[show abstract][hide abstract] ABSTRACT: Biosimilars are here, but there's no clear pathway yet for their approval. Difficult realities about their effect on drug prices, innovation, and competition need to be faced.
[show abstract][hide abstract] ABSTRACT: This study examines how to reduce greenhouse gas emissions in the U.S. through the widespread delivery of broadband services and the expansion of telecommuting. Telecommuting can reduce greenhouse gas emissions over the next 10 years by approximately 588.2 tons of which 247.7 million tons is due to less driving, 28.1 million tons is due to reduced office construction, and 312.4 million tons because of less energy usage by businesses. This paper explores these broadband services and their effects on the environment, specifically as a means to achieve better and cleaner energy use, while enhancing economic output, worker productivity and the standard of living of American consumers.
[show abstract][hide abstract] ABSTRACT: The USA is now developing a process for expedited approval of biosimilars. Biopharmaceuticals are far more complex and costly to develop and produce than chemical drugs. Biosimilars raise greater safety issues owing to possible immune responses, are likely to offer smaller percentage price reductions than chemical generics and will probably obtain smaller market shares. Patents may not be as strong for biopharmaceuticals, which are often made by small firms, suggesting the desirability of greater data exclusivity protection. This article suggests that it is better to err on the side of too much protection than too little, given the uncertainties involved.
[show abstract][hide abstract] ABSTRACT: Specialty hospitals have been and continue to be a contentious issue in health care policy. Some claim that they provide services at lower cost, are more efficient, and create desirable competition for general, acute care hospitals. Others maintain that they serve the lower cost and better insured patients or offer only the relatively profitable services including heart or orthopedic care. General acute care hospitals claim that they are left with the high cost patients and/or services and are less able to offer unprofitable but necessary services like burn units or emergency rooms.This paper analyzes such policies of general acute-care hospitals as denying hospital privileges to physicians who own or work in specialty hospitals. In particular we analyze a recent case, Murphy vs. Baptist Hospital, No. CV2004-2002, Feb. 27, 2009 where the Arkansas courts held that a hospital could not deny privileges to physicians who owned a competing specialty hospital. Is it appropriate that a hospital must allow a competitor access to its facility? Is the long run interest of society enhanced by such a policy? Does it make a difference if the hospital is the only one in the area?We analyze other public policies related to specialty hospitals such as requiring them to offer emergency room services. Does such a policy enhance consumer welfare? Does it erect unnecessary entry barriers? We also investigate issues associated with the Stark Law. In particular, should physicians be allowed to refer patients to hospitals in which they have an ownership interest? The impacts of recent CMS changes regarding ancillary services are examined. We also consider the issues contained in the current health care reform bills related to restrictions on new and established specialty hospitals. Medicare payment rates are considered as are specific proposals to suppress the growth of specialty hospitals.The bottom line is whether society has a compelling interest in preventing the development of competition to general acute-care hospitals. This paper evaluates the economics of cross-subsidization, examines alternatives to the policy of curtailing competition from specialty hospitals, and proposes a framework for analysis.
[show abstract][hide abstract] ABSTRACT: As more biopharmaceuticals reach the market, more attention will be given to issues such as cost-effectiveness evaluations, biosimilars, and price controls. The value biologic therapies bring to the healthcare system may take years to appreciate in full -perhaps only when policy decisions allow for their economic effects to be understood.
[show abstract][hide abstract] ABSTRACT: Encouraging both generic drug competition and pharmaceutical innovation is difficult, especially in the case of follow-on biologics. Can the U.S. nurture a system that seeks both lower drug prices now and new and improved medications in the future?
[show abstract][hide abstract] ABSTRACT: Specialty hospitals are not a new phenomenon. From psychiatric and tuberculosis hospitals to children's and eye hospitals, they have long existed. The current interest lies in the development of single specialty hospitals for certain conditions or illness such as cardiology or orthopedics for which such hospitals were previously uncommon or non-existent. We include physician-owned surgical hospitals in our definition of single specialty hospitals. Some have claimed that these specialty hospitals (hereafter SSH) are an efficient way of producing services by concentrating them in one institution. They argue that SSHs avoid inefficiencies of scheduling and use of facilities not expressly designed for the illness or condition. Critics contend that doctors are simply trying to get the general hospital's profits and the ultimate impact will be a financial weakening of the general hospital. They argue that the cross-subsidy from these procedures and services are necessary to give general hospitals the ability to provide services to the uninsured and the poor. This debate led to a 30-month moratorium on new specialty hospitals which was lifted in August 2006. General acute care hospitals have responded by denying privileges to physicians who own or participate in competing SSHs. The appropriateness of such economic credentialing will be investigated. Further, we shall examine issues associated with Medicare pricing structures that encourage the development of SSHs as well as self-referral rules for physicians involved with SSHs. The real issue which has not been addressed is whether specialty hospitals create more value for the patient than the traditional acute care hospitals.
Journal of health care finance 02/2007; 34(2):1-9.
[show abstract][hide abstract] ABSTRACT: Background
Treatment of patients receiving hemodialysis who have anemia varies considerably despite the availability of established practice guidelines from the National Kidney Foundation Kidney Disease Outcomes Quality Initiative (KDOQI).Objective
To compare actual use of erythropoietin (EPO) and intravenous (IV) iron with that recommended in KDOQI guidelines.MethodsA budget impact model was used to calculate costs per member per month (PMPM) for actual practice versus recommended practice were calculated using Medicare reimbursement rates for EPO and IV iron. A sensitivity analysis tested the impact of varying the recommended dosages by ± 50%.ResultsFor EPO, a net savings PMPM of $257 (if administered by IV ) or $252 (if administered subcutaneously) could be achieved with adherence to KDOQI guidelines. Adherence to KDOQI recommendations for IV iron would increase Medicare reimbursements for this drug by an estimated $6 PMPM. Sensitivity analysis revealed a significant potential savings even if the dose of EPO used in practice was increased by 50%.Conclusions
In the face of limited resources and changing reimbursement policies, dialysis providers will need to find ways of reducing costs without compromising the quality of care. Clinical practice guidelines such as KDOQI can be used to assist providers in meeting this challenge. Among Medicare patients who have anemia of chronic kidney disease, adherence to KDOQI treatment recommendations could translate into a significant savings for Medicare. Our findings provide incentive for payers and dialysis centers to examine their current practices and improve the quality and efficiency of anemia treatment in this population.
[show abstract][hide abstract] ABSTRACT: The objective of this research was to compare the accuracy of two types of neural networks in identifying individuals at risk for high medical costs for three chronic conditions. Two neural network models-a population model and three disease-specific models-were compared regarding effectiveness predicting high costs. Subjects included 33,908 health plan members with diabetes, 19,264 with asthma, and 2,605 with cardiac conditions. For model development/ testing, only members with 24 months of continuous enrollment were included. Models were developed to predict probability of high costs in 2000 (top 15% of distribution) based on 1999 claims factors. After validation, models were applied to 2000 claims factors to predict probability of high 2001 costs. Each member received two scores-population model score applied to cohort and disease model score. Receiver Operating Characteristic (ROC) curves compared sensitivity, specificity, and total performance of population model and three disease models. Diabetes-specific model accuracy, C = 0.786 (95%CI = 0.779-0.794), was greater than that of population model applied to diabetic cohort, C = 0.767 (0.759-0.775). Asthma-specific model accuracy, C = 0.835 (0.825-0.844), was no different from that of population model applied to asthma cohort, C = 0.844 (0.835-0.853). Cardiac-specific model accuracy, C = 0.651 (0.620-0.683), was lower than that of population model applied to cardiac cohort, C = 0.726 (0.697-0.756). The population model predictive power, compared to the disease model predictive power, varied by disease; in general, the larger the cohort, the greater the advantage in predictive power of the disease model compared to the population model. Given these findings, disease management program staff should test multiple approaches before implementing predictive models.
[show abstract][hide abstract] ABSTRACT: This paper addresses the potential economic benefits of chromium picolinate plus biotin (Diachrome) use in people with Type 2 diabetes (T2DM). The economic model was developed to estimate the impact on health care systems' costs by improved HbA1C levels with chromium picolinate plus biotin (Diachrome). Lifetimes cost savings were estimated by adjusting a benchmark from the literature, using a price index to adjust for inflation. The cost of diabetes is highly dependent on the HbA1C level with higher initial levels and higher annual increments increasing the cost. Improvement in glycemic control has proven to be cost-effective in delaying the onset and progression of T2DM, reducing the risk for diabetes-associated complications and lowering utilization and cost of care. Chromium picolinate plus biotin (Diachrome) showed greater improvement of glycemic control in poorly controlled T2DM patients (HbA(1C) > or = 10%) compared to their better controlled counterparts (HbA(1C) < 10%). This improvement was additive to that achieved by oral hypoglycemic medications and correlates to calculated levels of cost savings. Average 3-year cost savings for chromium picolinate plus biotin (Diachrome) use could range from 1,636 dollars for a poorly controlled patient with diabetes without heart diseases or hypertension, to 5,435 dollars for a poorly controlled patient with diabetes, heart disease, and hypertension. Average 3-year cost savings was estimated to be between 3.9 billion dollars and 52.9 billion dollars for the 16.3 million existing patients with diabetes. Chromium picolinate plus biotin (Diachrome) use among the 1.17 million newly diagnosed patients with T2DM each year could deliver lifetime cost savings of 42 billion dollars, or 36,000 dollars per T2DM patient. Affordable, safe, and convenient, chromium picolinate plus biotin (Diachrome) could prove to be a cost-effective complement to existing pharmacological therapies for controlling T2DM.
[show abstract][hide abstract] ABSTRACT: To compare the costs with the benefits of using chlorhexidine gluconate dressings on central venous catheters and to determine the effectiveness of these dressings in reducing local infections and catheter-related bloodstream infections (CRBSIs), costs, and mortality.
Cost-benefit analysis using randomized, controlled trial data on chlorhexidine dressing prevention of local infection and CRBSI, data on cost of chlorhexidine dressing versus standard treatment, data on averted cost of treating local infection and CRBSI, and data on mortality attributable to CRBSI. Decision analysis evaluated averted CRBSI treatment cost per patient resulting from chlorhexidine dressing use. Sensitivity analyses demonstrated net benefit of chlorhexidine dressing, varying baseline rate of CRBSI, incremental cost of treating CRBSI, and number of catheters, and evaluated mortality preventable through chlorhexidine dressing use, varying baseline rate of CRBSI, number of catheters, and mortality attributable to CRBSI.
Patients of all Philadelphia area hospitals and one Philadelphia academic medical center.
Estimated potential annual U.S. net benefits from chlorhexidine dressing use ranged from $275 million to approximately $1.97 billion. Cost-benefit findings persisted in sensitivity analyses varying baseline rate of CRBSI, incremental cost of treating CRBSI, and overall number of catheters used. Preventable mortality analyses showed potential decreases of between 329 and 3,906 U.S. deaths annually as a result of nationwide use of chlorhexidine dressing.
Chlorhexidine dressings would reduce costs, local infections and CRBSIs, and deaths. Use of chlorhexidine dressings should be considered to prevent infections among patients with catheters.
Infection Control and Hospital Epidemiology 09/2004; 25(8):668-74. · 4.02 Impact Factor
[show abstract][hide abstract] ABSTRACT: Conclusion A fundamental question is whether society will be willing to spend an ever increasing portion of its GDP on healthcare. Accordingly,
as Getzen notes, the battle over revenues in the health sector is a constant phenomenon as the various players seek to improve
their bargaining position. In the healthcare industry as in other industries, the segment with market power reaps the most
profit. Historically, doctors had the market power, then the market power shifted to the insurance companies. In 2004, hospitals
and doctors have improved their bargaining power relative to insurance companies. Getzen documents these battles over resources
through his flow of founds approach. He has provided an excellent treatment for health economics courses and others interested
in this increasingly improtant and contentious area of study.
[show abstract][hide abstract] ABSTRACT: The purpose of this study was to review economic considerations related to establishing a diagnosis of Crohn's disease, and to compare the costs of a diagnostic algorithm incorporating wireless capsule endoscopy (WCE) with the current algorithm for diagnosing Crohn's disease suspected in the small bowel. Published literature, clinical trial data on WCE in comparison to other diagnostic tools, and input from clinical experts were used as data sources for (1) identifying contributors to the costs of diagnosing Crohn's disease; (2) exploring where WCE should be placed within the diagnostic algorithm for Crohn's; and (3) constructing decision tree models with sensitivity analyses to explore costs (from a payor perspective) of diagnosing Crohn's disease using WCE compared to other diagnostic methods. Literature review confirms that Crohn's disease is a significant and growing public health concern from clinical, humanistic and economic perspectives, and results in a long-term burden for patients, their families, providers, insurers, and employers. Common diagnostic procedures include radiologic studies such as small bowel follow through (SBFT), enteroclysis, CT scans, ultrasounds, and MRIs, as well as serologic testing, and various forms of endoscopy. Diagnostic costs for Crohn's disease can be considerable, especially given the cycle of repeat testing due to the low diagnostic yield of certain procedures and the inability of current diagnostic procedures to image the entire small bowel. WCE has a higher average diagnostic yield than comparative procedures due to imaging clarity and the ability to visualize the entire small bowel. Literature review found the average diagnostic yield of SBFT and colonoscopy for work-up of Crohn's disease to be 53.87%, whereas WCE had a diagnostic yield of 69.59%. A simple decision tree model comparing two arms--colonoscopy and SBFT, or WCE--estimates that WCE produces a cost savings of 291dollars for each case presenting for diagnostic work-up for Crohn's. Sensitivity analysis varying diagnostic yields of colonoscopy and SBFT vs. WCE demonstrates that WCE is still less costly than SBFT and colonoscopy even at their highest reported yields, as long as the diagnostic yield of WCE is 64.10% or better. Employing WCE as a first-line diagnostic procedure appears to be less costly, from a payor perspective, than current common procedures for diagnosing suspected Crohn's disease in the small bowel. Although not addressed in this model, earlier diagnosis with WCE (due to higher diagnostic yield) also could lead to earlier management, improved quality of life and workplace productivity for people with Crohn's disease.
[show abstract][hide abstract] ABSTRACT: The spate of hospital mergers in recent years has yielded both substantial increases in market power and many divestitures. These seemingly contradictory results stem from the pressures imposed by stakeholders of merging hospitals and the inability of those stakeholders to exert control over nonprofit institutions prior to the effectuation of a merger. This Article examines several recent mergers, analyses their failures, and recommends that the judiciary and state attorneys general look carefully at merging nonprofits so as to fill the void left by the lack of market control mechanisms.
[show abstract][hide abstract] ABSTRACT: This review article examines the issues raised by shifting from the "customary, prevailing, and reasonable" system of paying doctors under Medicare to a fee schedule based on construction of relative resource costs, in particular relative physician work effort. The volume edited by H.E. Frech III provides the basis to consider issues such as whether a relative surplus of specialist physicians exists and if so, whether changes in reimbursement will alleviate the maldistribution. Regulation of physician fees is likely to impact patient access, especially if balance billing is not allowed. Early research on the implementation of the new system indicates that fees have been set far below private insurance rates. Alternatives to price regulation are proposed.
[show abstract][hide abstract] ABSTRACT: This paper considers such issues involved in non-profit hospital mergers as relevant product and geographic markets and the impacts of mergers on competition. The roles of non-price competition, entry barriers, and merger-generated efficiencies are considered. Close attention is given to the relevance of the Justice Department Merger guideline to the hospital industry. Through detailed examination of four litigated or challenged cases, the geographic market is shown to depend upon particular medical services. Outpatient services are found to comprise a separate market from inpatient hospital services, and non-profit status is determined to warrant the usual antitrust merger treatment.
Review of Industrial Organization 07/1993; 8(4):473-490. · 0.48 Impact Factor