Healthcare Price Transparency: Policy Approaches and Estimated Impacts on Spending

Healthcare price transparency discussions typically focus on increasing patients' access to information about their out-of-pocket costs, but that focus is too narrow and should include other audiences -- physicians, employers, health plans and policymakers -- each with distinct needs and uses for healthcare price information. Greater price transparency can reduce U.S. healthcare spending.For example, an estimated $100 billion could be saved over the next 10 years if three select interventions were undertaken. However, most of the projected savings come from making price information available to employers and physicians, according to an analysis by researchers at the former Center for Studying Health System Change (HSC). Based on the current availability and modest impact of plan-based transparency tools, requiring all private plans to provide personalized out-of-pocket price data to enrollees would reduce total health spending by an estimated$18 billion over the next decade. While $18 billion is a substantial dollar amount, it is less than a tenth of a percent of the$40 trillionin total projected health spending over the same period. In contrast, using state all-payer claims databases to gather and report hospital-specific prices might reduce spending by an estimated $61 billion over 10 years.The effects of price transparency depend critically on the intended audience, the decision-making context and how prices are presented. And the impact of price transparency can be greatly amplified if target audiences are able and motivated to act on the information. Simply providing prices is insufficient to control spending without other shifts in healthcare financing, including changes in benefit design to make patients more sensitive to price differences among providers and alternative treatments. Other reforms that can amplify the impact of price transparency include shifting from fee-for-service payments that reward providers for volume to payment methods that put providers at risk for spending for episodes of care or defined patient populations. While price transparency alone seems unlikely to transform the healthcare system, it can play a needed role in enabling effective reforms in value-based benefit design and provider payment

Latent protein trees

Unbiased, label-free proteomics is becoming a powerful technique for measuring protein expression in almost any biological sample. The output of these measurements after preprocessing is a collection of features and their associated intensities for each sample. Subsets of features within the data are from the same peptide, subsets of peptides are from the same protein, and subsets of proteins are in the same biological pathways, therefore, there is the potential for very complex and informative correlational structure inherent in these data. Recent attempts to utilize this data often focus on the identification of single features that are associated with a particular phenotype that is relevant to the experiment. However, to date, there have been no published approaches that directly model what we know to be multiple different levels of correlation structure. Here we present a hierarchical Bayesian model which is specifically designed to model such correlation structure in unbiased, label-free proteomics. This model utilizes partial identification information from peptide sequencing and database lookup as well as the observed correlation in the data to appropriately compress features into latent proteins and to estimate their correlation structure. We demonstrate the effectiveness of the model using artificial/benchmark data and in the context of a series of proteomics measurements of blood plasma from a collection of volunteers who were infected with two different strains of viral influenza.Comment: Published in at http://dx.doi.org/10.1214/13-AOAS639 the Annals of Applied Statistics (http://www.imstat.org/aoas/) by the Institute of Mathematical Statistics (http://www.imstat.org

Method of analysis for compressible flow through mixed-flow centrifugal impellers of arbitrary design

A method is presented for analysis of the compressible flow between the hub and the shroud of mixed-flow impellers of arbitrary design. Axial symmetry was assumed, but the forces in the meridional (hub to shroud) plane, which are derived from tangential pressure gradients, were taken into account. The method was applied to an experimental mixed-flow impeller. The analysis of the flow in the meridional plane of the impeller showed that the rotational forces, the blade curvature, and the hub-shroud profile can introduce severe velocity gradients along the hub and the shroud surfaces. Choked flow at the impeller inlet as determined by the analysis was verified by experimental results

A MUSE map of the central Orion Nebula (M 42)

We present a new integral-field spectroscopic dataset of the central part of the Orion Nebula (M 42), observed with the MUSE instrument at the ESO VLT. We reduced the data with the public MUSE pipeline. The output products are two FITS cubes with a spatial size of ~5.9'x4.9' (corresponding to ~0.76 pc x 0.63 pc) and a contiguous wavelength coverage of 4595...9366 Angstrom, spatially sampled at 0.2". We provide two versions with a sampling of 1.25 Angstrom and 0.85 Angstrom in dispersion direction. Together with variance cubes these files have a size of 75 and 110 GiB on disk. They represent one of the largest integral field mosaics to date in terms of information content. We make them available for use in the community. To validate this dataset, we compare world coordinates, reconstructed magnitudes, velocities, and absolute and relative emission line fluxes to the literature and find excellent agreement. We derive a two-dimensional map of extinction and present de-reddened flux maps of several individual emission lines and of diagnostic line ratios. We estimate physical properties of the Orion Nebula, using the emission line ratios [N II] and [S III] (for the electron temperature $T_e$) and [S II] and [Cl III] (for the electron density $N_e$), and show two-dimensional images of the velocity measured from several bright emission lines.Comment: Resubmitted to A&A after incorporating referee comments; access to full dataset via http://muse-vlt.eu/science/data-release

Perspectives from deductible plan enrollees: plan knowledge and anticipated care-seeking changes

<p>Abstract</p> <p>Background</p> <p>Consumer directed health care proposes that patients will engage as informed consumers of health care services by sharing in more of their medical costs, often through deductibles. We examined knowledge of deductible plan details among new enrollees, as well as anticipated care-seeking changes in response to the deductible.</p> <p>Methods</p> <p>In a large integrated delivery system with a range of deductible-based health plans which varied in services included or exempted from deductible, we conducted a mixed-method, cross-sectional telephone interview study.</p> <p>Results</p> <p>Among 458 adults newly enrolled in a deductible plan (71% response rate), 51% knew they had a deductible, 26% knew the deductible amount, and 6% knew which medical services were included or exempted from their deductible. After adjusting for respondent characteristics, those with more deductible-applicable services and those with lower self-reported health status were significantly more likely to know they had a deductible. Among those who knew of their deductible, half anticipated that it would cause them to delay or avoid medical care, including avoiding doctor's office visits and medical tests, even services that they believed were medically necessary. Many expressed concern about their costs, anticipating the inability to afford care and expressing the desire to change plans.</p> <p>Conclusion</p> <p>Early in their experience with a deductible, patients had limited awareness of the deductible and little knowledge of the details. Many who knew of the deductible reported that it would cause them to delay or avoid seeking care and were concerned about their healthcare costs.</p

Les enseignants: à la recherche de leur profession

Les Enseignants: à la recherche de leur profession reprend les idées centrales présentées à la Conférence donnée, sur l'invitation de l'ATEE, au Séminaire de Barcelone, en 1993. Cet article est la reproduction du texte de support à la Conférence. Étant donné l'espace disponible, il n'a pas été possible de le travailler dans le sens d'une plus grande problématisation et élaboration théorique

Design and commissioning of Fermilab's vertical test stand for ILC SRF cavities.

As part of its ILC program, Fermilab is developing a facility for vertical testing of SRF cavities. It operates at a nominal temperature of 2K, using a cryoplant that can supply LHe in excess of 20g/sec and provide bath pumping capacity of 125W at 2K. The below-grade cryostat consists of a vacuum vessel and LHe vessel, equipped with magnetic shielding to reduce the ambient magnetic field to &lt;10mG. Internal fixed and external movable radiation shielding ensures that exposure to personnel is minimized. The facility features an integrated personnel safety system consisting of RF switches, interlocks, and area radiation monitors

Veterans Affairs Health System and Mental Health Treatment Retention among Patients with Serious Mental Illness: Evaluating Accessibility and Availability Barriers

We examine the impact of two dimensions of access—geographic accessibility and availability—on VA health system and mental health treatment retention among patients with serious mental illness (SMI). Methods . Among 156,631 patients in the Veterans Affairs (VA) health care system with schizophrenia or bipolar disorder in fiscal year 1998 (FY98), we used Cox proportional hazards regression to model time to first 12-month gap in health system utilization, and in mental health services utilization, by the end of FY02. Geographic accessibility was operationalized as straight-line distance to nearest VA service site or VA psychiatric service site, respectively. Service availability was assessed using county-level VA hospital beds and non-VA beds per 1,000 county residents. Patients who died without a prior gap in care were censored. Results . There were 32, 943 patients (21 percent) with a 12-month gap in health system utilization; 65,386 (42 percent) had a 12-month gap in mental health services utilization. Gaps in VA health system utilization were more likely if patients were younger, nonwhite, unmarried, homeless, nonservice-connected, if they had bipolar disorder, less medical morbidity, an inpatient stay in FY98, or if they lived farther from care or in a county with fewer VA inpatient beds. Similar relationships were observed for mental health, however being older, female, and having greater morbidity were associated with increased risks of gaps, and number of VA beds was not significant. Conclusions . Geographic accessibility and resource availability measures were associated with long-term continuity of care among patients with SMI. Increased distance from providers was associated with greater risks of 12-month gaps in health system and mental health services utilization. Lower VA inpatient bed availability was associated with increased risks of gaps in health system utilization. Study findings may inform efforts to improve treatment retention.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/73433/1/j.1475-6773.2006.00642.x.pd