Long‐term care and pay‐for‐performance programs

Pay‐for‐performance programs are gradually spreading across Asia. This paper builds on the longer experience in the United States to offer lessons for Asia. The Center for Medicare and Medicaid Services has introduced several pay‐for‐performance programs since 2012 to encourage hospitals to improve quality of care and reduce costs. Some state Medicaid programs have also introduced pay‐for‐performance for nursing homes. Long‐term care providers play an important role in hospital pay‐for‐performance programs because they can affect the readmission rate and also total episode payments. A good pay‐for‐performance program will focus on improving quality of care that affects health outcomes. In addition, that quality must vary across providers and be measurable. Furthermore, it is important that the measures be reported in a timely way, that both demand and supply respond to the measures, and that the measures be risk adjusted. Empirical data from Medicare beneficiaries in the state of Michigan show that mean episode payments and readmission rates in skilled nursing facilities vary widely and are sensitive to the number of observations. These practical matters create challenges for implementing pay‐for‐performance in practice. There is an extensive literature review of pay‐for‐performance in long‐term care in the United States and in Asia.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/145582/1/rode12359.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/145582/2/rode12359_am.pd

How Home Health Agencies’ Ownership Affects Practice Patterns

This study explores whether for‐profit home health agencies responded differently from non‐profit agencies to financial incentives embedded in the Medicare prospective payment system. Agencies were able to receive higher reimbursement per patient under the prospective payment system if they adjusted the number of therapy visits or the type of visits for a two‐month‐long episode. Agencies could also increase reimbursement by treating a patient for multiple episodes of care, because prospective payments were made on a per‐episode basis. Using the Medicare Claims and Provider of Services Files from 2001 to 2009, we examine differences between for‐profit and non‐profit agencies in these practice patterns during the first nine years of the prospective payment system. We find that for‐profit agencies were more likely to adopt most of these practice patterns than were non‐profit agencies. This finding suggests that for‐profit agencies were more responsive to financial incentives, and therefore disproportionately contributed to the increase in Medicare home health spending under the prospective payment system. Policymakers could consider revising the current prospective payment system that gives agencies incentives to distort practice patterns regardless of a patient’s health care needs.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/138406/1/fisc12136_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/138406/2/fisc12136-sup-0001-text.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/138406/3/fisc12136.pd

International Health Economics Association Seventeenth Annual Kenneth J. Arrow Award in Health Economics

No AbstractPeer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/60907/1/1406_ftp.pd

Weight and wages: fat versus lean paychecks

Past empirical work has shown a negative relationship between the body mass index (BMI) and wages in most cases. We improve on this work by allowing the marginal effect of non-linear BMI groups to vary by gender, age, and type of interpersonal relationships required in each occupation. We use the National Longitudinal Survey of Youth 1979 (1982–1998). We find that the often-reported negative relationship between the BMI and wages is larger in occupations requiring interpersonal skills with presumably more social interactions. Also, the wage penalty increases as the respondents get older beyond their mid-twenties. We show that being overweight and obese penalizes the probability of employment across all race–gender subgroups except black women and men. Our results for the obesity–wage association can be explained by either consumers or employers having distaste for obese workers. Copyright © 2008 John Wiley & Sons, Ltd.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/62135/1/1386_ftp.pd

Is a Skilled Nursing Facility’s Rehospitalization Rate a Valid Quality Measure?

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/134892/1/hesr12603-sup-0001-AuthorMatrix.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/134892/2/hesr12603.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/134892/3/hesr12603_am.pd

Testing for family influences on obesity: The role of genetic nurture

A large literature has documented strong positive correlations among siblings in health, including body mass index (BMI) and obesity. This paper tests whether that is explained by a specific type of peer effect in obesity: genetic nurture. Specifically, we test whether an individual’s weight is affected by the genes of their sibling, controlling for the individual’s own genes. Using genetic data in Add Health, we find no credible evidence that an individual’s BMI is affected by the polygenic risk score for BMI of their full sibling when controlling for the individual’s own polygenic risk score for BMI. Thus, we find no evidence that the positive correlations in BMI between siblings are attributable to genetic nurture within families.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/149721/1/hec3889.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/149721/2/hec3889_am.pd

The Design of Wind Tunnels and Wind Tunnel Propellers

Report discusses the theory of energy losses in wind tunnels, the application of the Drzewiecki theory of propeller design to wind tunnel propellers, and the efficiency and steadiness of flow in model tunnels of various types

Informal Care and Caregiver's Health

This study aims to measure the causal effect of informal caregiving on the health and health care use of women who are caregivers, using instrumental variables. We use data from South Korea, where daughters and daughters‐in‐law are the prevalent source of caregivers for frail elderly parents and parents‐in‐law. A key insight of our instrumental variable approach is that having a parent‐in‐law with functional limitations increases the probability of providing informal care to that parent‐in‐law, but a parent‐in‐law's functional limitation does not directly affect the daughter‐in‐law's health. We compare results for the daughter‐in‐law and daughter samples to check the assumption of the excludability of the instruments for the daughter sample. Our results show that providing informal care has significant adverse effects along multiple dimensions of health for daughter‐in‐law and daughter caregivers in South Korea. Copyright © 2013 John Wiley & Sons, Ltd.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/110580/1/hec3012.pd

Standard errors for the retransformation problem with heteroscedasticity.

Abstract Economists often estimate models with a log-transformed dependent variable. The results from the log-transformed model are often retransformed back to the unlogged scale. Other studies have shown how to obtain consistent estimates on the original scale but have not provided variance equations for those estimates. In this paper, we derive the variance for three estimates -the conditional mean of y, the slope of y, and the average slope of y -on the retransformed scale. We then illustrate our proposed procedures with skewed health expenditure data from a sample of Medicaid eligible patients with severe mental illness.