Integrating comparative effectiveness research programs into predictive health: A unique role for academic health centers

Abstract The growing burden of chronic disease, an aging population, and rising health care costs threaten the sustainability of our current model for health care delivery

High Quality Care and Ethical Pay-for-Performance: A Society of General Internal Medicine Policy Analysis

BACKGROUND: Pay-for-performance is proliferating, yet its impact on key stakeholders remains uncertain. OBJECTIVE: The Society of General Internal Medicine systematically evaluated ethical issues raised by performance-based physician compensation. RESULTS: We conclude that current arrangements are based on fundamentally acceptable ethical principles, but are guided by an incomplete understanding of health-care quality. Furthermore, their implementation without evidence of safety and efficacy is ethically precarious because of potential risks to stakeholders, especially vulnerable patients. CONCLUSION: We propose four major strategies to transition from risky pay-for-performance systems to ethical performance-based physician compensation and high quality care. These include implementing safeguards within current pay-for-performance systems, reaching consensus regarding the obligations of key stakeholders in improving health-care quality, developing valid and comprehensive measures of health-care quality, and utilizing a cautious evaluative approach in creating the next generation of compensation systems that reward genuine quality

Correlates of Controlled Hypertension in Indigent, Inner-City Hypertensive Patients

OBJECTIVE: To identify correlates of controlled hypertension in a largely minority population of treated hypertensive patients. DESIGN: Case-control study. SETTING: Urban, public hospital. PATIENTS: A consecutive sample of patients who were aware of their diagnosis of hypertension for at least 1 month and had previously filled an antihypertensive prescription. Control patients had a systolic blood pressure (SBP) ≤ 140 mm Hg and diastolic blood pressure (DBP) ≤ 90 mm Hg, and case patients had a SBP ≥ 180 mm Hg or DBP ≥ 110 mm Hg. MEASUREMENTS AND MAIN RESULTS: Control subjects had a mean blood pressure (BP) of 130/80 mm Hg and case subjects had a mean BP of 193/106 mm Hg. Baseline demographic characteristics between the 88 case and the 133 control subjects were not significantly different. In a logistic regression model, after adjusting for age, gender, race, education, owning a telephone, and family income, controlled hypertension was associated with having a regular source of care (odds ratio [OR] 7.93; 95% confidence interval [CI] 3.86, 16.29), having been to a doctor in the previous 6 months (OR 4.81; 1.14, 20.31), reporting that cost was not a deterrent to buying their antihypertensive medication (OR 3.63; 1.59, 8.28), and having insurance (OR 2.15; 1.02, 4.52). Being compliant with antihypertensive medication regimens was of borderline significance (OR 1.96; 0.99, 3.88). A secondary analysis found that patients with Medicaid coverage were significantly less likely than the uninsured to report cost as a barrier to purchasing antihypertensive medications and seeing a physician. CONCLUSIONS: The absence of out-of-pocket expenditures under Medicaid for medications and physician care may contribute significantly to BP control. Improved access to a regular source of care and increased sensitivity to medication costs for all patients may lead to improved BP control in an indigent, inner-city population

Designing Insurance to Promote Use of Childhood Obesity Prevention Services

Childhood obesity is a recognized public health crisis. This paper reviews the lessons learned from a voluntary initiative to expand insurance coverage for childhood obesity prevention and treatment services in the United States. In-depth telephone interviews were conducted with key informants from 16 participating health plans and employers in 2010-11. Key informants reported difficulty ensuring that both providers and families were aware of the available services. Participating health plans and employers are beginning new tactics including removing enrollment requirements, piloting enhanced outreach to selected physician practices, and educating providers on effective care coordination and use of obesity-specific billing codes through professional organizations. The voluntary initiative successfully increased private health insurance coverage for obesity services, but the interviews described variability in implementation with both best practices and barriers identified. Increasing utilization of obesity-related health services in the long term will require both family- and provider-focused interventions in partnership with improved health insurance coverage

Delivering Public Health Care Services: Substitutes, Complements, or Both?

In this article we investigate how the availability of public health care providers increases (complement) or decreases (substitute) the likelihood of having public or private health insurance. The probability of each of three insurance alternatives (uninsured, Medicaid, private insurance) is modeled as a function of the availability of public programs in the respondents'community along with individual characteristics including family income, health status, and family structure. Using population-based estimates, public hospitals are associated with a crowd-out rate of 3.5 percent to 8.6 percent. Federally qualified health centers were associated with a net complementary effect (additional public insurance take-up) of 7.1 percent. (JEL "I11", "I18", "I38") Copyright 2005 Western Economic Association International.