am, Manchester Grand Hyatt, Edward A
American Economic Association
Information, Health, and Insurance (I1)
Presiding: Keith Ericson (Boston University)
How Product Standardization Affects Choice: Evidence from the Massachusetts Health Insurance Exchange
Keith Marzilli Ericson (Boston University)
Amanda Starc (University of Pennsylvania)

Jan 06, 2013 10:15 am, Manchester Grand Hyatt, Elizabeth Ballroom A
American Economic Association
Measurement Issues in the National Accounts
Price Indexes for Clinical Trial Research: A Feasibility Study
Ernst R. Berndt (Massachusetts Institute of Technology and NBER)
Iain M. Cockburn (Boston University and NBER)

Jan 06, 2013 10:15 am, Marriott Marquis & Marina, Cardiff & Carlsbad
American Finance Association
Compensation and Incentives (G3)
Discussants:
Carola Frydman (Boston University)

Jan 06, 2013 10:15 am, Manchester Grand Hyatt, America's Cup A & B
Econometric Society
Labor Markets and the Aggregate Economy (J6)
Unions in a Frictional Labor Market
Per Krusell (Stockholm University)
Leena Rudanko (Boston University)

Jan 06, 2013 10:15 am, Manchester Grand Hyatt, Gibbons
Econometric Society
Weakly Identified Models (C2)
Presiding: Zhongjun Qu (Boston University)
Bonferroni-Based Size-Correction for Nonstandard Testing Problems
Adam McCloskey (Brown University)
Local and Global Parameter Identification in DSGE Models Allowing for Indeterminacy
Zhongjun Qu (Boston University)
Denis Tkachenko (National University of Singapore)

Jan 06, 2013 10:15 am, Marriott Marquis & Marina, Laguna
Labor & Employment Relations Association
Unionization and Occupational Licensing: Similarities and Differences (J5)
Discussants:
David Weil (Boston University)

Jan 06, 2013 10:15 am, Marriott Marquis & Marina, Torrey Pines 3
National Economic Association
The Legacy of the War on Poverty (H3)
Discussants:
Robert Margo (Boston University)

Jan 06, 2013 1:00 pm, Manchester Grand Hyatt, Elizabeth Ballroom F
American Economic Association
Causes and Consequences of Credit Default Swap Trading (G1)
The Anatomy of the CDS Market
Martin Oehmke (Columbia University)
Adam Zawadowski (Boston University)

Jan 06, 2013 1:00 pm, Manchester Grand Hyatt, Randle E
American Economic Association
Impacts of Unilateral Climate Change Policy (Q5)
Discussants:
Ian Sue Wing (Boston University)

Jan 06, 2013 1:00 pm, Manchester Grand Hyatt, Manchester H & I
American Economic Association

Economic Analysis of Subjective Well-being

Aggregating Subjective Well-being for Marginal Policy Adjustments

Daniel Benjamin (Cornell University)
Ori Heffetz (Cornell University)
Miles Kimball (University of Michigan)
Nichole Szembrot (Cornell University)

 

--
_________________________________________
Randall P. Ellis, Ph.D.
Professor, Department of Economics, Boston University
270 Bay State Road, Boston MA 02215 USA
tel: 617-353-2741    ellisrp@bu.edu    http://blogs.bu.edu/ellisrp/

Wolfram site for Mathematica calculations and data

BU, BUHealth, General Economics

This is from an 2010 BUHealth post, but I am reposting it now since the alpha site is still live and useful.

I thank BU alum Veronica Vargas for sending me the following link to a Wolfram alpha web site. It can be a waste of time, but it also can provide scientific, numeric, and demographic information that is calculated specific to your interests at remarkable speed.  Visit it when you have time to kill. It seems to do most simple Mathematica can do without requiring any  license.

Overview with lots of examples

http://www.wolframalpha.com/examples/

Medical test examples useful for benchmarks.

http://www.wolframalpha.com/examples/MedicalTests.html

county level info
http://www.wolframalpha.com/input/?i=suffolk+county+ma

Math results, of course, which is their traditional strength. http://www.wolframalpha.com/input/?i=x^2+sin%28x%29

ASHEcon 2012 Ellis Presidential Address

BUHealth, Conferences

I have just posted the paper version of my June 11, 2012 Presidential Address to the American Society of Health Economists.

The title of the talk and paper is

Five Questions for Health Economists

Here are the five questions in case you want to ponder them before reading the paper.

Q1: If the ceiling in this room fell down and permanently paralyzed both of your legs, what type of health insurance coverage would you want?

Q2. What approach do you prefer to ensure that the individual premiums of older workers (age 65 and over) are not ten times the premium of young workers?

Q3a: If you were to choose one class of providers to give incentives to reduce total health spending, which one would it be?

Q3b. What would be your preferred alternative to fee-for-service payment for primary care practitioners (PCPs)?

Q4 How well is competition working at keeping down the costs of health care in the market where you live?

Q5 Why do economists spend so much time looking under lamp posts?

The written version of the address is now forthcoming (Expected:September, 2012) as Ellis, Randall P., 2012, Five Questions for Health Economists. International Journal of Health Care Finance and Economics, and will be available at www.Springerlink.com.



Average rebate was $151 per family, received by 19-31% of people

BUHealth

Why is this important ACA achievement getting so little attention in the US media?

From the British Medical Journal.

August 7, 2012

US health insurance firms issue $1.1bn in rebates to policy holders

BMJ 2012; 345 doi: 10.1136/bmj.e5329 (Published 7 August 2012)  

Cite this as: BMJ 2012;345:e5329

 

  1. Janice Hopkins Tanne

 

Nearly 13 million US citizens are receiving rebates totalling $1.1bn (£0.7bn; €0.9bn) from their health insurance companies this month.

President Barack Obama has pointed to the rebates as a benefit of the Affordable Care Act, the health reform law he passed in March 2010.1

The rebates were due because some health insurance companies failed to spend 80% to 85% of the insurance premiums they received on providing medical care, as required by the law.

The medical loss ratio, as it’s called, was 80:20 for insurance companies providing health insurance to smaller companies and 85:15 for those insuring larger firms. The health insurance companies can spend the remaining 20% or 15% on overheads, administration, bonuses, marketing, advertising, and so on.

Health insurers are now required to report their spending each year to the Department of Health and Human Services. Those that didn’t spend enough on medical care in 2011 have had to issue rebates for the difference. Some large insurers such as Aetna, Cigna, Humana, and United Healthcare were among them.

Consumers in each state received a notice from their insurance company telling them about the 80/20 or 85/15 rule, whether their company met it, and whether they would receive a rebate, said the Department of Health and Human Services. The information will also be posted on the department’s website.

The average rebate was about $151 per family, with rebates varying by insurance company and state.

Most people get their health insurance through their jobs, so their rebate was sent to their employer, which can share the rebate with the employee or use it to reduce future insurance premiums or to improve health benefits.

About 28% of smaller employers and 19% of larger employers providing group health insurance to their employees are getting rebates, said the Kaiser Family Foundation, an independent health policy and communications foundation.

Nearly a third (31%) of people who buy insurance directly from a health insurance company are receiving a rebate cheque in the mail.

The effect of the law is to encourage insurance companies to reduce their expenses, stop raising premiums to increase profits, and spend the premiums they receive on providing medical care.

The Kaiser Family Foundation estimated that the cost of employer provided health insurance plans for a family rose to $15 000 last year.2 Health insurance is paid partly by the employer and partly by the employee.

The law does not apply to people who receive healthcare through the Medicare (government insurance for elderly people and some disabled people) or Medicaid (insurance for poor people) programmes.

Notes

Cite this as: BMJ 2012;345:e5329

References

1.  Tanne JH. US House of Representatives approves historic healthcare reform bill. BMJ2010;340:c1635.
FREE Full Text
2.   Roehr B. Cost of employer provided health insurance double in US in a decade. BMJ2011;343:d6256.
FREE Full Text

Behavioral Economics: Toward a New Paradigm by Amitai Etzioni

BU, BUHealth, General Economics

I happened upon an interesting article in the American Behavioral Scientist which gave me new insights. I recommend it highly to you.

Behavioral Economics: Toward a New Paradigm

by Amitai Etzioni (George Washington University)

http://icps.gwu.edu/files/2011/09/Beh-Ec-New-Paradigm.pdf

American Behavioral Scientist 55(8) 1099–1119

Abstract
This article discusses the challenges behavioral economics poses for neoclassical economics
and the ways in which the young field may move forward. After reviewing some of
behavioral economics’ accomplishments and the responses to these accomplishments,
the article asks whether its findings can be incorporated into the neoclassical paradigm
and suggests additional steps behavioral economics may consider undertaking in order
to expand its reach.

Risk-adjusted Payment and Performance Assessment for Primary Care

BUHealth

Arlene and I have been working on calibrating risk adjustment models for primary care for four years, and are happy that this work is finally being reflected in a major article in Medical Care in August 2012. The articles are already available online, and should be officially in print soon. The four editorials signal how controversial our approach has proven.

 

Ash, Arlene S., Ellis, Randall P.  Risk-adjusted Payment and Performance Assessment for Primary Care.
Medical Care 50(8) August 2012.  643-653. DOI: 10.1097/MLR.0b013e3182549c74
Article

Horner, Ronnie D., Risk-adjusted Capitation in an Era of Personalized Medicine: A Dangerous Opportunity to Bend the Health Care Cost Curve.
Medical Care 50(8) August 2012. 633-634. DOI: 10.1097/MLR.0b013e31825c3e14
Editorial

Stukenborg, George J. , Commentary on Ash AS, Ellis RP Risk-adjusted Payment and Performance Assessment for Primary Care.
Medical Care 50(8) August 2012. 635-636. DOI: 10.1097/MLR.0b013e31825ca047
Editorial

Goroll, Allan H. , Risk Adjustment for Primary Care: An Essential Tool for Health System Reform.
Medical Care 50(8) August 2012. 637-639 DOI: 10.1097/MLR.0b013e31825cb499
Editorial

Grazier, Kyle L.,  Risk-adjusted Payment for and Performance Assessment of Primary Care.
Medical Care 50(8) August 2012. 640-642
DOI: 10.1097/MLR.0b013e31825cb487
Editorial

 

NEJM article on the Supreme Court Decision

BUHealth, Politics

I was leaving for vacation the day of the supreme court decision on the ACA, and did not make a posting. The following 2.5 page article from NEJM provides a nice summary of the decisions, which are slightly more complex than has been presented in the media.  The author is a law professor at Suffolk University here in Boston.

R.M. Landers | July 2, 2012 | DOI: 10.1056/NEJMp1206847

http://www.nejm.org/doi/full/10.1056/NEJMp1206847?query=TOC

 

17-Month Extension of OPT for Econometrics etc.

BU, BUHealth, General Economics, Jobs,

UPDATE: On May 11, 2012, the U.S. Department of Homeland Security added several fields of study to the list of CIP codes that now qualify for the 17-month extension of initial 12 months of Optional Practical Training (OPT). The new list of  majors - and their corresponding CIP codes - that qualify for the extension (updated in May 2012) include:

45.0603 Econometrics and Quantitative Economics
51.2007 Pharmacoeconomics/Pharmaceutical Economics

For more info visit:
http://www.bu.edu/isso/students/current/f1/employment/off-campus/17MonthExt.html

The list of fields included is shown here.
http://www.ice.gov/doclib/sevis/pdf/stem-list.pdf

Unfortunately the BU Economics program majors do not fit exactly into these areas, so this extension does NOT immediately apply to BU graduates. BU ISSO is working on it though. I apologize that my earlier post was more encouraging.

Ash and Ellis “Risk-adjusted Payment and Performance Assessment for Primary Care” is out

BUHealth, EC 581, EC 782

After working in the area for the past three years, I am happy to report that the paper below is finally out in  Medical Care.

Risk-adjusted Payment and Performance Assessment for Primary Care

Ash, Arlene S. PhD; Ellis, Randall P. PhD

The full version is currently posted as printed ahead of print, although the actual date of the publication is not yet known. You will need a OVID or a Lippincott Williams & Wilkins subscription to have access to the full paper. you can see if your university has access by visiting the site above. There is also a rich appendix with further results and tables.

Abstract
Background: Many wish to change incentives for primary care practices through bundled population-based payments and substantial performance feedback and bonus payments. Recognizing patient differences in costs and outcomes is crucial, but customized risk adjustment for such purposes is underdeveloped.

Research Design: Using MarketScan's claims-based data on 17.4 million commercially insured lives, we modeled bundled payment to support expected primary care activity levels (PCAL) and 9 patient outcomes for performance assessment. We evaluated models using 457,000 people assigned to 436 primary care physician panels, and among 13,000 people in a distinct multipayer medical home implementation with commercially insured, Medicare, and Medicaid patients.

Methods: Each outcome is separately predicted from age, sex, and diagnoses. We define the PCAL outcome as a subset of all costs that proxies the bundled payment needed for comprehensive primary care. Other expected outcomes are used to establish targets against which actual performance can be fairly judged. We evaluate model performance using R2's at patient and practice levels, and within policy-relevant subgroups.

Results: The PCAL model explains 67% of variation in its outcome, performing well across diverse patient ages, payers, plan types, and provider specialties; it explains 72% of practice-level variation. In 9 performance measures, the outcome-specific models explain 17%-86% of variation at the practice level, often substantially outperforming a generic score like the one used for full capitation payments in Medicare: for example, with grouped R2's of 47% versus 5% for predicting "prescriptions for antibiotics of concern."

Conclusions: Existing data can support the risk-adjusted bundled payment calculations and performance assessments needed to encourage desired transformations in primary care.

(C) 2012 Lippincott Williams & Wilkins, Inc.

It is currently only available as a publication ahead of print, 2012 Apr 19. [Epub ahead of print]

http://journals.lww.com/lww-medicalcare/Abstract/publishahead/Risk_adjusted_Payment_and_Performance_Assessment.99429.aspx

Risk-adjusted Payment and Performance Assessment for Primary Care.
Ash AS, Ellis RP.

2012 Handbook of Health Economics, on ScienceDirect

BUHealth, EC 581, EC 782, ,

2012 Handbook of Health Economics (Pauly, McGuire and Barros) is free on-line. Here is the link to the pdf files.

Excellent literature reviews and new insights. I purchased the hard cover version, but this is wonderfully accessible.

http://www.sciencedirect.com/science/handbooks/15740064

Many research universities, including BU have access to ScienceDirect.

It is unusual for Elsevier to post its new material for free access in this way.

Enjoy.

US Physician office visits declined 17% from 2009-2011

BUHealth, EC 581, EC 782

Being insured is no guarantee unemployed will seek care

Research suggests they may be unable to cover co-pays and deductibles, or fear they cannot afford the expenses that result.

By Victoria Stagg Elliott, amednews staff. Posted Feb. 7, 2012.

Unemployed people who have private health insurance are less likely to put off care because of cost than those without insurance or on public plans. But they are much more likely than the employed to stay away from the doctor's office.

"Even if you have insurance, you typically have to pay 20% or more of the price, and when you become unemployed, you become more cautious about spending money," said Randall Ellis, PhD, professor of economics at Boston University and president of the American Society of Health Economists. "You put off preventive visits, and if you have the flu, you choose not to go in for treatment."

About 29.3% of the unemployed had private insurance, according to a data brief issued Jan. 24 by the Centers for Disease Control and Prevention's National Center for Health Statistics analyzing adults 18-64 who participated in the National Health Interview Survey for 2009-2010 (www.cdc.gov/nchs/data/databriefs/db83.htm).

Full article is here.

http://www.ama-assn.org/amednews/2012/02/06/bisd0207.htm

Puzzling fact is that outpatient office visits declined by 17%:

"Outpatient office visits declined 17% among patients with private insurance -- from 156 million in the second quarter of 2009 to 129 million in the second quarter of 2011."

(Ibid)

Yet  total private insurance spending on physicians remained almost unchanged.

2009 2010 Change
Total $408.3 billion $415.8 billion 1.8%
Private insurance $209.0 billion $209.4 billion 0.2%

Source: National Health Expenditure Data, Centers for Medicare & Medicaid Services Office of the Actuary, January (www.cms.gov/nationalhealthexpenddata/01_overview.asp)

Also see: http://www.ama-assn.org/amednews/2012/01/23/gvl10123.htm

Could be worth exploring...

ARF 2009-10 is available free

BUHealth, EC 581, EC 782

ARF=Area Resource File

2009-2010 ARF Can Now Be Downloaded at No Cost.

The 2009-2010 ARF data files and documentation can now be downloaded. Click the link below to learn how to download ARF documentation and data.

http://arf.hrsa.gov/purchase.htm

"The basic county-specific Area Resource File (ARF) is the nucleus of the overall ARF System. It is a database containing more than 6,000 variables for each of the nation's counties. ARF contains information on health facilities, health professions, measures of resource scarcity, health status, economic activity, health training programs, and socioeconomic and environmental characteristics. In addition, the basic file contains geographic codes and descriptors which enable it to be linked to many other files and to aggregate counties into various geographic groupings."

"You may also choose to search the ARF to see what data variables are available in the current file."

The table of contents below gives a sense of the county level information included.



I.       DATA ELEMENT DESCRIPTIONS AND REFERENCES. 1


A.  CODES AND CLASSIFICATIONS. 1


A-1)        Header for ARF. 1


A-2)        State and County Codes. 1


A-3)        Census County Group Codes. 7


A-4)        County Typology Codes. 7


A-5)        Metropolitan/Micropolitan and Combined Statistical Areas. 10


A-6)        Rural/Urban Continuum Codes. 11


A-7)        Urban Influence Codes. 13


A-8)        BEA Economic Area Codes and Names and Component Economic 14                          Area Codes and Names.


A-9)        Federal Region Code and Census Region and Division Codes and Names. 14


A-10)     Veterans Administration Codes. 16


A-11)     Contiguous Counties. 17


A-12)     Health Service Area Codes. 18


A-13)     Area Health Education Center (AHEC) Codes and Names. 18


A-14)     HPSA Codes. 19


A-15)     SSA Beneficiary State and County Codes. 21


B.   HEALTH PROFESSIONS. 22


B-1)        Physicians. 22


B-2)        Dentists and Dental Hygienists. 31


B-3)        Optometrists. 36


B-4)        Pharmacists. 37


B-5)        Podiatrists. 38


B-6)        Veterinarians. 39


B-7)        Nurses. 40


B-8)        Physician Assistants. 43


B-9)        Chiropractors. 45


B-10)      Occupational Therapists. 46


B-11)      Physical Therapists. 46


B-12)      Psychology and Social Work Teachers. 47


B-13)      Psychologists. 47


B-14)      Sociologists. 48


B-15)      Social Workers. 48


B-16)     Audiologists   49


B-17)     Speech Language Pathologists  49


B-18)      Healthcare Practitioner Professionals. 50


B-19)      Decennial Census Occupation Data. 50


C.  HEALTH FACILITIES. 53


C-1)        Hospital Type. 54


C-2)        Hospital Services (or Facilities) 57


C-3)        Hospital Employment 57


C-4)        Nursing and Other Health Facilities. 58


C-5)        Health Maintenance Organizations. 60


C-6)        Preferred Provider Organizations (PPOs) 61


D.  UTILIZATION.. 61


D-1)        Utilization Rate. 62


D-2)        Inpatient Days. 62


D-3)        Outpatient Visits. 62


D-4)        Surgical Operations and Operating Rooms. 62


E.   EXPENDITURES. 63


E-1) Hospital Expenditures. 63


E-2) Medicare Advantage Adjusted Average Per Capita Cost (AAPCC) 63


F.   POPULATION.. 68


F-1) Population Estimates. 68


F-2) Population Counts and Number of Families and Households. 72


F-3) Population Percents. 82


F-4) Labor Force. 84


F-5) Per Capita Incomes. 86


F-6) Income. 88


F-7) Persons and Families Below Poverty Level 90


F-8) Ratio of Income to Poverty Level 92


F-9) Median Family Income. 93


F-10)      Household Income. 93


F-11)      Medicaid Eligibles. 97


F-12)      Medicare Enrollment Data. 99


F-13)      Medicare Advantage/Managed Care Penetration. 100


F-14)      Medicare Prescription Drug Plan (PDP) Penetration. 103


F-15)      Health Insurance Estimates. 103


F-16)      Food Stamp/SNAP Recipient Estimates. 104


F-17)      Social Security Program.. 104


F-18)      Supplemental Security Income Program Recipients. 105


F-19)      5‑Year Infant Mortality Rates. 107


F-20)      Infant Mortality Data. 108


F-21)      Mortality Data. 108


F-22)      Total Deaths. 111


F-23)      Natality Data. 111


F-24)      Births in Hospitals. 113


F-25)      Total Births. 113


F-26)      Education. 114


F-27)      Census Housing Data. 114


F-28)      Veteran Population. 117


G.  ENVIRONMENT.. 119


G-1)        Land Area and Density. 119


G-2)        Population Per Square Mile. 119


G-3)        Elevation. 119

	

	
	


							


	

		
				

			FAIR Health claims data, N=125 million
		

		
		

			BUHealth, 					

	


		

		


Window to the marketplace




FAIR Health now delivers the industry's primary source of out-of-network benchmarks with unprecedented transparency


"What was referred to as a "black box" in February 2008 today has become an open window to the healthcare marketplace. The  industry's privately owned database of usual-and-customary (UC) charge information is now a transparent, public information  source called FAIR Health." 


http://managedhealthcareexecutive.modernmedicine.com/mhe/Executive+Profile/Window-to-the-marketplace/ArticleStandard/Article/detail/747558?contextCategoryId=47227


Data sources


"Currently, FAIR has approximately 80 different data sources nationwide, collectively contributing claims data for 125 million  covered lives. Data is deidentified as to the payer source and the individual member's identity. By aggregating claims in  this way, FAIR can meet HIPAA requirements and discourage the use of information for competitive advantages among participating  payers. 


Gelburd says the required fields that FAIR collects from the claims data supplied by contributors include CPT codes, standard  charges, date and location of service. Additional fields include ICD-9 and ICD-10 codes, provider identifiers and negotiated,  in-network charges. The optional fields are particularly useful from a research perspective."


I would welcome comments from anyone who has used this data.


Randy








	

	
	


							

							


	

		
				

			Brocolli and Insurance Mandate
		

		
		

			BUHealth, Politics, 					

	


		

		
This is an excellent short NEJM article summarizing why the federal government does have the authority to mandate that people buy health insurance.   Written by a Harvard Law School professor.


The Irrelevance of the Broccoli Argument against the Insurance Mandate


Einer Elhauge, J.D.


N Engl J Med 2012; 366:e1January 5, 2012


Favorite passage:


"Others argue that the Constitution's framers could not possibly have envisioned a congressional power to force purchases. However, in 1790, the first Congress, which was packed with framers, required all ship owners to provide medical insurance for seamen; in 1798, Congress also required seamen to buy hospital insurance for themselves. In 1792, Congress enacted a law mandating that all able-bodied citizens obtain a firearm. This history negates any claim that forcing the purchase of insurance or other products is unprecedented or contrary to any possible intention of the framers."