Unbiased Analysis of Today's Healthcare Issues

Friday Links

Written By: Jason Shafrin - Mar• 28•14

Madness at the HWR

Written By: Jason Shafrin - Mar• 27•14

Christopher Fleming has posted an excellent edition of the Health Wonk Review (HWR) at Health Affairs BlogA March Madness Health Wonk Review.

And the news from Syria gets worse…

Written By: Jason Shafrin - Mar• 27•14

Individual health in Syria is not only at risk due to violence, but also due to contagious diseases.  In fact, one disease that had previously been eradicated from the country is now back.  The BBC reports:

Syria was declared free of polio in 1999. But the disease re-emerged last year, after two years of conflict. The World Health Organization (WHO) says there are now 25 laboratory-confirmed cases in the country, with another 13 confirmations pending. But Syrian doctors put the number of children with clinical symptoms of polio much higher, at at least 110. And for every victim, there are at least 200 people – some doctors say up to 1,000 – carrying and spreading the virus.

The human toll of the war in Syria keeps growing.

Comparing Cost-Benefit Analysis and Social Welfare Functions

Written By: Jason Shafrin - Mar• 25•14

When evaluating whether a policy or medical treatment approved, policymakers often rely on cost-benefit analysis (CBA).  However, how does one measure costs and benefits?  Costs are often measured in monetary terms and benefits are often measured as decreases in mortality or morbidity.

One way to ensure to tradeoff cost and benefits is to monetize health benefits using the value of a statistical life (VSL) framework.  VSL measures the marginal rate of substitution between fatality risk in a specified time period, and wealth. In other words, it is the change in an individual’s wealth required to compensate him for a small change in his risk of dying during the period, divided by the risk change.  Policymakers use VSL as an input to value health benefits in cost-benefit analysis.

Another approach to evaluate policies or medical treatmetns is to use a social welfare function.  In the social welfare function (SWF), treatment costs and health benefits are arguments in a utility function.  For instance, a utilitarian SWF simply sums individual utilities.  The goal of policymakers is to maximize utility of the entire population.  Another approach is to use a concave SWF where the utility of the worst-off members of society receives more weight than the best-off.

How does the use of VSL and SWF compare?  And article by Adler, Hammitt and Treich (2014) provides a comparison.


The importance of genes

Written By: Jason Shafrin - Mar• 25•14

…may be smaller than previously thought for many chronic conditions.  A paper by Thompson (2014) uses data from 125,000 parent-child pairs to determine that:

children with a parent who has a specific chronic health condition are at least 100% more likely to have the same condition themselves. To assess the role of genetic mechanisms in generating these strong correlations, I estimate models using a sample of approximately 2,400 adoptees, and find that genetic transmission accounts for only 20%-30% of the baseline associations.

Could adoption itself play a role in the reduce transmission of chronic diseases? Additional evidence seems to discount this claim:

to corroborate these adoptee-based estimates, I examine health correlations among monozygotic twins, which provide an upper bound estimate of genetic influences, and find a similarly modest role for genetic transmission

The modest role of genetics in the incidence of chronic conditions may be due to a number of factors. For instance, many chronic conditions appear or are exacerbated by lifestyle considerations such as patient diet and exercise habits. Additionally, the prevalence of chronic conditions is increasing as medical advances both decrease the health impact of many acute diseases and increase longevity for people who have chronic diseases.


Obamacare: “The single, biggest untold story of the numbers right now”

Written By: Jason Shafrin - Mar• 23•14

How many people will sign up for coverage under the Affordable Care Act (ACA, Obamacare)?

There are a number of different projections. WonkBlog reports:

The big political focus has been on whether exchange enrollment by March 31 will reach 6 million, the revised estimate provided by the Congressional Budget Office. After the Department of Health and Human Services announced 4.2 million sign-ups through the end of February, the Avalere Health consulting firm projected that sign-ups would hit 5.4 million by the deadline.

Charles Gaba of ACAsignups.net predicts the final sign-up tally will hit 6.22 million.  

However, there is another pathway for individuals to gain insurance: buy it the old fashioned way; not through the exchange.  For individuals who do not qualify for subsidies, they have limited incentives to sign up for insurance through the exchange.  Thus, the ACA’s individual mandate may be increasing health care coverage, but in ways that were not entirely foreseen when the bill was written.


Written By: Jason Shafrin - Mar• 20•14

Some people have March Madness.

Other people are mad about the U.S. healthcare system.

And ending on a positive note:

Inpatient Psychiatric Facilities: Patient Population and Readmissions

Written By: Jason Shafrin - Mar• 20•14

The Affordable Care Act has required that CMS begin to address excess readmissions in short term acute care hospitals paid under the Inpatient Prospective Payment System (IPPS) through the Hospital Readmissions Reduction program.  This program requires CMS to reduce payments to IPPS hospitals with excessive readmissions for a set of three conditions—acute myocardial infarction (AMI), heart failure, and pneumonia…In the 2013 IPPS Final Rule, CMS has estimated that the Hospital Readmissions Reduction Program would save $280 million for the first year.

What would happen if CMS extended the hospital readmission reductions program to inpatient psychiatric facilities (IPF) through the IPF Prospective payment System (IPF PPS)?  Currently, IPF PPS is used to reimburse two types of IPF: those that are specific units within a larger hospital and those that are freestanding units.    A policy paper by the Moran Company provides some details on current patient population using IPF PPS as well as readmission rates.

  • Medicare discharges made up around 25% of IPFs’ total discharges
  • Beneficiaries who use IPFs are likely to be poor and disabled.  In fact, a majority of Medicare beneficiaries admitted to an IPF qualified due to disability (rather than age).  Further, over half of these beneficiaries with an IPF admission are dual-eligibles.
  • Freestanding IPFs have longer lengths of stay (29 days for government facilities, 12 days for non-government) compared to inpatient psychiatric units (12 days for government facilities and 11 days for non-government).
  • Patients admitted to an IPF have higher rates of chronic illness (e.g., HIV/AIDS, diabetes) than those non-psychiatric patients in the inpatient setting.  Patients with serious mental illness are much more likely to have substance abuse problems.
  • Readmission rates for IPF are high.  Thirty percent of Medicare beneficiaries with at least one psychiatric facility stay in a given calendar  have a readmission during the same calendar year.


The Cavalcade of Risk turns 204

Written By: Jason Shafrin - Mar• 19•14

Insurance Regulatory Law blog posts this week’s edition of the Cavalcade of Risk. Check it out!

The future of cancer therapy: Viruses?

Written By: Jason Shafrin - Mar• 18•14

The Economist has an interesting profile of Dr. Angela Belcher, who uses viruses to create batteries and new touchscreens is now moving into the medical field. Here is how she proposes to improve tumor detection–and potential treatment–in the future:

The plan is to produce a medical probe which can be used to locate extremely small tumours. One way this is being tried is to get genetically engineered viruses to latch onto carbon nanotubes which glow under light from a laser. These viruses carrying the tubes would be injected into the body, and with light shining on the skin, be capable of glowing up to 10cm or so inside the body. The glow can be detected with a specialised camera.

To get these beacon viruses into the right places, the researchers engineer them to have a second affinity, one that makes them bind to certain kinds of cancer cells. They would then find any tumours, attach to them and glow.

The technique is still experimental and is being tried out in the laboratory on cellular models of ovarian cancer, which can be difficult for surgeons to detect when the tumours are tiny. There is a lot to do, but, says Dr Belcher, “I know we can find very small tumours and that should allow surgeons to remove them.”

It also raises an obvious question: if the viruses can find tumours and light them up could they also carry with them some kind of lethal weapon? Not surprisingly, that possibility is being explored, with attempts to engineer cancer-seeking viruses that can carry both an imaging material and a chemotherapy agent.

One question is how viruses are disposed of after they identify the tumor? Another is ensuring that viruses do not evolve to have a symbiotic relationship with the tumor. Nevertheless, this is a very interesting line or research.