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Chris Sampson’s journal round-up for 15th June 2020

Every Monday our authors provide a round-up of the latest peer-reviewed journal publications. We cover all issues of major health economics journals as well as some other notable releases. Visit our Resources page for links to more journals or follow the HealthEconBot. If you’d like to write one of our weekly journal round-ups, get in touch.

Health Economics

Volume 29, Issue 7

The July 2020 issue of Health Economics includes a variety of theoretical, empirical, and methodological papers. Of most interest to me is a paper on Sen’s capability approach. The authors establish a theoretical framework that incorporates capabilities, activities, and well-being, allowing for increases in some functionings to arise from reductions in capabilities. Testing this empirically, with a focus on physical disabilities, the authors suggest that their framework may be better suited for the comparison of states defined by disability. I’ll need to give this one some more attention.

We also have a couple of other papers outlining new theoretical models. One study is concerned with doctors having to issue sick notes in the context of asymmetric information. The authors establish a model of physician and worker behaviour to understand the scenarios in which shirkers might get away with an unnecessary sick note. Doctors are more likely to side with the patient than with the insurer. Policies should therefore focus on making shirking less attractive, rather than trying to strong-arm doctors into mistrusting patients. I wonder how such a model could generalise to the NHS, where doctors’ sense of duty to social welfare may be greater.

Another study outlines a theoretical framework to explain the observation that cost-sharing causes people to reduce their health care use without adequate recognition of the value of that care. Based on a theoretical model of insurance, the author argues that this is because a) people are unable to distinguish high value from low value and b) access to valuable care is reduced by cost-sharing. Some alternative incentives to tackle moral hazard are discussed.

The impact of insurance market policies on people’s behaviour is the subject of a study evaluating the impact of a change in policy in Medicare Advantage in the US. The policy change allowed people to switch plans at any time (rather than being restricted to a designated time period) so long as they were switching to a 5-star plan. As intended by the policy, more people did switch, and that switching came with improvements in health.

A study from Germany looks into the nursing home market. It shows that quality reporting does not affect people’s choice of nursing home. Using individual-level data, the authors exploit the fact that most individuals’ choice sets included nursing homes with and without ratings. While the quality reporting didn’t matter, price and distance were important in determining choice.

There’s more on the impact of health-related social policies. A brief difference in difference study shows that reducing the blood alcohol content limit for driving in Scotland did not have an impact on road traffic accidents or fatalities. Another study reports evidence from across OECD countries to suggest that mandatory sex education may be associated with increases in teenage pregnancy rates. Such policies therefore cannot explain current downward trends.

Finally, a study of inequality of opportunity in health presents a novel methodology using a latent class model. The authors use UK household panel data to capture inequality in a risk score derived from blood-based biomarkers. Three classes are identified that explain a good deal of inequality in the sample and demonstrate the usefulness of the approach.

Health Affairs

Volume 39, Issue 6

As usual, it’s a mammoth issue from Health Affairs, with 18 research articles and a dozen other features. The June issue features articles on COVID-19, rural hospitals, opioid use, mental health services, and more, mostly with a US focus.

On COVID-19, there’s a simulation study that estimates the cost impact of the pandemic for US health care, based on around $3,000 per infection. A survey conducted in Israel finds that compliance with self-isolation is likely to depend on people’s expectations about financial compensation. People need to know that their livelihood is secure. There’s also a letter concerning the role of community health workers and a piece considering our readiness for the next pandemic.

Several studies look at mental health care services in the US. A survey of over 8,000 facilities found that only around 1 in 8 had a clinician with specialised training in autism spectrum disorder. Another study links multiple data sources to identify the determinants of the use of electronic health records for patients in psychiatric settings. The authors argue that more incentives are needed to ensure that information is exchanged as individuals move across settings. Navigating US health care can be challenging, and one study in this issue shows that people using mental health provider directories often encounter incorrect information, and that these errors can lead to surprise bills as a result of using out-of-network providers. Though another study shows that out-of-network spending has, in general, declined.

Opioid use continues to be a hot topic. Rates of diagnosis of opioid use disorder have increased in recent years, but medication-assisted treatment rates have declined. One study demonstrates that access to buprenorphine (used to treat opioid use disorder) may be a challenge for younger people, despite increased prescribing in recent years. Another study finds that restricting direct-to-physician marketing by pharmaceutical companies may reduce the number of opioids prescribed by physicians.

A couple of studies are concerned with the high cost of new medicines. One study explores the impact of delays in generic drugs entering the market. The authors find that patient litigation is the biggest cause of delay, and that delays cost Medicaid more than $100 million per year. Value frameworks appear in another study, which outlines various forms of value-based payment arrangements for medical products. The article seems to outline previous arguments rather than reinvent the wheel.

This issue includes an account from one doctor of their experience of racism as a student. On a related note, a research article investigates inequalities in ambulatory care according to race. Though inequality in hospitalisations between black and white Medicare beneficiaries has declined over time, this appears to be an artefact of coding behaviour, with the use of ‘observation status’ increasing at a higher rate for black people.

There are plenty of studies looking at the organisation of US health care and the impact of different policies. One study highlights the increasing number of accountable care organisations in the US and shows that the ACO workforce is changing. There has been a shift towards more non-physician practitioners in recent years. Using a series of interviews, another study attempts to understand the attractiveness of private equity investment in ophthalmology services. There’s more evidence that Medicare Advantage affects people’s use of health care. In one study, use of home health care is shown to be lower for people enrolled in Medicare Advantage. There’s also a study of birth outcomes and costs associated with different prenatal services offered as part of a federal initiative. We also have a study of hospice use at the end of life.

Rural health care in the US faces particular challenges. One study in this issue finds that hospitals’ financial viability depends on occupancy rates, and that financial viability has declined in states that did not expand eligibility for Medicaid. We also see that targeted additional payments for rural hospitals’ Medicare provision can sustain the supply of services.

Just one study takes us outside the US. A randomised controlled trial conducted in Nigeria found that conditional cash transfers to encourage expectant mothers to use health facilities was associated with modest improvements in the quality of delivery care.

In addition to letters and other short contributions there is an account of the Zuni Youth Enrichment Project, which aims to improve the health of young people from Native American communities. There are also book reviews for The Soul of Care by Arthur Kleinman and The Political Determinants of Health by Daniel Dawes.


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  • Chris Sampson

    Founder of the Academic Health Economists' Blog. Senior Principal Economist at the Office of Health Economics. ORCID: 0000-0001-9470-2369

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3 years ago

For the Cantor et al paper, I’m not sure how you can train for autism treatment currently. The “intense world” hypothesis is the opposite of Baron-Cohen’s notion that people with autism have low empathy. There’s so little consensus on the subject of autism that any training would be contentious.

As ever, more research is required.

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