July 29, 2009
Jason M. Fletcher, Steven F. Lehrer. Using Genetic Lotteries within Families to Examine the Causal Impact of Poor Health on Academic Achievement. NBER Working Paper No. 15148, July 2009. [Abstract (html)]
While there is a well-established, large positive correlation between mental and physical health and education outcomes, establishing a causal link remains a substantial challenge. Building on findings from the biomedical literature, we exploit specific differences in the genetic code between siblings within the same family to estimate the causal impact of several poor health conditions on academic outcomes. We present evidence of large impacts of poor mental health on academic achievement. Further, our estimates suggest that family fixed effects estimators by themselves cannot fully account for the endogeneity of poor health. Finally, our sensitivity analysis suggests that these differences in specific portions of the genetic code have good statistical properties and that our results are robust to reasonable violations of the exclusion restriction assumption.
July 28, 2009
CBO. Additional Information Regarding the Effects of Specifications in the America’s Affordable Health Choices Act Pertaining to Health Insurance Coverage. Congressional Budget Office, July 26, 2009. [Full Text (pdf)]. Provides an explanation for why CBO estimates of coverage under public plan differ by a factor of 8 from the estimates from Lewin Group regarding the impact of the House bill.
July 28, 2009
Eric A. Finkelstein, Justin G. Trogdon, Joel W. Cohen, and William Dietz. Annual Medical Spending Attributable To Obesity: Payer- And Service-Specific Estimates. Health Affairs 28, no. 5 (2009): w822-w831 (published online 27 July 2009) [Abstract (html)]
In 1998 the medical costs of obesity were estimated to be as high as $78.5 billion, with roughly half financed by Medicare and Medicaid. This analysis presents updated estimates of the costs of obesity for the United States across payers (Medicare, Medicaid, and private insurers), in separate categories for inpatient, non-inpatient, and prescription drug spending. We found that the increased prevalence of obesity is responsible for almost $40 billion of increased medical spending through 2006, including $7 billion in Medicare prescription drug costs. We estimate that the medical costs of obesity could have risen to $147 billion per year by 2008.
July 28, 2009
Congressional Research Service. Private Health Insurance Provisions of H.R. 3200. CRS Report R40724, July 27, 2009.[Full Text (pdf)]
This report summarizes key provisions affecting private health insurance in H.R. 3200, Americas Affordable Health Choices Act of 2009, as ordered reported by House Committees on Education and Labor and on Ways and Means. Specifically, this report focuses on Division A or I of H.R. 3200 from those committees. Division A of H.R. 3200 focuses on reducing the number of uninsured, restructuring the private health insurance market, setting minimum standards for health benefits, and providing financial assistance to certain individuals and, in some cases, small employers. In general, H.R. 3200 would require individuals to maintain health insurance and employers to either provide insurance or pay into a fund, with penalties/taxes for non-compliance. Several insurance market reforms would be made, such as modified community rating and guaranteed issue and renewal. Both the individual and employer mandates would be linked to acceptable health insurance coverage, which would meet required minimum standards and incorporate the market reforms included in the bill. Acceptable coverage would include 1 coverage under a qualified health benefits plan QHBP, which could be offered either through the newly created Health Insurance Exchange the Exchange or outside the Exchange through new employer plans; 2 grandfathered employment based plans; 3 grandfathered nongroup plans; and 4 other coverage, such as Medicare and Medicaid. The Exchange would offer private plans alongside a public option. Based on income, certain individuals could qualify for subsidies toward their premium costs and cost-sharing deductibles and copayments; these subsidies would be available only through the Exchange. In the individual market the nongroup market, a plan could be grandfathered indefinitely, but only if no changes were made to the terms and conditions of that plan, including benefits and cost-sharing, and premiums were only increased as allowed by statute. Most of these provisions would be effective beginning in 2013.
July 26, 2009
Brownson RC, Chriqui JF, Stamatakis KA. Understanding evidence-based public health policy. Am J Public Health. 2009 Jul 16. [Abstract (html)]
Public health policy has a profound impact on health status. Missing from the literature is a clear articulation of the definition of evidence-based policy and approaches to move the field forward. Policy-relevant evidence includes both quantitative (e.g., epidemiological) and qualitative information (e.g., narrative accounts). We describe 3 key domains of evidence-based policy: (1) process, to understand approaches to enhance the likelihood of policy adoption; (2) content, to identify specific policy elements that are likely to be effective; and (3) outcomes, to document the potential impact of policy. Actions to further evidence-based policy include preparing and communicating data more effectively, using existing analytic tools more effectively, conducting policy surveillance, and tracking outcomes with different types of evidence.
via Understanding evidence-based public health policy | Institute for Health Research and Policy | University of Illinois at Chicago.
July 25, 2009
P. Cunningham. Chronic Burdens: The Persistently High Out-of-Pocket Health Care Expenses Faced by Many Americans with Chronic Conditions. The Commonwealth Fund, July 2009. [Full Text (pdf)]
Using data from the 2001–2005 Medical Expenditure Panel Survey, this study shows that nearly 40 percent of nonelderly adults with three or more chronic conditions had out-of-pocket expenses and premiums exceeding 5 percent of income for two consecutive years, compared with 20 percent of people who had a single chronic condition and 14 percent who had no chronic conditions. Prescription drug spending accounts for over half of the out-of-pocket spending by individuals who have multiple chronic conditions and who have had persistently high financial burdens that last two years or more. The prevalence of persons with persistently high financial burdens is likely to increase in the future, because of expected increases in prescription drug costs as well as chronic disease prevalence.
July 25, 2009
The Economic Effects of Health Care Reform on Small Businesses and Their Employees. The Council of Economic Advisors CEA released a report on small businesses and health care, examining the challenges currently faced by smaller firms in the health insurance market and the likely impacts of health care reform on small businesses and the workers they employ. July 25, 2009. [Full Text (pdf)]