Does Increased Hospital Spending Reduce Mortality?

According to Romley, Jena and Goldman (2011), the answer is yes. For each of 6 diagnoses at admission—acute myocardial infarction, congestive heart failure, acute stroke, gastrointestinal hemorrhage, hip fracture, and pneumonia—patient admission to higher-spending hospitals was associated with lower risk-adjusted inpatient mortality. During 1999 to 2003, for example, patients admitted with acute myocardial infarction to…

The Unintended Consequences of P4P

Pay-for-performance (P4P) may be better at improving documentation of outcomes rather than actually improving outcomes.  Farmer, Black and Bonow give the following example: Beginning in the fourth quarter of 2008, [CMS] ceased to reimburse for costs due to selected preventable adverse events, including patient safety indicator 5 (PSI-5) (leaving a foreign object in the body…

Will you have enough money for retirement?

For many individuals, the answer is increasingly ‘no’.   Yahoo and the Wall Street Journal report that: Fifty-seven percent of U.S. workers surveyed reported less than $25,000 in total household savings and investments excluding their homes, according to a report to be released Tuesday by the Employee Benefit Research Institute. Only 49% reported having so…

Local Instrumental Variables

What is the effect of a treatment on health outcomes?  The real question is: can you be more specific? Researchers may measure the treatment effect a variety of ways.  Sensible research questions include: What is the average effect of the treatment across all individuals? What is the average treatment effect only among those who received…

Device Pricing Policies in the U.S. and Europe

How do public payers set device reimbursement in the U.S. and Europe?  A Health Affairs article by Sorenson, Drummond and Burns answers this question. Compared to the United States, Europe more formally and consistently considers value to determine which technologies to cover and at what price, especially for complex, costly devices. Both the United States and Europe have…

Solving the War on Drugs?

Ultimately, the solution to the drug problem might be the solution to the problem of life, which is how to navigate our time here with minimal suffering. Unfortunately, the policy that offers that solution will be not a drug policy but an existential one, and it remains as elusive as ever. Graeme Wood in The…