Are you over 18 and want to see adult content?
More Annotations
A complete backup of www.milliyet.com.tr/gundem/mucize-doktor-23-yeni-bolum-fragmani-yayinda-22-son-bolumde-nazli-ve-aliden-bekl
Are you over 18 and want to see adult content?
Favourite Annotations
A complete backup of live-tv-channels.org
Are you over 18 and want to see adult content?
A complete backup of emsasoccerportal.com
Are you over 18 and want to see adult content?
A complete backup of sabahtourism.com
Are you over 18 and want to see adult content?
A complete backup of univoftulsa-my.sharepoint.com
Are you over 18 and want to see adult content?
A complete backup of aficionados.com.br
Are you over 18 and want to see adult content?
A complete backup of dreamerfromanotherplanet.tumblr.com
Are you over 18 and want to see adult content?
A complete backup of thewordpressghost.wordpress.com
Are you over 18 and want to see adult content?
A complete backup of lenguaje-html-cufinho.blogspot.com
Are you over 18 and want to see adult content?
Text
COUNTERFACTUALS
The only time I had lunch with Jon Gruber he told me the biggest problem in policy debates is a lack of clear understanding of the counterfactual. Since then, I’ve been paying more attention, and he’s right that it is not well understood. Since I used the concept repeatedly in the comments on a post WHAT’S BEHIND THE GROWTH IN ALCOHOL CONSUMPTION? The following originally appeared on The Upshot (copyright 2021, The New York Times Company) and was coauthored by Nambi Ndugga and Austin Frakt. It also appeared on page A4 of the print edition on April 21, 2021.. American deaths from misuse of substances, including alcohol, have increased over the past two decades, but not uniformly across various demographic groups. RISK CORRIDORS: WHAT THEY ARE AND WHAT THEY DO The following is a guest post by Galen Benshoof, a Master in Public Affairs candidate at Princeton University’s Woodrow Wilson School, where he focuses on health policy.Find him on Twitter: @benshoof. Critics of the Affordable Care Act have a new bugbear: a program known as risk corridors, which is part of a trio of premium stabilization mechanisms collectively known as the 3Rs. EXPLICIT V. IMPLICIT RATIONING The publication of the American College of Physicians ethics manual has garnered lots of comment. Aaron has weighed in with two posts and the comments show that people have very strong feelings about the role of physicians in using cost and effectiveness information to make clinical decisions. On balance, I come down thinking that it UPCODING PART ONE: WHAT IS IT AND HOW COMMON IS IT? Specifically, providers and payers can sometimes hide behind that complexity to intentionally bill erroneously. Upcoding is one potentially fraudulent form of billing. Upcoding occurs when more intensive and expensive diagnoses or treatments are documented than what was actually provided to the patient or medically necessary. SURVIVAL RATES ARE NOT THE SAME AS MORTALITY RATES Survival rates are something else entirely. They calculate the percentage of people with a disease who are still alive a set amount of time after diagnosis. The five year survival rate for people with lung cancer in the US is 15.6%. But here’s the thing. You can only decrease the mortality rate by preventing death, or curing thedisease.
HEALTH CARE MARKET FAILURES (AND WHAT CAN BE DONE ABOUT Health care market failures (and what can be done about them) This post complements one yesterday that focused on market failures in health insurance ( read it first ). It’s loosely based on the content of Economics of the Public Sector, by Joe Stiglitz. Here’s a run down of market failures pertaining to the provision of healthcare.
WINDOWS 7 SOUND NOT WORKING. HOW TO FIX WITHOUT RESTARTING Obviously this is not about health policy. But the time I have spent searching for a solution could have been spent on health policy. Here’s what happens: I restart my Windows 7 computer before departing from work. Once every month or two, when I log in the next morning, the sound doesn’t work. Restarting the THE INCIDENTAL ECONOMISTCHOICEEXPLAINING RESEARCHTHE DISASTERS THAT BUILT THE FDA AND WHERE WE GO FROM HERE Millions of Americans struggle with substance use disorder, with estimates suggesting as many as 1 in 13 people needed treatment in 2018. Between high demand for services and lack of regulation, this is an area of health care already rife with predatory behavior. ANALYSIS OF “WHAT’S 2/3 OF THE AVERAGE” The 2/3 of the average problem posed on Friday is a well known puzzle in game theory, and it illustrates some fundamental game theoretic concepts. To recap, here’s the problem statement: Suppose everyone in your town selects a real number between 0 and 100, inclusive (i.e. 0 and 100 are both possible choices, as isCOUNTERFACTUALS
The only time I had lunch with Jon Gruber he told me the biggest problem in policy debates is a lack of clear understanding of the counterfactual. Since then, I’ve been paying more attention, and he’s right that it is not well understood. Since I used the concept repeatedly in the comments on a post WHAT’S BEHIND THE GROWTH IN ALCOHOL CONSUMPTION? The following originally appeared on The Upshot (copyright 2021, The New York Times Company) and was coauthored by Nambi Ndugga and Austin Frakt. It also appeared on page A4 of the print edition on April 21, 2021.. American deaths from misuse of substances, including alcohol, have increased over the past two decades, but not uniformly across various demographic groups. RISK CORRIDORS: WHAT THEY ARE AND WHAT THEY DO The following is a guest post by Galen Benshoof, a Master in Public Affairs candidate at Princeton University’s Woodrow Wilson School, where he focuses on health policy.Find him on Twitter: @benshoof. Critics of the Affordable Care Act have a new bugbear: a program known as risk corridors, which is part of a trio of premium stabilization mechanisms collectively known as the 3Rs. EXPLICIT V. IMPLICIT RATIONING The publication of the American College of Physicians ethics manual has garnered lots of comment. Aaron has weighed in with two posts and the comments show that people have very strong feelings about the role of physicians in using cost and effectiveness information to make clinical decisions. On balance, I come down thinking that it UPCODING PART ONE: WHAT IS IT AND HOW COMMON IS IT? Specifically, providers and payers can sometimes hide behind that complexity to intentionally bill erroneously. Upcoding is one potentially fraudulent form of billing. Upcoding occurs when more intensive and expensive diagnoses or treatments are documented than what was actually provided to the patient or medically necessary. SURVIVAL RATES ARE NOT THE SAME AS MORTALITY RATES Survival rates are something else entirely. They calculate the percentage of people with a disease who are still alive a set amount of time after diagnosis. The five year survival rate for people with lung cancer in the US is 15.6%. But here’s the thing. You can only decrease the mortality rate by preventing death, or curing thedisease.
HEALTH CARE MARKET FAILURES (AND WHAT CAN BE DONE ABOUT Health care market failures (and what can be done about them) This post complements one yesterday that focused on market failures in health insurance ( read it first ). It’s loosely based on the content of Economics of the Public Sector, by Joe Stiglitz. Here’s a run down of market failures pertaining to the provision of healthcare.
WINDOWS 7 SOUND NOT WORKING. HOW TO FIX WITHOUT RESTARTING Obviously this is not about health policy. But the time I have spent searching for a solution could have been spent on health policy. Here’s what happens: I restart my Windows 7 computer before departing from work. Once every month or two, when I log in the next morning, the sound doesn’t work. Restarting the COVID VACCINE MONTH OF ACTION The Biden administration has announced a new a goal when it comes to Covid-19 vaccinations in the US: It aims for at least 70% of Americans to receive at least one dose by July 4th. The current administration has announced a plan and lots of companies are pitching in to help incentivize these efforts – WHAT’S BEHIND THE GROWTH IN ALCOHOL CONSUMPTION? The following originally appeared on The Upshot (copyright 2021, The New York Times Company) and was coauthored by Nambi Ndugga and Austin Frakt. It also appeared on page A4 of the print edition on April 21, 2021.. American deaths from misuse of substances, including alcohol, have increased over the past two decades, but not uniformly across various demographic groups. THE MEDICAL ARMS RACE The medical arms race. This is a TIE-U post associated with Jonathan Kolstad’s The Economics of Health Care and Policy (Penn’s HCMG 903-001, Spring 2012). For other posts in this series, see the course intro. Standard economics theory teaches us that competition increases “ social welfare .”. But that theory is premised on a market with HOSPITAL COST SHIFTING: BRIEF HISTORY AND POSSIBLE FUTURE The following is a slightly edited excerpt from the working paper version of my paper “How much do hospitals cost shift? A review of the evidence,” to appear in issue 1, volume 89 of The Milbank Quarterly (expected March 2011). See also “Estimating Hospital Cost Shift Rates:A Practitioners’ Guide“. This post has been cited in COST SHARING REDUCTION WEEDS: “SILVER LOADING” AND THE Last week I alluded to ways that consumers could be protected from premium spikes resulting from the Trump Administration’s cessation of cost sharing reduction payments to Marketplace insurers — so called “silver loading” and the “silver switcheroo.” Margot Sanger-Katz wrote about these this week at the Upshot. Some additional details are provided in the following interview with CHILDHOOD BULLYING: NOT A BIG DEAL? Children have been bullied since — well, since we’ve had childhood. There are now widespread movements to prevent school bullying. It’s clear that bullying was tragic for girls like Rehtaeh Parsons, who committed suicide after first being raped and then cyberbullied by the perpetrators, who sent pictures of the assault to her classmates.But this is an extreme event. METHODS: FALSIFICATION TESTS Methods: Falsification tests. nalyses in large data sets are not necessarily correct simply because they are larger. Control groups might not eliminate potential confounders, or many varying definitions of exposure to the agent may be tested (alternative thresholds for dose or duration of a drug)—a form of multiple- hypothesis testing OUT-OF-NETWORK PAYMENTS IN MEDICARE ADVANTAGE At the most basic level, when a Medicare Advantage HMO member willingly seeks care from an out-of-network provider, the member assumes full liability for payment. That is, neither the HMO plan nor TM will pay for services when an MA member goes out-of-network. The price that the provider can charge for these services, though, varies,and must
MORE ON THE SOCIAL CONTRACT AND HEALTH CARE REFORM More on the Social Contract and health care reform. 07/18/2014. Aaron Carroll. Two weeks ago, I blogged about a new paper I co-authored on the social contract and health care. It’s a little wonky, but Real Clear Policy interviewed friend/colleague/co-author Eric Meslin. Those of you who found the paper dense might enjoy the interview. HEALTH INSURANCE MARKET FAILURES (AND WHAT CAN BE DONE Health insurance market failures (and what can be done about them) 02/16/2011. Austin Frakt. In his textbook, Economics of the Public Sector, Joe Stiglitz categorizes market failures in general and those that exist in health care in particular. The following — focussed on health insurance, as opposed to health care — is based on his list THE INCIDENTAL ECONOMISTCHOICEEXPLAINING RESEARCHTHE DISASTERS THAT BUILT THE FDA AND WHERE WE GO FROM HERE Millions of Americans struggle with substance use disorder, with estimates suggesting as many as 1 in 13 people needed treatment in 2018. Between high demand for services and lack of regulation, this is an area of health care already rife with predatory behavior. ANALYSIS OF “WHAT’S 2/3 OF THE AVERAGE” The 2/3 of the average problem posed on Friday is a well known puzzle in game theory, and it illustrates some fundamental game theoretic concepts. To recap, here’s the problem statement: Suppose everyone in your town selects a real number between 0 and 100, inclusive (i.e. 0 and 100 are both possible choices, as is RISK CORRIDORS: WHAT THEY ARE AND WHAT THEY DO The following is a guest post by Galen Benshoof, a Master in Public Affairs candidate at Princeton University’s Woodrow Wilson School, where he focuses on health policy.Find him on Twitter: @benshoof. Critics of the Affordable Care Act have a new bugbear: a program known as risk corridors, which is part of a trio of premium stabilization mechanisms collectively known as the 3Rs. UPCODING PART ONE: WHAT IS IT AND HOW COMMON IS IT? Specifically, providers and payers can sometimes hide behind that complexity to intentionally bill erroneously. Upcoding is one potentially fraudulent form of billing. Upcoding occurs when more intensive and expensive diagnoses or treatments are documented than what was actually provided to the patient or medically necessary. WHY CONSUMER SURPLUS IS NEGATIVE THE INTEGRAL OF THE To show formally that consumer surplus is the negative of the integral of demand (or that demand is negative the derivative of consumer surplus), one can use the rule for integrating inverses. To do so, let. Q denote quantity and P denote price, Q = D (P) be the demand function, and the equilibrium quantity and price be Q0 and P0,respectively.
HOSPITAL COST SHIFTING: BRIEF HISTORY AND POSSIBLE FUTURE The following is a slightly edited excerpt from the working paper version of my paper “How much do hospitals cost shift? A review of the evidence,” to appear in issue 1, volume 89 of The Milbank Quarterly (expected March 2011). See also “Estimating Hospital Cost Shift Rates:A Practitioners’ Guide“. This post has been cited in COST SHARING REDUCTION WEEDS: “SILVER LOADING” AND THE Last week I alluded to ways that consumers could be protected from premium spikes resulting from the Trump Administration’s cessation of cost sharing reduction payments to Marketplace insurers — so called “silver loading” and the “silver switcheroo.” Margot Sanger-Katz wrote about these this week at the Upshot. Some additional details are provided in the following interview with EXPLICIT V. IMPLICIT RATIONING The publication of the American College of Physicians ethics manual has garnered lots of comment. Aaron has weighed in with two posts and the comments show that people have very strong feelings about the role of physicians in using cost and effectiveness information to make clinical decisions. On balance, I come down thinking that it CHILDHOOD BULLYING: NOT A BIG DEAL? Children have been bullied since — well, since we’ve had childhood. There are now widespread movements to prevent school bullying. It’s clear that bullying was tragic for girls like Rehtaeh Parsons, who committed suicide after first being raped and then cyberbullied by the perpetrators, who sent pictures of the assault to her classmates.But this is an extreme event. SURVIVAL RATES ARE NOT THE SAME AS MORTALITY RATES Survival rates are something else entirely. They calculate the percentage of people with a disease who are still alive a set amount of time after diagnosis. The five year survival rate for people with lung cancer in the US is 15.6%. But here’s the thing. You can only decrease the mortality rate by preventing death, or curing thedisease.
THE INCIDENTAL ECONOMISTCHOICEEXPLAINING RESEARCHTHE DISASTERS THAT BUILT THE FDA AND WHERE WE GO FROM HERE Millions of Americans struggle with substance use disorder, with estimates suggesting as many as 1 in 13 people needed treatment in 2018. Between high demand for services and lack of regulation, this is an area of health care already rife with predatory behavior. ANALYSIS OF “WHAT’S 2/3 OF THE AVERAGE” The 2/3 of the average problem posed on Friday is a well known puzzle in game theory, and it illustrates some fundamental game theoretic concepts. To recap, here’s the problem statement: Suppose everyone in your town selects a real number between 0 and 100, inclusive (i.e. 0 and 100 are both possible choices, as is RISK CORRIDORS: WHAT THEY ARE AND WHAT THEY DO The following is a guest post by Galen Benshoof, a Master in Public Affairs candidate at Princeton University’s Woodrow Wilson School, where he focuses on health policy.Find him on Twitter: @benshoof. Critics of the Affordable Care Act have a new bugbear: a program known as risk corridors, which is part of a trio of premium stabilization mechanisms collectively known as the 3Rs. UPCODING PART ONE: WHAT IS IT AND HOW COMMON IS IT? Specifically, providers and payers can sometimes hide behind that complexity to intentionally bill erroneously. Upcoding is one potentially fraudulent form of billing. Upcoding occurs when more intensive and expensive diagnoses or treatments are documented than what was actually provided to the patient or medically necessary. WHY CONSUMER SURPLUS IS NEGATIVE THE INTEGRAL OF THE To show formally that consumer surplus is the negative of the integral of demand (or that demand is negative the derivative of consumer surplus), one can use the rule for integrating inverses. To do so, let. Q denote quantity and P denote price, Q = D (P) be the demand function, and the equilibrium quantity and price be Q0 and P0,respectively.
HOSPITAL COST SHIFTING: BRIEF HISTORY AND POSSIBLE FUTURE The following is a slightly edited excerpt from the working paper version of my paper “How much do hospitals cost shift? A review of the evidence,” to appear in issue 1, volume 89 of The Milbank Quarterly (expected March 2011). See also “Estimating Hospital Cost Shift Rates:A Practitioners’ Guide“. This post has been cited in COST SHARING REDUCTION WEEDS: “SILVER LOADING” AND THE Last week I alluded to ways that consumers could be protected from premium spikes resulting from the Trump Administration’s cessation of cost sharing reduction payments to Marketplace insurers — so called “silver loading” and the “silver switcheroo.” Margot Sanger-Katz wrote about these this week at the Upshot. Some additional details are provided in the following interview with EXPLICIT V. IMPLICIT RATIONING The publication of the American College of Physicians ethics manual has garnered lots of comment. Aaron has weighed in with two posts and the comments show that people have very strong feelings about the role of physicians in using cost and effectiveness information to make clinical decisions. On balance, I come down thinking that it CHILDHOOD BULLYING: NOT A BIG DEAL? Children have been bullied since — well, since we’ve had childhood. There are now widespread movements to prevent school bullying. It’s clear that bullying was tragic for girls like Rehtaeh Parsons, who committed suicide after first being raped and then cyberbullied by the perpetrators, who sent pictures of the assault to her classmates.But this is an extreme event. SURVIVAL RATES ARE NOT THE SAME AS MORTALITY RATES Survival rates are something else entirely. They calculate the percentage of people with a disease who are still alive a set amount of time after diagnosis. The five year survival rate for people with lung cancer in the US is 15.6%. But here’s the thing. You can only decrease the mortality rate by preventing death, or curing thedisease.
WHAT’S BEHIND THE GROWTH IN ALCOHOL CONSUMPTION? The following originally appeared on The Upshot (copyright 2021, The New York Times Company) and was coauthored by Nambi Ndugga and Austin Frakt. It also appeared on page A4 of the print edition on April 21, 2021.. American deaths from misuse of substances, including alcohol, have increased over the past two decades, but not uniformly across various demographic groups. BLOOD CLOTS, FDA APPROVAL, AND THE ASTRAZENECA COVID Blood Clots, FDA Approval, and the AstraZeneca Covid Vaccine. 04/21/2021. Tiffany Doherty. There’s a lot of anxiety about the AstraZeneca vaccine thanks to recent reports of incomplete data, as well as reports on blood clot risks. Let’s take a look at both issues in context, understanding the efficacy data before and afternumbers were
KEEP OUR PEOPLE SAFE Two and a half months ago, I asked what each of us could do about the coronavirus. My answer was that we should talk to the people we are closely connected to and give them our best guidance on how to stay safe. That’s still my advice. The hard question is, what is the bestCOUNTERFACTUALS
The only time I had lunch with Jon Gruber he told me the biggest problem in policy debates is a lack of clear understanding of the counterfactual. Since then, I’ve been paying more attention, and he’s right that it is not well understood. Since I used the concept repeatedly in the comments on a post COST SHARING REDUCTION WEEDS: “SILVER LOADING” AND THE Last week I alluded to ways that consumers could be protected from premium spikes resulting from the Trump Administration’s cessation of cost sharing reduction payments to Marketplace insurers — so called “silver loading” and the “silver switcheroo.” Margot Sanger-Katz wrote about these this week at the Upshot. Some additional details are provided in the following interview with THE MEDICAL ARMS RACE The medical arms race. This is a TIE-U post associated with Jonathan Kolstad’s The Economics of Health Care and Policy (Penn’s HCMG 903-001, Spring 2012). For other posts in this series, see the course intro. Standard economics theory teaches us that competition increases “ social welfare .”. But that theory is premised on a market with HEALTH CARE MARKET FAILURES (AND WHAT CAN BE DONE ABOUT Health care market failures (and what can be done about them) This post complements one yesterday that focused on market failures in health insurance ( read it first ). It’s loosely based on the content of Economics of the Public Sector, by Joe Stiglitz. Here’s a run down of market failures pertaining to the provision of healthcare.
OVERIDENTIFICATION TESTS Overidentification tests. 05/14/2012. Austin Frakt. Last week, in Inquiry, my latest paper with Steve Pizer and Roger Feldman was published. An ungated, working paper version is also available. Note also that I wrote a bit about a portion of it in a prior post, though even that does not describe what the paper is about. WHAT’S WRONG WITH QALYS? What’s wrong with QALYs? 11/25/2015. Austin Frakt. In a 2009 Value in Health paper, Joseph Lipscomb and colleagues concisely summarized some of the common critiques of use of quality adjusted life years (QALYs) in economic and policy analysis. Below is an even more concise summary, informed by their paper. ACOS: ONE- VS TWO-SIDED RISK ACOs: one- vs two-sided risk. 12/06/2010. Austin Frakt. I understand that the “shared-savings” financial incentives for accountable care organizations (ACOs) are one-sided. That is, ACOs can only benefit from meeting quality and cost targets. At worst, if they fail to meet them, they’d still get all their fee-for-service paymentthey’d
THE INCIDENTAL ECONOMISTCHOICEEXPLAINING RESEARCHTHE DISASTERS THAT BUILT THE FDA AND WHERE WE GO FROM HERE Millions of Americans struggle with substance use disorder, with estimates suggesting as many as 1 in 13 people needed treatment in 2018. Between high demand for services and lack of regulation, this is an area of health care already rife with predatory behavior.COUNTERFACTUALS
The only time I had lunch with Jon Gruber he told me the biggest problem in policy debates is a lack of clear understanding of the counterfactual. Since then, I’ve been paying more attention, and he’s right that it is not well understood. Since I used the concept repeatedly in the comments on a post ANALYSIS OF “WHAT’S 2/3 OF THE AVERAGE” The 2/3 of the average problem posed on Friday is a well known puzzle in game theory, and it illustrates some fundamental game theoretic concepts. To recap, here’s the problem statement: Suppose everyone in your town selects a real number between 0 and 100, inclusive (i.e. 0 and 100 are both possible choices, as is WHAT’S BEHIND THE GROWTH IN ALCOHOL CONSUMPTION? The following originally appeared on The Upshot (copyright 2021, The New York Times Company) and was coauthored by Nambi Ndugga and Austin Frakt. It also appeared on page A4 of the print edition on April 21, 2021.. American deaths from misuse of substances, including alcohol, have increased over the past two decades, but not uniformly across various demographic groups. WHY CONSUMER SURPLUS IS NEGATIVE THE INTEGRAL OF THE Having just spent too many hours on this, I’m posting it so I won’t forget it. Maybe it’ll save some other folks some time too. I’ve learned that, up to a constant, consumer surplus is the integral of the demand function. That’s wrong. It’s negative theintegral of
RISK CORRIDORS: WHAT THEY ARE AND WHAT THEY DO The following is a guest post by Galen Benshoof, a Master in Public Affairs candidate at Princeton University’s Woodrow Wilson School, where he focuses on health policy.Find him on Twitter: @benshoof. Critics of the Affordable Care Act have a new bugbear: a program known as risk corridors, which is part of a trio of premium stabilization mechanisms collectively known as the 3Rs. EXPLICIT V. IMPLICIT RATIONING The publication of the American College of Physicians ethics manual has garnered lots of comment. Aaron has weighed in with two posts and the comments show that people have very strong feelings about the role of physicians in using cost and effectiveness information to make clinical decisions. On balance, I come down thinking that it HEALTH CARE MARKET FAILURES (AND WHAT CAN BE DONE ABOUT This post complements one yesterday that focused on market failures in health insurance (read it first). It’s loosely based on the content of Economics of the Public Sector, by Joe Stiglitz. Here’s a run down of market failures pertaining to the provision of health care. Please alert me to anything I’ve missed or relevant papers. CHILDHOOD BULLYING: NOT A BIG DEAL? Children have been bullied since — well, since we’ve had childhood. There are now widespread movements to prevent school bullying. It’s clear that bullying was tragic for girls like Rehtaeh Parsons, who committed suicide after first being raped and then cyberbullied by the perpetrators, who sent pictures of the assault to her classmates.But this is an extreme event. SURVIVAL RATES ARE NOT THE SAME AS MORTALITY RATES On the other hand, mortality rates are also subject to alot of other factors as well. For example, Japan’s mortality rates for some forms of cancer, are most likely related to diet or other population lifestyle factors as well as any other health care factors. THE INCIDENTAL ECONOMISTCHOICEEXPLAINING RESEARCHTHE DISASTERS THAT BUILT THE FDA AND WHERE WE GO FROM HERE Millions of Americans struggle with substance use disorder, with estimates suggesting as many as 1 in 13 people needed treatment in 2018. Between high demand for services and lack of regulation, this is an area of health care already rife with predatory behavior.COUNTERFACTUALS
The only time I had lunch with Jon Gruber he told me the biggest problem in policy debates is a lack of clear understanding of the counterfactual. Since then, I’ve been paying more attention, and he’s right that it is not well understood. Since I used the concept repeatedly in the comments on a post ANALYSIS OF “WHAT’S 2/3 OF THE AVERAGE” The 2/3 of the average problem posed on Friday is a well known puzzle in game theory, and it illustrates some fundamental game theoretic concepts. To recap, here’s the problem statement: Suppose everyone in your town selects a real number between 0 and 100, inclusive (i.e. 0 and 100 are both possible choices, as is WHAT’S BEHIND THE GROWTH IN ALCOHOL CONSUMPTION? The following originally appeared on The Upshot (copyright 2021, The New York Times Company) and was coauthored by Nambi Ndugga and Austin Frakt. It also appeared on page A4 of the print edition on April 21, 2021.. American deaths from misuse of substances, including alcohol, have increased over the past two decades, but not uniformly across various demographic groups. WHY CONSUMER SURPLUS IS NEGATIVE THE INTEGRAL OF THE Having just spent too many hours on this, I’m posting it so I won’t forget it. Maybe it’ll save some other folks some time too. I’ve learned that, up to a constant, consumer surplus is the integral of the demand function. That’s wrong. It’s negative theintegral of
RISK CORRIDORS: WHAT THEY ARE AND WHAT THEY DO The following is a guest post by Galen Benshoof, a Master in Public Affairs candidate at Princeton University’s Woodrow Wilson School, where he focuses on health policy.Find him on Twitter: @benshoof. Critics of the Affordable Care Act have a new bugbear: a program known as risk corridors, which is part of a trio of premium stabilization mechanisms collectively known as the 3Rs. EXPLICIT V. IMPLICIT RATIONING The publication of the American College of Physicians ethics manual has garnered lots of comment. Aaron has weighed in with two posts and the comments show that people have very strong feelings about the role of physicians in using cost and effectiveness information to make clinical decisions. On balance, I come down thinking that it HEALTH CARE MARKET FAILURES (AND WHAT CAN BE DONE ABOUT This post complements one yesterday that focused on market failures in health insurance (read it first). It’s loosely based on the content of Economics of the Public Sector, by Joe Stiglitz. Here’s a run down of market failures pertaining to the provision of health care. Please alert me to anything I’ve missed or relevant papers. CHILDHOOD BULLYING: NOT A BIG DEAL? Children have been bullied since — well, since we’ve had childhood. There are now widespread movements to prevent school bullying. It’s clear that bullying was tragic for girls like Rehtaeh Parsons, who committed suicide after first being raped and then cyberbullied by the perpetrators, who sent pictures of the assault to her classmates.But this is an extreme event. SURVIVAL RATES ARE NOT THE SAME AS MORTALITY RATES On the other hand, mortality rates are also subject to alot of other factors as well. For example, Japan’s mortality rates for some forms of cancer, are most likely related to diet or other population lifestyle factors as well as any other health care factors. COVID VACCINE MONTH OF ACTION 10 hours ago · The Biden administration has announced a new a goal when it comes to Covid-19 vaccinations in the US: It aims for at least 70% of Americans to receive at least one dose by July 4th. The current administration has announced a plan and lots of companies are pitching in to help incentivize these efforts – WHAT’S BEHIND THE GROWTH IN ALCOHOL CONSUMPTION? The following originally appeared on The Upshot (copyright 2021, The New York Times Company) and was coauthored by Nambi Ndugga and Austin Frakt. It also appeared on page A4 of the print edition on April 21, 2021.. American deaths from misuse of substances, including alcohol, have increased over the past two decades, but not uniformly across various demographic groups. OVERIDENTIFICATION TESTS Last week, in Inquiry, my latest paper with Steve Pizer and Roger Feldman was published. An ungated, working paper version is also available. Note also that I wrote a bit about a portion of it in a prior post, though even that does not describe what the paper is about. I’ll write more about the results THE MEDICAL ARMS RACE This is a TIE-U post associated with Jonathan Kolstad’s The Economics of Health Care and Policy (Penn’s HCMG 903-001, Spring 2012). For other posts in this series, see the course intro. Standard economics theory teaches us that competition increases “social welfare.” But that theory is premised on a market with certain attributes that are not always present. (Strictly HOSPITAL COST SHIFTING: BRIEF HISTORY AND POSSIBLE FUTURE The following is a slightly edited excerpt from the working paper version of my paper “How much do hospitals cost shift? A review of the evidence,” to appear in issue 1, volume 89 of The Milbank Quarterly (expected March 2011). See also “Estimating Hospital Cost Shift Rates:A Practitioners’ Guide“. This post has been cited in METHODS: FALSIFICATION TESTS From “Prespecified Falsification End Points: Can They Validate True Observational Associations?” by Vinay Prasad and Anupam Jena: nalyses in large data sets are not necessarily correct simply because they are larger. Control groups might not eliminate potential confounders, or many varying definitions of exposure to the agent may be tested (alternative thresholds for dose or MORE ON THE SOCIAL CONTRACT AND HEALTH CARE REFORM Two weeks ago, I blogged about a new paper I co-authored on the social contract and health care. It’s a little wonky, but Real Clear Policy interviewed friend/colleague/co-author Eric Meslin. Those of you who found the paper dense might enjoy the interview. Small excerpt: What is the “social contract,” and what political message does itconvey?
UPCODING PART ONE: WHAT IS IT AND HOW COMMON IS IT? Specifically, providers and payers can sometimes hide behind that complexity to intentionally bill erroneously. Upcoding is one potentially fraudulent form of billing. Upcoding occurs when more intensive and expensive diagnoses or treatments are documented than what was actually provided to the patient or medically necessary. ALL THE REASONS TO EXPAND MEDICAID. ALL THE REASONS NOT TO Let’s see if we can list all pros and cons for Medicaid expansion we’ve heard articulated. Let’s try to provide links to or about them. I’m making no attempt to exclude reasons that are not supported by evidence. I’m making no attempt to exclude “bad” reasons or include “good” ones. I’m trying to capture them WINDOWS 7 SOUND NOT WORKING. HOW TO FIX WITHOUT RESTARTING Obviously this is not about health policy. But the time I have spent searching for a solution could have been spent on health policy. Here’s what happens: I restart my Windows 7 computer before departing from work. Once every month or two, when I log in the next morning, the sound doesn’t work. Restarting the THE INCIDENTAL ECONOMISTCHOICEEXPLAINING RESEARCHTHE DISASTERS THAT BUILT THE FDA AND WHERE WE GO FROM HERE Cecille Joan Avila is a policy analyst at Boston University School of Public Health. She tweets @cecilleavila.. Paid family and medical leave has been the main focus lately, but paid sick leave is equally important.I talk more about its importance and why it matters for women’s health in Prism: addresses those who hold up society but are often invisible. KEEP OUR PEOPLE SAFE Two and a half months ago, I asked what each of us could do about the coronavirus. My answer was that we should talk to the people we are closely connected to and give them our best guidance on how to stay safe. That’s still my advice. The hard question is, what is the best COST SHARING REDUCTION WEEDS: “SILVER LOADING” AND THE Last week I alluded to ways that consumers could be protected from premium spikes resulting from the Trump Administration’s cessation of cost sharing reduction payments to Marketplace insurers — so called “silver loading” and the “silver switcheroo.” Margot Sanger-Katz wrote about these this week at the Upshot. Some additional details are provided in the following interview withCOUNTERFACTUALS
The only time I had lunch with Jon Gruber he told me the biggest problem in policy debates is a lack of clear understanding of the counterfactual. Since then, I’ve been paying more attention, and he’s right that it is not well understood. Since I used the concept repeatedly in the comments on a post HOSPITAL COST SHIFTING: BRIEF HISTORY AND POSSIBLE FUTURECOST SHIFTING EXAMPLESCOST SHIFTING HYDRAULICCOST SHIFTING IN HEALTH CAREIS COST SHIFTING ETHICALADVANTAGES OF COST SHIFTINGBENEFITS OF COST SHIFTING The following is a slightly edited excerpt from the working paper version of my paper “How much do hospitals cost shift? A review of the evidence,” to appear in issue 1, volume 89 of The Milbank Quarterly (expected March 2011). See also “Estimating Hospital Cost Shift Rates:A Practitioners’ Guide“. This post has been cited in UPCODING PART ONE: WHAT IS IT AND HOW COMMON IS IT? Specifically, providers and payers can sometimes hide behind that complexity to intentionally bill erroneously. Upcoding is one potentially fraudulent form of billing. Upcoding occurs when more intensive and expensive diagnoses or treatments are documented than what was actually provided to the patient or medically necessary. SURVIVAL RATES ARE NOT THE SAME AS MORTALITY RATES Survival rates are something else entirely. They calculate the percentage of people with a disease who are still alive a set amount of time after diagnosis. The five year survival rate for people with lung cancer in the US is 15.6%. But here’s the thing. You can only decrease the mortality rate by preventing death, or curing thedisease.
EXPLICIT V. IMPLICIT RATIONING The publication of the American College of Physicians ethics manual has garnered lots of comment. Aaron has weighed in with two posts and the comments show that people have very strong feelings about the role of physicians in using cost and effectiveness information to make clinical decisions. On balance, I come down thinking that it CHILDHOOD BULLYING: NOT A BIG DEAL? Children have been bullied since — well, since we’ve had childhood. There are now widespread movements to prevent school bullying. It’s clear that bullying was tragic for girls like Rehtaeh Parsons, who committed suicide after first being raped and then cyberbullied by the perpetrators, who sent pictures of the assault to her classmates.But this is an extreme event. WINDOWS 7 SOUND NOT WORKING. HOW TO FIX WITHOUT RESTARTING Obviously this is not about health policy. But the time I have spent searching for a solution could have been spent on health policy. Here’s what happens: I restart my Windows 7 computer before departing from work. Once every month or two, when I log in the next morning, the sound doesn’t work. Restarting the THE INCIDENTAL ECONOMISTCHOICEEXPLAINING RESEARCHTHE DISASTERS THAT BUILT THE FDA AND WHERE WE GO FROM HERE Cecille Joan Avila is a policy analyst at Boston University School of Public Health. She tweets @cecilleavila.. Paid family and medical leave has been the main focus lately, but paid sick leave is equally important.I talk more about its importance and why it matters for women’s health in Prism: addresses those who hold up society but are often invisible. KEEP OUR PEOPLE SAFE Two and a half months ago, I asked what each of us could do about the coronavirus. My answer was that we should talk to the people we are closely connected to and give them our best guidance on how to stay safe. That’s still my advice. The hard question is, what is the best COST SHARING REDUCTION WEEDS: “SILVER LOADING” AND THE Last week I alluded to ways that consumers could be protected from premium spikes resulting from the Trump Administration’s cessation of cost sharing reduction payments to Marketplace insurers — so called “silver loading” and the “silver switcheroo.” Margot Sanger-Katz wrote about these this week at the Upshot. Some additional details are provided in the following interview withCOUNTERFACTUALS
The only time I had lunch with Jon Gruber he told me the biggest problem in policy debates is a lack of clear understanding of the counterfactual. Since then, I’ve been paying more attention, and he’s right that it is not well understood. Since I used the concept repeatedly in the comments on a post HOSPITAL COST SHIFTING: BRIEF HISTORY AND POSSIBLE FUTURECOST SHIFTING EXAMPLESCOST SHIFTING HYDRAULICCOST SHIFTING IN HEALTH CAREIS COST SHIFTING ETHICALADVANTAGES OF COST SHIFTINGBENEFITS OF COST SHIFTING The following is a slightly edited excerpt from the working paper version of my paper “How much do hospitals cost shift? A review of the evidence,” to appear in issue 1, volume 89 of The Milbank Quarterly (expected March 2011). See also “Estimating Hospital Cost Shift Rates:A Practitioners’ Guide“. This post has been cited in UPCODING PART ONE: WHAT IS IT AND HOW COMMON IS IT? Specifically, providers and payers can sometimes hide behind that complexity to intentionally bill erroneously. Upcoding is one potentially fraudulent form of billing. Upcoding occurs when more intensive and expensive diagnoses or treatments are documented than what was actually provided to the patient or medically necessary. SURVIVAL RATES ARE NOT THE SAME AS MORTALITY RATES Survival rates are something else entirely. They calculate the percentage of people with a disease who are still alive a set amount of time after diagnosis. The five year survival rate for people with lung cancer in the US is 15.6%. But here’s the thing. You can only decrease the mortality rate by preventing death, or curing thedisease.
EXPLICIT V. IMPLICIT RATIONING The publication of the American College of Physicians ethics manual has garnered lots of comment. Aaron has weighed in with two posts and the comments show that people have very strong feelings about the role of physicians in using cost and effectiveness information to make clinical decisions. On balance, I come down thinking that it CHILDHOOD BULLYING: NOT A BIG DEAL? Children have been bullied since — well, since we’ve had childhood. There are now widespread movements to prevent school bullying. It’s clear that bullying was tragic for girls like Rehtaeh Parsons, who committed suicide after first being raped and then cyberbullied by the perpetrators, who sent pictures of the assault to her classmates.But this is an extreme event. WINDOWS 7 SOUND NOT WORKING. HOW TO FIX WITHOUT RESTARTING Obviously this is not about health policy. But the time I have spent searching for a solution could have been spent on health policy. Here’s what happens: I restart my Windows 7 computer before departing from work. Once every month or two, when I log in the next morning, the sound doesn’t work. Restarting the PAID SICK LEAVE IS A WOMEN’S HEALTH ISSUE Cecille Joan Avila is a policy analyst at Boston University School of Public Health. She tweets @cecilleavila.. Paid family and medical leave has been the main focus lately, but paid sick leave is equally important.I talk more about its importance and why it matters for women’s health in Prism: addresses those who hold up society but are often invisible. BUPRENORPHINE REGULATIONS AND BETTER TREATMENT OF We face a lot of obstacles on the road to ending the opioid crisis, and one of them revolves around access to evidence-based addiction treatments. The X-waiver, a waiver physicians must obtain to prescribe the partial opioid agonist Buprenorphine, is one of them. New regulations have eased the requirements for this waiver, hopefullypaving the
YOUR COVID-19 THOUGHTS ARE NOT CRAZY Your COVID-19 thoughts are not crazy. I’ve spent the last several days having conversations with various colleagues, friends, and family members about the COVID-19 pandemic. The one general truth about all these conversations is this: People are in different places emotionally and thinking about different facets of the crisis. RISK CORRIDORS: WHAT THEY ARE AND WHAT THEY DO The following is a guest post by Galen Benshoof, a Master in Public Affairs candidate at Princeton University’s Woodrow Wilson School, where he focuses on health policy.Find him on Twitter: @benshoof. Critics of the Affordable Care Act have a new bugbear: a program known as risk corridors, which is part of a trio of premium stabilization mechanisms collectively known as the 3Rs. 1619 PROJECT: LIST OF ARTICLES 1619 Project: list of articles. The articles in The New York Times’ 1619 Project — observing the 400th anniversary of American slavery and its implications — are worth your time, and mine. It’s a beautiful online interactive, but very inconvenient if you want to gradually work you way through the articles over a span of days. ANALYSIS OF “WHAT’S 2/3 OF THE AVERAGE” The 2/3 of the average problem posed on Friday is a well known puzzle in game theory, and it illustrates some fundamental game theoretic concepts. To recap, here’s the problem statement: Suppose everyone in your town selects a real number between 0 and 100, inclusive (i.e. 0 and 100 are both possible choices, as is WHY CONSUMER SURPLUS IS NEGATIVE THE INTEGRAL OF THE To show formally that consumer surplus is the negative of the integral of demand (or that demand is negative the derivative of consumer surplus), one can use the rule for integrating inverses. To do so, let. Q denote quantity and P denote price, Q = D (P) be the demand function, and the equilibrium quantity and price be Q0 and P0,respectively.
OUT-OF-NETWORK PAYMENTS IN MEDICARE ADVANTAGE The complexity of Medicare Advantage (MA) physician networks has been well-documented, but the payment regulations that underlie these plans remain opaque, even to experts. If an MA plan enrollee sees an out-of-network doctor, how much should she expect to pay? HEALTH CARE MARKET FAILURES (AND WHAT CAN BE DONE ABOUT Health care market failures (and what can be done about them) This post complements one yesterday that focused on market failures in health insurance ( read it first ). It’s loosely based on the content of Economics of the Public Sector, by Joe Stiglitz. Here’s a run down of market failures pertaining to the provision of healthcare.
NICUS COST HOW MANY THOUSANDS PER DAY? AND PARENTS NEED Yeah, I know. The government is set to shut down on Tuesday—by non-coincidence the very day health insurance exchanges open for business for ObamaCare. And I’m about to talk about hospital parking? Bear with me. This is actually an important issue: The incredible way our health system so terribly disserves families caringfor loved-ones with
THE INCIDENTAL ECONOMIST The health services research blog*
* About the blog
* FAQ
* Podcast archive
* Site policies
* TIE-U
*
*
MASTHEAD
_EDITORS IN CHIEF_
Austin Frakt
Aaron Carroll
_MANAGING EDITOR_
Adrianna McIntyre
_CONTRIBUTORS_
Kevin Outterson
Bill Gardner
Nicholas Bagley
Other Contributors
*
RECENT POSTS
* New Research On Plant-Based Diets and Mortality * Why Doctors Still Offer Treatments That May Not Help * Facts Don’t Really Change Minds * Planned Parenthood Withdraws from Title X Funding: What Does ThatMean For Patients?
* JAMA Forum: Price transparency * Why Warning Pregnant Women Not to Drink Can Backfire * Why Is It So Hard to Lower Drug Prices? * More Bad Nutrition Studies: Red Meat and Cancer * 1619 Project: list of articles * Come work with me!*
ARCHIVES
Archives Select Month September 2019 (1) August 2019 (17) July 2019 (22) June 2019 (19) May 2019 (18) April 2019 (16) March 2019 (12) February 2019 (20) January 2019 (13) December 2018 (14) November 2018 (18) October 2018 (12) September 2018 (19) August 2018 (17) July 2018 (19) June 2018 (27) May 2018 (30) April 2018 (46) March 2018 (22) February 2018 (17) January 2018 (32) December 2017 (19) November 2017 (24) October 2017 (33) September 2017 (26) August 2017 (27) July 2017 (35) June 2017 (32) May 2017 (27) April 2017 (28) March 2017 (39) February 2017 (31) January 2017 (30) December 2016 (30) November 2016 (50) October 2016 (37) September 2016 (48) August 2016 (48) July 2016 (38) June 2016 (46) May 2016 (51) April 2016 (42) March 2016 (37) February 2016 (47) January 2016 (54) December 2015 (47) November 2015 (56) October 2015 (48) September 2015 (58) August 2015 (56) July 2015 (53) June 2015 (73) May 2015 (67) April 2015 (53) March 2015 (62) February 2015 (56) January 2015 (76) December 2014 (77) November 2014 (72) October 2014 (66) September 2014 (82) August 2014 (78) July 2014 (93) June 2014 (66) May 2014 (74) April 2014 (75) March 2014 (91) February 2014 (77) January 2014 (79) December 2013 (91) November 2013 (106) October 2013 (112) September 2013 (84) August 2013 (97) July 2013 (85) June 2013 (85) May 2013 (77) April 2013 (92) March 2013 (88) February 2013 (94) January 2013 (134) December 2012 (74) November 2012 (78) October 2012 (77) September 2012 (93) August 2012 (121) July 2012 (78) June 2012 (80) May 2012 (75) April 2012 (66) March 2012 (121) February 2012 (116) January 2012 (118) December 2011 (154) November 2011 (171) October 2011 (155) September 2011 (195) August 2011 (162) July 2011 (98) June 2011 (162) May 2011 (180) April 2011 (155) March 2011 (163) February 2011 (130) January 2011 (129) December 2010 (122) November 2010 (150) October 2010 (123) September 2010 (145) August 2010 (122) July 2010 (72) June 2010 (76) May 2010 (76) April 2010 (86) March 2010 (110) February 2010 (80) January 2010 (109) December 2009 (90) November 2009 (63) October 2009 (90) September 2009 (74) August 2009 (26) July 2009 (28) June 2009 (21) May 2009 (16) April 2009 (9)March 2009 (5)
*
FOR SPEAKING INQUIRIES Interested in having Aaron or Austin speak to your group? For information on Aaron speaking, click here.
For information on Austin speaking, contact the Leigh Bureau.
*
AARON’S STUFF
_SELECTED APPEARANCES:_The Colbert Report
Good Morning America Sound Medicine (most recent)The Ed Show
*
AUSTIN’S STUFF
Click here for
links to Austin’s peer-reviewed publications and/or related posts.*
NEW RESEARCH ON PLANT-BASED DIETS AND MORTALITY September 1, 2019 at 5:13 pmTiffany Doherty
A new study out this month claims plant-based diets are associated with lower risk of not only cardiovascular disease and mortality but of all-cause mortality as well. Let’s see how the results stand upto scrutiny.
@DrTiff_
Share this...
email Tweetable
Comments closed
Explaining Research
Healthcare Triage
,
Nutrition studies
,
Plant-based diets
*
WHY DOCTORS STILL OFFER TREATMENTS THAT MAY NOT HELP August 28, 2019 at 7:00 amAustin Frakt
_The following originally appeared on The Upshot (copyright 2019, The New York Times Company). It also appeared in theprint edition
on August 15, 2019._ When your doctor gives you health advice, and your insurer pays for the recommended treatment, you probably presume it’s based on solid evidence. But a great dealof
clinical practice that’s covered by private insurers and publicprograms isn’t.
The British Medical Journal sifted throughthe
evidence for thousands of medical treatments to assess which are beneficial and which aren’t. According to the analysis, there is evidence of some benefit for just over 40 percent of them. Only 3 percent are ineffective or harmful; a further 6 percent are unlikely to be helpful. But a whopping 50 percent are of unknown effectiveness. We haven’t done the studies. Sometimes uncertain and experimental treatments are warranted; patients may even welcome them. When there is no known cure for a fatal or severely debilitating health condition, trying something uncertain — as evidence is gathered—
is a reasonable approach, provided the patient is informed andconsents.
“We have lots of effective treatments, many of which were originally experimental,” said Dr. Jason H. Wasfy, an assistant professor of medicine at Harvard Medical School and a cardiologist at Massachusetts General Hospital. “But not every experimental treatment ends up effective, and many aren’t better than existing alternatives. It’s important to collect and analyze the evidence so we can stop doing things that don’t work to minimize patient harm.” In many cases, routinely delivered treatments aren’t rigorously tested for years. Benefits are assumed, harms ignored. This might have killed George Washington.
At 67 years old and a few months shy of three years after his presidency, Washington reportedly awoke short of breath, with a sore throat, and soon developed a fever. Over the next 12 hours, doctorsdrained 40 percent
of his
blood, among other questionable treatments. Then he died. Washington surely had a serious illness. Theories include croup, diphtheria, pneumonia and acute bacterial epiglottitis. Whatever it was, bloodletting did little but cause additional misery, and most likely hastened his death. Though the procedure was common at the time for a variety of ailments, its benefits were based on theory, not rigorous evidence. In the era of modern medicine, this may strike some as primitive and ignorant. Yet, hundreds of years later, the same thing still happens (though fortunately not with bloodletting). In the late 1970s, some doctors thought they had found a way to treat breast cancer patients with what would otherwise be lethal doses of chemotherapy. The approach involved harvesting bone marrow stem cells from the patients before treatment and reintroducing them afterward. Fueled by encouraging comments from doctors, the 1980s news
media reported higher chemotherapy dosesas
the means to survival. Yet there was no compelling evidence that bone marrow transplants protected patients. But, told they would, many patients fought insurers in court to get them. Under pressure from Congress, in 1994 all health plans for federal workers were required to cover the treatment. Yet not a single randomized trial had been done.Finally, in 1995
,
the first randomized trial was published, with impressive results: Half of women who received bone marrow transplants had no subsequent evidence of a tumor, compared with just 4 percent in the control group. But these results didn’t hold up, with four subsequent clinical trials contradicting them. The approach was recognized for what it was: ineffective at best, lethal at worst. Wishful thinking that runs ahead of or goes against research findings is behind today’s opioid epidemic,
too. Despite a lack of solid evidence, for years many believed that modern opioid medications were not addictive. It’s now abundantly clear they are. But the damage is done. There are countless other examples of common treatments and medical advice provided without good evidence: magnesium supplementsfor
leg cramps; oxygen therapyfor acute
myocardial infarction; IV salinefor certain kidney
disease patients; the avoidance of peanutsto
prevent allergies in children; many kneeand spine
operations; tight
blood sugar control
in critically
ill patients; clear liquid dietsbefore
colonoscopies; bed restto prevent
preterm birth; the prescribingof unnecessary
medications,
to list just a few. In some of these cases, there is even evidence of harm. It is not uncommon for newer evidence to contradict what had been standard practice. A studyby
an Oregon Health & Science University School of Medicine physician, Vinay Prasad, and colleagues examined 363 articles in the New England Journal of Medicine from 2001 to 2010 that addressed an existing medical practice. Forty percent of the articles found the existing practice to be ineffective or harmful. Some of these reversals are well known. For example, three articles contradicted hormone replacement therapy for postmenopausal women.
Another three reported increased risk of heart attacks and strokes from the painkiller Vioxx.
Looked at one way, medical reversals like these reflect a failure; we didn’t gather enough evidence before a practice became commonplace. But in another way, they were at least a partial success: Science eventually caught up with practice. That doesn’t always happen. “Only a fraction of unproven medical practice is reassessed,” said Dr. Prasad, who is co-author of a book on medical reversals,
along with Adam Cifu, a University of Chicago physician. Dr. Prasad’s work is part of a growing movement to identify harmfuland wasteful care
and
purge it from health care systems. The American Board of Internal Medicine’s Choosing Wisely campaign identifies five practices in each of dozens of clinical specialties that lack evidence, cause harm, or for which better approaches exist. The organization that assessed the value of treatments in England has identified more than 800 practices that officials there feel should not be delivered. It’s an uphill battle. Even when we learn something doesn’t make us better, it’s hard to get the system to stop doing it. It takesyears or even
decades to reverse medical convention. Some practitioners clingto weak
evidence of effectiveness even when strong evidence of lack of effectiveness exists. This is not unique to clinical medicine. It exists in health policy,too
.
Much of what we do lacks evidence; and even when evidence mounts that a policy is ineffective, our political system often caters to invested stakeholders who benefit from it. An honest assessment of the state of science behind clinical practice and health policy is humbling. Though many things we do and pay for are effective, there is a lot we don’t know. That’s inevitable. What isn’t inevitable — and where the real problems lie — is assuming, without evidence, that something works.@afrakt
Share this...
email Tweetable
Comments closed
Health Policy
evidence-based health policy,
evidence-based medicine,
Upshot
*
FACTS DON’T REALLY CHANGE MINDS August 27, 2019 at 1:13 pmTiffany Doherty
GMOs. Vaccines. Death Panels. There are a lot of “beliefs” circulating about a wide variety of health policy issues. Luckily, these are all pretty well researched areas. Thanks to thorough investigations, we can conclude with certainty that vaccines are safe and effective, that GMOs are generally safe, and that the Affordable Care Act was not intended to execute any old people. But here’s a funny thing about these beliefs: giving the facts to people who are against these things doesn’t convince them to change their mind. Often, the people who hold to these ideas most stridently are the least knowledgeable about science, but BELIEVE they are the most knowledgeable about these subjects. Let’s talk about Dunning-Kruger and the paradox of incompetence.
This video was adapted from a column Aaron wrote for the Upshot.
Links to sources can be found there.
@DrTiff_
Share this...
email Tweetable
Comments closed
Explaining Research
,
Life
Dunning-Kruger
,
GMOs ,
Healthcare Triage
,
Knowledge deficit
,
vaccines
*
PLANNED PARENTHOOD WITHDRAWS FROM TITLE X FUNDING: WHAT DOES THAT MEANFOR PATIENTS?
August 23, 2019 at 4:45 pmTiffany Doherty
Title X is a federally funded Family Planning Program that has been around since 1970 as part of the Public Health Service Act. Following new restrictions on healthcare providers in clinics receiving Title X funding, Planned Parenthood announced this week that it would withdraw from the federal program.
@DrTiff_
Share this...
email Tweetable
Comments closed
Health Policy
Healthcare Triage
,
Planned Parenthood
,
Title X
*
JAMA FORUM: PRICE TRANSPARENCY August 22, 2019 at 2:57 pmAustin Frakt
> The idea behind price transparency is that informed consumers can > price shop for medical services that have widely varying prices, > like elective surgeries or magnetic resonance imaging (MRI). The > concept is very popular, both in the United States>
> and abroad
> .
> Most recently, President Trump signed an executive order> aimed
> at requiring hospitals to disclose what patients will “actually > pay” for care. But evidence shows that transparency does little by > itself. Some argue health care prices may actually go up> in
> some cases. Giving consumers information alone does not mean> they
> will actively use it to shop around for lower costs. That’s from my piece at JAMA Forum with Gilbert Benavidez.
It’s mostly the sad tale of woe about how price transparency isn’t working out the way many hoped. But, there’s a glimmer of optimismat the end.
> For example, a recent article in the _American Journal of Health > Economics_ by Christopher Whaley, PhD, and colleagues at the > University of California, Berkeley, examined pairing price > transparency with reference pricing> for
> Safeway employees.>
> The study watched for employee health care behavior changes over 2 > years, looking at laboratory and imaging test prices. After the > first year, during which only price transparency tools were offered, > the authors confirmed the findings of previous studies: health plan > members rarely shopped.>
> But when the reference pricing information was added in the second > year things changed. Shopping picked up and prices decreased. > Specifically, laboratory test prices dropped 27% and imaging test > prices decreased 13%. The authors concluded that price tools will > capture the attention of consumers only if the consumers have strong > financial incentives to shop in the first place. It’s only one study. Clearly we need to see a lot more work on price transparency paired with reference pricing. Still, it’s the most promising thing in this area I’ve seen. __Research for this piece was supported by the Laura and John ArnoldFoundation.__
@afrakt
Share this...
email Tweetable
Comments closed
Explaining Research
JAMA Forum
, LJAF
, price
transparency
*
WHY WARNING PREGNANT WOMEN NOT TO DRINK CAN BACKFIRE August 21, 2019 at 8:30 amTiffany Doherty
_The following originally appeared on The Upshot(copyright
2019, The New York Times Company)_ In many areas of health policy, the best of intentions can lead to more harm than good. Such is the case with America’s approach to alcohol and pregnancy. The best evidence shows that punitive policies — such as equating drinking while pregnant as child abuse and threatening to involve child protective services — can dissuade women from getting prenatalcare.
Fetal alcohol spectrum disorders refer to a collection of problems in babies and children. These include low birth weight; impaired growth; and problems in the heart, kidneys and brain. Children can have developmental delays, communication difficulties, learning disabilities and lower I.Q. Some of these last a lifetime. It’s hard to know how many American children are affected. Studies done by the Centers for Disease Control and Prevention have estimated that between 2 and 15 infants per 10,000 born in the United States have fetal alcohol syndrome, the most severe form of the disorders. Some community-based studies that use the broader definition of the disorder have found more affected children, up to 5
percent .
We know that infants of women who drink alcohol in pregnancy may develop these disorders. The problem is what we don’t know. We don’t know the level of alcohol exposure in utero that could cause a child to develop these disorders. We don’t know if the timing of the exposure matters. We don’t know why some women who drink little might have a child who is affected, while some can binge drink during pregnancy and have a child with no apparent problems. Because of this, most medical organizations, including the American Academy of Pediatricsand the
C.D.C ., recommend that women forgo alcohol during pregnancy. The only dose known to be “safe” is none, they say, and therefore women should not drink at all. Many women in the United States comply with this directive. But a significant number do not. A study published in Aprilfound
that 11.5 percent of women who are pregnant report drinking alcohol. Almost 4 percent report binge drinking — defined as four or more drinks on any occasion — in the last month. Given that women may be ashamed to acknowledge this, the true numbers may be higher. To combat this, 43 states have enacted policies. These can be affirmative measures, like giving pregnant women priority for substance-abuse treatment, or punitive ones, like defining drinking alcohol during pregnancy as child abuse or neglect. Proponents of such policies believe that they are making things better, especially for children. A recent study suggests they’rewrong.
Researchers gathered birth certificate data for more than 155 million live births from 1972 to 2015. The researchers were interested in how many children were born at a low birth weight or prematurely. They compared the rates of these undesirable outcomesin
times and places when alcohol-pregnancy policies did and did not exist. They controlled for a number of demographic and related factors, including those known to be associated with poorer birth outcomes, like poverty and cigarette smoking. They found that policies that defined alcohol use during pregnancy as child abuse or neglect were associated with an increase of more than 12,000 preterm births. The cost of these were more than $580 million in the first year of life. Policies mandating warning signs where alcohol was sold were associated with an increase of more than 7,000 babies born at low birth weight, at a cost of more than $150 million. A previous study looking at how these policies affected women’sdrinking
found
mixed results. States with punitive policies had more drinking, not less. Over all, neither type of policy seemed to be associated with lower levels of drinking. It’s possible that states that already had more drinking might have put such policies in place in response to it. But the research methods used accounted for this and state-level data on drinking, and the prevalence of fetal alcohol spectrum disorders weren’t available when most of the policies were enacted, making it hard to believe that the relative levels of problems were what spurred policymakers to act. Dr. Sarah Roberts, an associate professor of obstetrics and gynecology at the University of California, San Francisco, is an author of this study and other related work. Doctors have long discussed potential dangers with patients, one on one, with many benefits, she noted. But policies that punish women for or publicly warn them about harms from alcohol or drug use during pregnancy may lead to further harms by scaring women into forgoing prenatal care, she said. Such policies may even convince them that talking with their physicians isn’t a good idea. “Qualitative researchfinds that
pregnant women who use drugs avoid prenatal care out of fear that, if their providers find out about their drug use, they will be reported to child protective services and lose their children,” she said. “Our study found that child abuse/neglect policies led to decreased prenatal care use.” Other research confirms this hypothesis. Three years ago, researchers (including me) published the findingsof
a survey on legal requirements for drug testing in prenatal care. Although most women were tolerant of laws requiring screening of pregnant women, 21 percent reported they would be offended if their doctors asked them about drug use as part of prenatal care, and 14 percent said that mandatory testing would discourage prenatal careattendance.
It’s that last bit that most concerns physicians. Avoiding medical care is not what we’d like to see happen. The goal of all of these policies is to improve the health not only of pregnant women, but also of the children they bear. Many people assume that if physicians simply provide more information — if women are just warned — things will improve. Without research, those assumptions are just unproven hopes. Dr. Roberts had two suggestions for what might work better. The first: Start over and go through a rigorous process of engaging with women who drink during pregnancy to find out — from them — what would help. Second, stop treating pregnancy as a special case when it comesto alcohol.
“There is some evidence that general population alcohol policies — such as limiting where alcohol can be sold — are associated with improved birth outcomes,” Dr. Roberts said. “This makes sense as research shows that the biggest predictor of drinking during pregnancy is drinking before pregnancy. Women don’t start drinking during pregnancy; if they drink during pregnancy, it’s usually a continuation of the way and the amount they were drinking prior topregnancy.”
It might be better to spend time making sure that women are connected to the health care system in general, and that they enter pregnancy healthy — rather than focusing on the nine months of pregnancy, as if that were the only time that mattered. It’s easy to stigmatize women who drink during pregnancy, with words and with policy. The goal, though, is healthier mothers and infants. To achieve that, policymakers may need to stop stigmatizing and startover.
@aaronecarroll
Share this...
email Tweetable
Comments closed
Health Policy
fetal alcohol syndrome,
pregnancy
, Upshot
*
WHY IS IT SO HARD TO LOWER DRUG PRICES? August 20, 2019 at 6:32 pmTiffany Doherty
There are many, many factors that contribute to high drug prices. Regulating them is complicated. We try to shed some light on thesituation.
This video was adapted from a column written by Austin Frakt for theUpshot
.
Links to sources can be found there.
@DrTiff_
Share this...
email Tweetable
Comments closed
Health Policy
drug prices
,
health care costs
,
Healthcare Triage
*
MORE BAD NUTRITION STUDIES: RED MEAT AND CANCER August 19, 2019 at 9:56 amTiffany Doherty
The old chestnut that eating red meat leads to cancer is back. A study last week claimed that eating red meat increased cancer risks by up to 28 percent! That sounds scary, but this study has a lot of problems.@DrTiff_
Share this...
email Tweetable
Comments closed
Explaining Research
cancer ,
Healthcare Triage News,
red meat
*
1619 PROJECT: LIST OF ARTICLES August 18, 2019 at 10:51 amAustin Frakt
The articles in The New York Times’ 1619 Project — observing the 400th anniversary of American slavery and its implications — are worth your time, and mine. It’s a beautiful online interactive, but very inconvenient if you want to gradually work you way through the articles over a span of days. I poked around, but couldn’t find a simple list of links to articles, so here’sone:
* Our democracy’s founding ideals were false when they were written. Black Americans have fought to make them true,
by Nikole Hannah-Jones * If you want to understand the brutality of American capitalism, you have to start on the plantation, by
Matthew Desmond
* Myths about physical racial differences were used to justify slavery — and are still believed by doctors today,
by Linda Villarosa
* America holds onto an undemocratic assumption from its founding: that some people deserve more power than others,
by Jamelle Bouie
* For centuries, black music has been the sound of artistic freedom. No wonder everybody’s always stealing it,
by Wesley Morris
* What does a traffic jam in Atlanta have to do with segregation?Quite a lot
,
by Kevin Kruse
* Why doesn’t the United States have universal health care? The answer begins with policies enacted after the Civil War,
by Jeneen Interlandi * Slavery gave America a fear of black people and a taste for violent punishment. Both still define our prison system,
by Bryan Stevenson
* The sugar that saturates the American diet has a barbaric history as the ‘white gold’ that fueled slavery,
by Khalil Gibran Muhammad * A vast wealth gap, driven by segregation, redlining, evictions and exclusion, separates black and white America,
by Trymaine Lee
* Their ancestors were enslaved by law. Today, they are graduates of the nation’s preeminent historically black law school,
a photo essay by Djeneba AduayomHere is
,
what I am told, a full PDF version of all these articles, as they appeared in print. Hereis where to buy
it in print.
The NYT site
promises more to come. I’m not sure how I’ll learn about them, but if/when I do, I’ll update this list.@afrakt
Share this...
email Tweetable
Comments closed
Law
race ,
slavery
*
COME WORK WITH ME!
August 15, 2019 at 11:40 amAustin Frakt
Colleagues and I are advertising for two policy analysts. If that’s you, this is an opportunity to work with us at the Partnered Evidence-based Policy Resource Center (PEPReC). Though PEPReC is a center in the Veterans Health Administration, the position will be filled through Boston University.Apply here
(writing focus) or here (budget/spreadsheet focus).@afrakt
Share this...
email Tweetable
Comments closed
Uncategorized
jobs
*
* 1
* 2
* 3
* …
* 872
* »
Loading
*
FOLLOW THE BLOG
Why all these options?*
TIE BOOKS
Amazon.com
Barnes & Noble
Indiebound
iBooks
Kobo
Amazon.com
Barnes & Noble
Books-A-Million
iBooks
IndieBound
Powells
Buy at Amazon.com
Summary
Excerpt: Economic profit Excerpt: Diminishing marginal utility Excerpt: Four factors of production Excerpt: Monopoly marginal revenue Excerpt: Consumer/producer surplusAmazon.com
Barnes & Noble
Books-A-Million
Borders
IndieBound
Powells
Borders
Barnes & Noble
IndieBound
Amazon.com
Books-A-Million
Powells
Austin and Aaron are participants in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to amazon.com.*
TAG CLOUD
ACA
AcademyHealth
access
accountable care organizationsAffordable Care Act
announcement
blogging
cancer
comic
competitive bidding
costs cost
shifting
deficit
employer-sponsored health insurancehealth care costs
Healthcare Triage
health insurance
health insurance mandateshealth reform
hospital readmissionshospitals
individual mandate
insurance exchange
market power
Massachusetts
Medicaid
Medicare
Medicare Advantage
mortality
nutrition
obesity
On The
Record
physicians
politics
PPACA
premiums
prescription drugs
quality
reading list
reflex RWJF
spending
uninsured
Upshot
vaccines
Work posted here under copyright © of the authors. Details on the Site Policies page.2019 The Authors*
Details
Copyright © 2024 ArchiveBay.com. All rights reserved. Terms of Use | Privacy Policy | DMCA | 2021 | Feedback | Advertising | RSS 2.0