Patient Reported Quality

Should doctors financial incentives be tied to patient perceptions of quality?  Some physicians are reluctant for this to happen.  Paula Chatterjee and co-authors, however, argue that patient satisfaction should play a role in how incentives tied to value-based care are measured. Although I do not disagree with Chatterjee, it is not clear how patient perceptions of…

ICD-10 Oddities

On October 1, Medicare switched from ICD-9 to ICD-10 diagnosis coding.  As a researcher, I appreciate that ICD-10 will give a much more granular representation of a disease.  However, the risk is that the level of granularity is so fine that the administrative costs on providers becomes high.  Some of the diagnose codes, in fact, seem…

Income and weight gain

Cross sectional analysis finds that individuals with lower income are more likely to be overweight or obese. Does this imply that increased income causes weight loss? A paper by Au and Johnston (2015) find the opposite result. In this paper, we use nationally representative panel data and exogenous wealth shocks (primarily inheritances and lottery wins)…

Innovation: The good and the bad

Our data, for example, show that a third of Medicare’s spending in physician or outpatient settings in 2012 reflects technology that did not exist a decade earlier…When it comes to technology development, the central challenge is to encourage high-value innovation while discouraging innovation that drives up costs without much improving health. Bagley, Chandra and Frakt. Correcting Signals for…

Angus Deaton wins nobel prize in economics

You can find the Nobel website press release here: The work for which Deaton is now being honored revolves around three central questions: How do consumers distribute their spending among different goods?Answering this question is not only necessary for explaining and forecasting actual consumption patterns, but also crucial in evaluating how policy reforms, like changes…

“Best price”

What price does Medicaid pay for drugs? The answer is, the “best price”.  What is “best price?” The 1990 Omnibus Reconciliation Act (OBRA) codified that pharmaceutical manufacturers must give Medicaid steep discounts in order to receive coverage by state Medicaid agency.  How big are the discounts?  The answer is the larger of a fixed percentage of the…

The end of dose-based drug pricing?

A Health Affairs post by Dana Goldman and Darius Lakdawalla argues that dose-based pricing for pharmaceuticals is suboptimal.  They make a clear distinction between typical goods, where cost and benefits are roughly proportional to quantity consumed, and pharmaceuticals. Buying two bunches of bananas naturally costs twice as much as one bunch. Twice as many bananas can…