Workplace wellness programs have become increasingly common in the United States, although there is not yet consensus regarding the ability of such programs to improve employees’ health and reduce health care costs. In this paper, we study a program offered by a large U.S. employer that provides substantial financial incentives directly tied to employees’ health. The program has a high participation rate among eligible employees, around 80%, and we analyze the data on the first 4 years of the program, linked to health care claims. We document robust improvements in employee health and a correlation between certain health improvements and reductions in health care cost. Despite the latter association, we cannot find direct evidence causally linking program participation to reduced health care costs, although it seems plausible that such a relationship will arise over longer horizons.
The impact of financial incentives on health and health care: Evidence from a large wellness program – Einav – 2019 – Health Economics – Wiley Online LibraryJanuary 10, 2019
Hunger Pains? SNAP Timing, and Emergency Room Visits by Chad D. Cotti, John Gordanier, Orgul D. Ozturk :: SSRNJanuary 2, 2019
The impact of poor nutrition has been established as an important determinant of health. It has also been demonstrated that the single monthly treatment of SNAP benefits leaves meaningful nutritional deficiencies in recipient households during the final weeks of the benefits cycle. Further, health related behaviors have been documented to be altered on the date of food stamp receipt. This project exploits highly detailed and linked administrative data on health care utilization of food stamp recipients and randomized food stamp receipt dates to allow us to measure the impact of food stamp treatment days and the low nutritional periods created by the SNAP benefits cycle on the likelihood of emergency department (ER) utilization among the Medicaid population. Our main finding is that among SNAP receiving individuals in the ER on a particular day, the share that received benefits on that day is 3.5% lower than would be expected. This effect is present across all age groups, although the magnitude is smallest for young children. Further, we find that for individuals 55 and over, the share of ER visits that comes from individuals that are past the third week of their SNAP benefit month, i.e. received benefits more than 21 days ago, is 1.5% larger than would be expected. This suggests that these older individuals are more likely to visit the ER late in the SNAP benefit cycle, which is consistent with increased food insecurity as a possible mechanism linking the food stamp benefits cycle to emergency care utilization. We find no such effect for younger individuals.
Medical-Legal Partnerships and Mental Health: Qualitative Evidence that Integrating Legal Services and Health Care Improves Family Well-Being by Dayna Bowen Matthew :: SSRNJanuary 2, 2019
Medical-Legal partnerships are an innovative health care delivery model that integrates lawyers into primary care clinical settings. The objective is to preventively address patients’ legal needs that also have an adverse impact on their health outcomes. Since the first medical-legal partnership formally opened at the Boston Medical Center in 1993, nearly 300 of these entities have formed around the country. The empirical evidence that they improve health, however, is still emerging. This essay contributes results of interviews conducted among families who received medical legal partnership help as an intervention in Colorado. The evidence supports the conclusion that addressing patients’ legal stressors improves their mental health and family well-being.
Prices for Medical Services Vary Within Hospitals, But Vary More Across Them by Nathan Wilson, Ted Rosenbaum, Matthew Panhans :: SSRNJanuary 2, 2019
Using commercial claims for 2012-2013 from Colorado’s All-Payer Claims Database, we examine how medical service prices vary for five hospital-based procedures and the complexity adjusted inpatient price. We find that prices vary substantially in multiple dimensions. Our analysis indicates that there is significant price variation across payers for the same service in the same hospital. If prices converged to the lowest rate each hospital receives, commercial expenditures would fall by 10-20%. The share of overall price variation accounted for by hospitals variation tends to be even more substantial. For four out of six prices, we find that differences associated just with hospitals’ metropolitan areas account for over 45% of the total variation. We observe substantial residual variation (17-50%) after accounting for factors specific to a given payer or provider.
Reliance on Medicare Providers by Veterans after Becoming Age‐Eligible for Medicare is Associated with the Use of More Outpatient ServicesDecember 20, 2018
To estimate the effect of Medicare use on the receipt of outpatient services from 2001 through 2015 for a cohort of Veterans Administration (VA) users who became age‐eligible for Medicare in 1998–2000.
Data Sources/Study Setting
VA administrative data linked with Medicare claims for veterans who participated in the 1999 Large Health Survey of Enrolled Veterans.
We coded each veteran as VA‐reliant or Medicare‐reliant based on the number of visits in each system and compared the health and social risk factors between VA‐reliant and Medicare‐reliant veterans. We used bivariate probit and instrumental variables models to estimate the association between a veteran’s reliance on Medicare and the receipt of outpatient procedures in Medicare and the VA.
Veterans who chose to rely on the VA (n = 4,317) had substantially worse social and health risk factors than Medicare‐reliant veterans (n = 2,567). Medicare reliance was associated with greater use of outpatient services for 24 of the 28 types of services considered. Instrumental variable estimates found significant effects of Medicare reliance on receipt of advanced imaging and cardiovascular testing.
Expanded access to fee‐for‐service care in the community may be expensive, while the VA will likely continue to care for the most vulnerable veterans.
via Reliance on Medicare Providers by Veterans after Becoming Age‐Eligible for Medicare is Associated with the Use of More Outpatient Services – Hebert – 2018 – Health Services Research – Wiley Online Library
Medical Aid In Dying And Telemedicine: Improving Access And Protecting Patients by Konstanin Tretyakov :: SSRNOctober 19, 2018
Medical aid in dying is a form of medical treatment recognized in several states and the District of Columbia and available to adult residents of those states who are competent and suffer from a terminal disease. It is critical to ensure timely access to this form of treatment to qualifying patients. The paper explores the possibility of improving access to medical aid in dying via telemedicine — a method of delivery of health care remotely by means of electronic communication. The paper explores the feasibility of this option from clinical and legal perspectives and also explores several normative issues lying at the intersection of telemedicine and medical aid in dying.
Predictive analytics and “big data” are emerging as important new tools for diagnosing and treating patients. But as data collection becomes more pervasive, and as machine learning and analytical methods become more sophisticated, the companies that traffic in health-related big data will face competitive pressures to make more aggressive claims regarding what their programs can predict. Already, patients, practitioners, and payors are inundated with claims that software programs, “apps,” and other forms of predictive analytics can help solve some of the health care system’s most pressing problems. This article considers the evidence and substantiation that we should require of these claims, focusing on “health” claims, or claims to diagnose, treat, or manage diseases or other medical conditions. The problem is that three very different paradigms might apply, depending on whether we cast predictive analytics as akin to medical products, medical practice, or merely as medical information. Because big data methods are so opaque, its claims may be uniquely difficult to substantiate, requiring a new paradigm. This article offers a new framework that considers intended users and appropriate evidentiary baselines.