Heterogeneity in the Effect of Common Shocks on Healthcare Expenditure Growth

Health care expenditure growth is affected by important unobserved common shocks such as technological innovation, changes in sociological factors, shifts in preferences and the epidemiology of diseases. While common factors impact in principle all countries, their effect is likely to differ across countries. To allow for unobserved heterogeneity in the effects of common shocks, we estimate a panel data model of health care expenditure growth in 34 OECD countries over the years 1980 to 2012 where the usual fixed or random effects are replaced by a multifactor error structure. We address model uncertainty with Bayesian Model Averaging, to identify a small set of important expenditure drivers from 43 potential candidates. We establish 16 significant drivers of healthcare expenditure growth, including growth in GDP per capita and in insurance premiums, changes in financing arrangements and some institutional characteristics, expenditures on pharmaceuticals, population aging, costs of health administration, and inpatient care. Our approach allows us to derive estimates that are less subject to bias than in previous analyses, and provide robust evidence to policy makers on the drivers that were most strongly associated with the growth in health care expenditures over the past 32 years

The impact of CHIP premium increases on insurance outcomes among CHIP eligible children

Background: Within the United States, public insurance premiums are used both to discourage private health policy holders from dropping coverage and to reduce state budget costs. Prior research suggests that the odds of having private coverage and being uninsured increase with increases in public insurance premiums. The aim of this paper is to test effects of Children's Health Insurance Program (CHIP) premium increases on public insurance, private insurance, and uninsurance rates. Methods: The fact that families just below and above a state-specific income cut-off are likely very similar in terms of observable and unobservable characteristics except the premium contribution provides a natural experiment for estimating the effect of premium increases. Using 2003 Medical Expenditure Panel Survey (MEPS) merged with CHIP premiums, we compare health insurance outcomes for CHIP eligible children as of January 2003 in states with a two-tier premium structure using a cross-sectional regression discontinuity methodology. We use difference-in-differences analysis to compare longitudinal insurance outcomes by December 2003. Results: Higher CHIP premiums are associated with higher likelihood of private insurance. Disenrollment from CHIP in response to premium increases over time does not increase the uninsurance rate. Conclusions: When faced with higher CHIP premiums, private health insurance may be a preferable alternative for CHIP eligible families with higher incomes. Therefore, competition in the insurance exchanges being formed under the Affordable Care Act could enhance choice

A Retrospective Cohort Study of the Potency of lipid-lowering therapy and Race-gender Differences in LDL cholesterol control

<p>Abstract</p> <p>Background</p> <p>Reasons for race and gender differences in controlling elevated low density lipoprotein (LDL) cholesterol may be related to variations in prescribed lipid-lowering therapy. We examined the effect of lipid-lowering drug treatment and potency on time until LDL control for black and white women and men with a baseline elevated LDL.</p> <p>Methods</p> <p>We studied 3,484 older hypertensive patients with dyslipidemia in 6 primary care practices over a 4-year timeframe. Potency of lipid-lowering drugs calculated for each treated day and summed to assess total potency for at least 6 and up to 24 months. Cox models of time to LDL control within two years and logistic regression models of control within 6 months by race-gender adjust for: demographics, clinical, health care delivery, primary/specialty care, LDL measurement, and drug potency.</p> <p>Results</p> <p>Time to LDL control decreased as lipid-lowering drug potency increased (P < 0.001). Black women (N = 1,440) received the highest potency therapy (P < 0.001) yet were less likely to achieve LDL control than white men (N = 717) (fully adjusted hazard ratio [HR] 0.66 [95% CI 0.56-0.78]). Black men (N = 666) and white women (N = 661) also had lower adjusted HRs of LDL control (0.82 [95% CI 0.69, 0.98] and 0.75 [95% CI 0.64-0.88], respectively) than white men. Logistic regression models of LDL control by 6 months and other sensitivity models affirmed these results.</p> <p>Conclusions</p> <p>Black women and, to a lesser extent, black men and white women were less likely to achieve LDL control than white men after accounting for lipid-lowering drug potency as well as diverse patient and provider factors. Future work should focus on the contributions of medication adherence and response to treatment to these clinically important differences.</p

DEPRESSION OF PHAGOCYTOSIS BY SOLUTES IN CONCENTRATIONS FOUND IN THE KIDNEY AND URINE

Immunologic processes in the kidney encounter wide variations in solute concentration and os-motic pressure that exist in no other extracellular fluids (1). It can be anticipated, for example, that leukocytes in the kidney might be exposed to 425 mM per L sodium and 850 mM per L urea, tissue concentrations demonstrated in the renal papillae of mammals. Between the extremes of maximum diuresis and antidiuresis, phagocytic cells might be exposed to tubular fluid that ranges from under 50 to over 1,300 mOsm per L, or ap-proximately one-sixth to four times the osmotic pressure of plasma (1). In order to determine how leukocytes function in this environment, the present study was made of phagocytosis in urine and in improvised fluids containing solutes in the concentrations found in the kidney and urinary tract. The results show that such concentrations of urinary solutes depress phagocytosis and may thereby contribute to the unique susceptibility of the kidney to infection by bacteria that seldom produce disease elsewhere. METHODS A. Technique for studying phagocytosis Four-tenths (0.4) ml fresh heparinized human venous blood or 0.2 ml plasma-leukocyte suspensions were added to 2 ml of test solution and mixed with 0.2 ml of bac-terial suspensions in sterile pyrogen-free glass tubes 10 to 11 mm in diameter and 10 cm long. The tubes were immediately stoppered and rotated mechanically at 5 revolutions per minute at 37 ° C. Tubes containing staphylococci were rotated for 30 minutes and those con-taining Escherichia coli for 2 hours, periods found in preliminary studies to be required for heavy phagocytosis of either species of bacteria. After rotation the tubes were inverted 10 to 15 times, and smears prepared on glass slides for staining with combined Wright-Giemsa&apos;s stain. The number of bacteria per 100 neutrophiles and the per cent of cells exhibiting phagocytosis were compare

credit, including © notice, is given to the source. Learning and the Value of Information: Evidence From Health Plan Report Cards

capable programming assistance of Joe Vasey. The views expressed herein are those of the authors and not necessarily those of the National Bureau of Economic Research, the Federal Reserve Bank of San Francisco or any other institution with which the authors are affiliated

Price vs. quantity in health insurance reimbursement

While “integrated” systems regulate the quantity of health services, “Bismarckian” systems regulate their price. This paper compares the consumers’ allocations implemented within the two reimbursement systems. In the model, illness has a negative impact on labor productivity while public insurance is financed through income tax. Consumers have private information with respect to a parameter which can be interpreted as heterogeneity either in intensity of their preferences for treatment or in the type of illness. The social planner may be constrained to adopt uniform insurance plans, or may be free to choose self selecting plans. The analysis of uniform plans shows that Bismarckian systems dominate integrated systems from the social welfare point of view; whereas the opposite ranking holds with self-selecting plans. Copyright Springer Science+Business Media, LLC 2006Public health insurance, In-kind transfers, Reimbursement insurance, Adverse selection, I11, I18, D82, H42,