Unbiased Analysis of Today's Healthcare Issues

Some good news

Written By: Jason Shafrin - May• 13•15

The Ebola epidemic in Liberia has ended according to the WHO.  The NY Times reports:

“The outbreak of Ebola virus disease in Liberia is over,” the W.H.O. said in a statement read by Dr. Alex Gasasira, the group’s representative to Liberia, in a packed conference room at the emergency command center in Monrovia, the capital.

For those still interested in Ebola, CDC has the 1 things you need to know about Ebola and Vox has a review of reporters’ coverage of the epidemic.

Here is a CDC map of total Ebola cases and Days since last Ebola case in West Africa as of May 13, 2015.

Total Cases


Days since Last Case


Mid-Week Links

Written By: Jason Shafrin - May• 12•15

Innovation vs. Equity in Health Care Philanthropy

Written By: Jason Shafrin - May• 11•15

In the Denver Post, Dottie Lamm makes discusses Larry Ellison’s hope to live forever and his donation towards anti-aging research.  Ellison has donated $450 million to anti-aging research. Ms. Lamm worries that this research will only benefit the rich.

If such measures are available only to billionaires, or millionaires, or even to “one-percenters,” I see a dismal world where healthy, spritely, “reinvented” 105-year-olds walk around, proudly robust and dementia-free. At the same time, many poor and even working-class Americans at the bottom of the economic heap would exist at the same level they do now, lacking preventive care.

Ms. Lamm also cites Bill Gates:

Microsoft founder Bill Gates, who has donated his millions mainly toward health and education in the less developed world, chides billionaires like Ellison. “It seems pretty ego-centric while we still have malaria and TB, for rich people to fund things so they can live longer,” he says.

Clearly, the safest bet and the one with the highest payoff for individuals currently living is to donate the funds to existing treatments that have been shown to be effective. In the long-run, however, Mr. Ellison’s donation may prove more effective for future generations.

Consider the case of the cell phone. Once cell phones were invented, society could have taken one of two tracks. The first track would be to use resources to provide all currently living individuals with a cell phone. A second track would be spend large amounts of money on research to improving the phone. In the end, the second path was largely chosen and we now have the smartphone. At first, smart phones were only affordable for the well off in the first world. However, as the smartphone technology has become less expensive, smart phones are now accessbile for the majority of individuals in the rich world and a large share of individuals in 2nd and 3rd World countries.

On the other hand, the smart phone route is fraught with risk. It could have been the case that smart phone technology was not feasible or was prohibitively expensive to manufacture. Clearly, every investment in R&D will not yield a revolutionary technology such as the smart phone.

Thus, do not dismiss Ellison’s donation as a purely self-interested ploy. We clearly need a balance of Ellison’s and Gates'; those who invest in the future and those who work to redistribute resources to those currently in need.

HWR at Medicare Resources Blog

Written By: Jason Shafrin - May• 10•15

Steve Anderson says the cat is out of the bag – he tapped into “a general vibe of grumpiness out there in the health policy blogosphere” posting The Grumpy Cat Edition of Health Wonk Review at his MedicareResources.org blog.

What is the CPS?

Written By: Jason Shafrin - May• 05•15

The CPS is the Current Population Survey (CPS). This survey is administered by the Census and is one of the most widely used surveys in social science, particularly economics. A paper by Pascale et al. (2015) provides an overview of the survey and its quesitons related to health insurance:

The CPS is a monthly labor survey of the civilian noninstitutional population. Interviews are conducted in person or through telephone interviewing. The survey is based on a rotating panel design in which households are interviewed once a month for 4 consecutive months, are dormant for 8 months, and then in sample for another four consecutive months, for a total time span of 16 months in sample. In February through April of each year, the basic monthly questionnaire is supplemented with additional questions on income and health insurance (the ASEC).

In early spring of 2014, the CPS redesigned the health insurance questions on the ASEC. Some of the redesign was to facilitate more rapid interviewing in order to not require all members of a household to repeat coverage information for which they are a dependent. To examine how this change effects responses, the authors randomly assigned individuals to answer the old and new survey questions. They found:

Our results indicate that the odds of being insured at some point during the previous calendar year were higher in the new versus the old CPS, and the integrated calendar-year/point-in-time question series in the new CPS generated estimates of past calendar-year coverage that were higher than and distinct from estimates of coverage at a point-in-time….The test resulted in higher estimates of ESI [employer-sponsored insurance] than the control by 3.91 percentage points (p < .0021), and the control resulted in higher estimates of coverage from someone outside the household by almost a percentage point (p < .0060), and more military coverage by 1.82 percentage points (p = .0001). We found no significant differences in reporting of directly purchased coverage, or Medicaid or Medicare—as individual categories or combined with each other.


Tuesday Links

Written By: Jason Shafrin - May• 04•15

Dartmouth, France?

Written By: Jason Shafrin - May• 03•15

The Dartmouth Atlas is well known for examining regional variation in practice patterns in the U.S. It looks like researchers in France are taking a similar approach to evaluate their own single payer system. A paper by Mercier, Georgescu and Bousquet (2015) find:

We assessed disparities in potentially avoidable hospitalizations in France in 2012 and analyzed their determinants. The standardized rate of potentially avoidable hospitalizations ranged from 0.1 to 44.4 cases per 1,000 inhabitants, at the ZIP code level. Increased potentially avoidable hospitalizations were associated with higher mortality, lower density of acute care beds and ambulatory care nurses, lower median income, and lower education levels. This study unveils considerable variation in the rate of potentially avoidable hospitalizations in spite of France’s mandatory, publicly funded health insurance system.

The authors find that primary care organizations play a role in the rate of avoidable hospitalizations in a given geographic region.


Quotation of the Day

Written By: Jason Shafrin - Apr• 30•15

“We are what we pretend to be, so we must be careful about what we pretend to be.”

-Kurt Vonnegut

Medicare Advantage vs. FFS

Written By: Jason Shafrin - Apr• 29•15

Austin Frakt summarizes some recent research presented at AcademyHealth.

There are three principle MA plan types: HMOs, PPOs, and private fee for service (PFFS) plans. It’s HMOs that are lowest in cost, because they tend to offer the most restrictive networks. As Biles et al. report, based on 2012 data, HMOs have costs 7 percent below traditional Medicare on average. But PPOs’ and PFFS plans’ costs are 12-18 above those of traditional Medicare. PPO networks are less restrictive than HMOs’, and PFFS plans do not establish networks at all.

Although it looks like only certain types of Medicare Advantage (MA) plans are a good deal for CMS, there is likely significant adverse selection occuring whereby sicker patients choose PPOs and PFFS and healthier patients choose HMOs. Although plan payments are risk-adjusted, there will almost certainly be unobservable differences in patient health status across different types of MA plans and between MA plans and traditional Medicare FFS.

Health in Baltimore

Written By: Jason Shafrin - Apr• 28•15

Baltimore is in the news, and not for the best reasons.  The arrest and eventual death of Freddie Gray have unleashed a series of protests and riots.  One conference where the Healthcare Economist had a poster presentation–the American Heart Association (AHA) Quality of Care and Outcomes Research (QCOR) Scientific Sessions (conference) was cancelled this week due to the protests.

Today we focus on the health of the residents in Baltimore–particularly African American residents.  Quartz reports that:

In Baltimore, the average life expectancy is 73.5 years, five years less than the national average, and for African Americans the divide is even higher: at 70.2, their life expectancy is 5.6 years lower than the US average.

Cardiovascular disease and HIV are much higher among African Americans in Baltimore than the national average.

According to a 2011 Baltimore City Health Department Report, in the Sandtown-Winchester/Harlem Park neighborhood, life expectancy is only 65.3. The teen birth rate is almost twice as high as the citywide average and infant mortality is also twice as high.

Slate reports that the incarceration rate in Mr. Gray’s neighborhood was also extremely high:

For starters, look at the juvenile arrest rate: Citywide, Baltimore saw 145.1 kids out of every thousand arrested between 2005 and 2009; in Sandtown-Winchester/Harlem Park, that number was 252.3. As the Baltimore Sun pointed out in an op-ed, that means a quarter of all 10-to-17-year-olds in Gray’s neighborhood were arrested at some point during the time period in question.

It is a sad situation. An tragic death. Riots. Chaos. Although the level of frustration is understandable, at least some community members will not tolerate this level of chaos.