Physician Consolidation and the Spread of Accountable Care Organizations

Accountable Care Organizations (ACOs) are groups of physicians and hospitals that jointly contract to care for a patient population. ACO contracts incentivize coordination of care across providers. This can lead to greater consolidation of physician practices, which can in turn generate higher costs and lower quality. Given this, the study asks, as ACOs enter health care markets, do physician practices grow larger

A distance of a point from a line

U ovom članku razmatra se metoda računanja udaljenosti točke od eksplicitno, parametarski, te polarno zadane krivulje. U literaturi za ovaj problem postoji eksplicitno rješenje za slučaj afine funkcije, te za još neke specijalne slučajeve.This article considers the method for calculating the distance of a point to the curve given explicitly, in parameter and polar form. In literature, there exists an explicit solution to this problem for the case of affine fuctions as well as for some other special cases

The role of community health centers in reducing racial disparities in spatial access to primary care

Introduction: Racial minorities are more likely to live in primary care shortage areas. We sought to understand community health centers’ (CHCs) role in reducing disparities. Methods: We surveyed all primary care practices in an urban area, identified low access areas, and examined how CHCs influence spatial accessibility. Results: Census tracts with higher rates of public insurance (≥40% vs <10%, odds ratio [OR] = 31.06, P < .001; 30-39% vs 10%, OR = 7.84, P = 0.001) were more likely to be near a CHC and those with moderate rates of uninsurance (10%-19% vs <10%, OR = 0.42, P = .045) were less likely. Racial composition was not associated with proximity. Tracts close to a CHC were less likely (OR = 0.11, P < .0001) to be in a low access area. This association did not differ based on racial composition. Discussion: Although CHCs were more likely to be in areas with a greater fraction of racial minorities, location was more strongly influenced by public insurance rates. CHCs reduced the likelihood of being in low access areas but the effect did not vary by tract racial composition

Economic Evaluations of Pharmacologic Treatment for Opioid Use Disorder: A Systematic Literature Review

The crisis of opioid use puts a strain on resources in the United States and worldwide. There are 3 US Food and Drug Administration–approved medications for treatment of opioid use disorder: methadone, buprenorphine, and injectable extended-release naltrexone (XR-NTX). The comparative effectiveness and cost vary considerably among these 3 medications. Economic evaluations provide evidence that help stakeholders efficiently allocate scarce resources. Our objective was to summarize recent health economic evidence of pharmacologic treatment of opioid use disorder interventions. We searched PubMed for peer-reviewed studies in English from August 2015 through December 2019 as an update to a 2015 review. We used the Drummond checklist to evaluate and categorize economic evaluation study quality. We summarized results by economic evaluation methodology and pharmacologic treatment modality. We identified 105 articles as potentially relevant and included 21 (4 cost-offset studies and 17 cost-effectiveness/cost-benefit studies). We found strengthened evidence on buprenorphine and methadone, indicating that these treatments are economically advantageous compared with no pharmacotherapy, but found limited evidence on XR-NTX. Only half of the cost-effectiveness studies used a generic preference-based measure of effectiveness, limiting broad comparison across diseases/disorders. The disease/disorder-specific cost-effectiveness measures vary widely, suggesting a lack of consensus on the value of substance use disorder treatment. We found studies that provide new evidence supporting the cost-effectiveness of buprenorphine compared with no pharmacotherapy. We found a lack of evidence supporting superior economic value for buprenorphine versus methadone, suggesting that both are attractive alternatives. Further economic research is needed on XR-NTX, as well as other emerging pharmacotherapies, treatment modalities, and dosage forms. •There is new evidence on buprenorphine and strengthened evidence on methadone, indicating that both are economically advantageous treatments for opioid use disorder compared with no pharmacotherapy.•Approximately half of the recent cost-effectiveness studies used a generic preference-based measure of effectiveness (ie, quality-adjusted life-years or disability-adjusted life-years), limiting broad comparison across diseases/disorders because quality-adjusted life-years or disability-adjusted life-years are the only health economic effectiveness measures with commonly accepted value thresholds. There is wide variation in disease/disorder-specific measures, thereby limiting comparisons within the substance use disorder literature.•More economic evidence is needed on injectable naltrexone and novel treatment-delivery modalities