Copyright (c) 2008 All rights reserved. http://works.bepress.com/dana_goldman Recent documents in Dana Goldman en-us Sun, 30 Nov 2008 08:41:02 PST 3600 http://works.bepress.com/dana_goldman/61 http://works.bepress.com/dana_goldman/61 Wed, 24 Sep 2008 17:11:38 PDT Dana P. Goldman Health Economics http://works.bepress.com/dana_goldman/60 http://works.bepress.com/dana_goldman/60 Fri, 14 Mar 2008 15:56:21 PDT Today the United States may be on the cusp of changing from a cost-unconscious health care system to one that seeks value. The consequences of adopting a valuebased approach to coverage have not been well studied; however, several broad strands of the health literature suggest that spending could be reduced by as much as 30 percent without adversely affecting health. Alan Garber Health Policy http://works.bepress.com/dana_goldman/59 http://works.bepress.com/dana_goldman/59 Fri, 14 Mar 2008 15:47:27 PDT It is an unresolved issue whether age or (expected) remaining life years better predicts health care expenditures. We first estimate a set of hazard models to predict life expectancy based on individual demographic characteristics and health conditions, and then use regression analyses to compare the predictive power of age and life expectancy in explaining health care expenditures. This paper differs from previous studies in that it uses predicted life expectancy to address the censoring of death; as a result, this paper goes beyond the large health care expenditures at the end of life and the results apply to both deceased and survivors. We find that age has little additional predictive power on health care expenditures after controlling for life expectancy, but the predictive power of life expectancy itself diminishes as health status measures are introduced into the model. These results are not of esoteric interest only for their statistical properties; we show that using life expectancy rather than age results in lower projections of future health care expenditures. This result suggests that increases in longevity might be less costly than models based on the current age profile of spending would predict. Baoping Shang Health Economics http://works.bepress.com/dana_goldman/58 http://works.bepress.com/dana_goldman/58 Fri, 14 Mar 2008 15:16:03 PDT Context: Prescription drugs are instrumental to managing and preventing chronic disease. Recent changes in US prescription drug cost sharing could affect access to them. Objective: To synthesize published evidence on the associations among costsharing features of prescription drug benefits and use of prescription drugs, use of nonpharmaceutical services, and health outcomes.Data Sources: We searched PubMed for studies published in English between 1985 and 2006. Study Selection and Data Extraction: Among 923 articles found in the search, we identified 132 articles examining the associations between prescription drug plan cost-containment measures, including co-payments, tiering, or coinsurance (n=65), pharmacy benefit caps or monthly prescription limits (n=11), formulary restrictions (n=41), and reference pricing (n=16), and salient outcomes, including pharmacy utilization and spending, medical care utilization and spending, and health outcomes. Results: Increased cost sharing is associated with lower rates of drug treatment, worse adherence among existing users, and more frequent discontinuation of therapy. For each 10% increase in cost sharing, prescription drug spending decreases by 2% to 6%, depending on class of drug and condition of the patient. The reduction in use associated with a benefit cap, which limits either the coverage amount or the number of covered prescriptions, is consistent with other cost-sharing features. For some chronic conditions, higher cost sharing is associated with increased use of medical services, at least for patients with congestive heart failure, lipid disorders, diabetes, and schizophrenia. While low-income groups may be more sensitive to increased cost sharing, there is little evidence to support this contention.Conclusions: Pharmacy benefit design represents an important public health tool for improving patient treatment and adherence. While increased cost sharing is highly correlated with reductions in pharmacy use, the long-term consequences of benefit changes on health are still uncertain. Dana P. Goldman Health Policy http://works.bepress.com/dana_goldman/55 http://works.bepress.com/dana_goldman/55 Fri, 14 Mar 2008 14:05:23 PDT High drug prices are a major barrier to patients' access to drugs and compliance with treatment. Yet low drug prices are often argued to provide inadequate incentives for innovation. We propose a drug-licensing model for health care, which has the promise of increasing drug use without altering patients' out-of-pocket spending, health plans' costs, or drug companies' profits. In such a model, people would purchase annual drug licenses that would guarantee unfettered access to a clinically optimal number of prescriptions over the course of a year. Using the example of statins, we illustrate how such a model could be implemented. Dana P. Goldman Health Policy http://works.bepress.com/dana_goldman/53 http://works.bepress.com/dana_goldman/53 Tue, 11 Mar 2008 13:46:11 PDT Kenneth Thorpe and David Howard provide an important snapshot of the longterm trends in Medicare beneficiaries’ health care spending. They use clever methods to shed new light on increases in per capita spending, convincingly demonstrating that treatment patterns are a major factor. But several puzzles remain. Trends in per capita spending differ from other findings in that Thorpe and Howard find costs rising fastest for those with multiple conditions, and it is unclear what would happen if one took lifetime spending into account. Reliable predictions about long-term trends will require information on any health benefits associated with increases in diagnosis and treatment. Neeraj Sood Health Policy http://works.bepress.com/dana_goldman/52 http://works.bepress.com/dana_goldman/52 Tue, 11 Mar 2008 13:46:06 PDT Many companies have defined-contribution benefit plans requiring employees to pay the full cost (before taxes) of more generous health insurance choices. Research has shown that employee decisions are quite responsive to these arrangements. What is less clear is how the total compensation package changes when health insurance premiums rise. This paper examines employee compensation decisions during a three-year period when health insurance premiums were rising rapidly. The data come from a single large firm with a flexible benefits plan wherein employees explicitly choose how to allocate compensation between cash wages and other benefits. Under such an arrangement, higher health insurance premiums must induce changes in the composition of total compensation-either in lower after-tax wages or in decreased contributions to other benefits. The results suggest that about two-thirds of the premium increase is financed out of cash wages and the remaining one-thirds is financed by a reduction in benefits. Dana P. Goldman Health Economics http://works.bepress.com/dana_goldman/51 http://works.bepress.com/dana_goldman/51 Tue, 11 Mar 2008 13:46:00 PDT As policymakers consider expanding insurance coverage for the human immunodeficiency virus (HIV+) population, it is useful to ask whether insurance has any effect on health outcomes, and, if so, whether public insurance is as efficacious as private insurance in preventing premature death. Using data from a nationally representative cohort of HIV-infected persons receiving regular medical care, we estimate the impact of different types of insurance on mortality in this population. Our main findings are that (1) ignoring observed and unobserved health status misleads one to conclude that insurance may not be protective for HIV patients, (2) after accounting for observed and unobserved heterogeneity, insurance does protect against premature death, and (3) private insurance is more effective than public insurance. The better performance of private insurance can be explained in part by more restrictive Medicaid prescription drug policies that limit access to highly efficacious treatment. Neeraj Sood Methods http://works.bepress.com/dana_goldman/50 http://works.bepress.com/dana_goldman/50 Tue, 11 Mar 2008 13:45:56 PDT We used claims data from a large U.S. employer that introduced changes in its medical and drug coverage offerings in 2002 for non-Medicare eligible retirees. In addition to the existing plans, the employer introduced two new plans in 2002 that were less generous both in terms of medical and drug coverage. Further, one of the new plans had an annual benefit limit of $2,500 on prescription drugs, similar to the "doughnut hole" in the standard Medicare Part D benefit. We examined beneficiaries switching behavior in response to the new choice set and estimated the independent effects of medical and drug benefits on plan selection. We found that beneficiaries in better health were more likely to switch to the new, less generous plans. While the generosity of the medical benefit played a more important role in choosing a plan, choices did not vary significantly by health status. In contrast, sicker individuals were more likely to enroll in plans with generous drug benefits. This suggests that drug coverage may be more susceptible to adverse selection than medical insurance. Dana Goldman Health Economics http://works.bepress.com/dana_goldman/49 http://works.bepress.com/dana_goldman/49 Tue, 11 Mar 2008 13:45:50 PDT Obesity could have serious consequences for older cohorts. We used a microsimulation to estimate lifetime costs, life expectancy, disease, and disability for seventy-year-olds based on body mass. Obese seventy-year-olds will live about as long as those of normal weight but will spend more than $39,000 more on health care. Moreover, they will enjoy fewer disability-free life years and experience higher rates of diabetes, hypertension, and heart disease. Medicare will spend about 34 percent more on an obese person than on someone of normal weight. Obesity might cost Medicare more than other diseases, because higher costs are not offset by reduced longevity. Darius Noshir Lakdawalla Health Policy