David L. Weimer

David L. Weimer
University of Wisconsin–Madison | UW · Robert M. La Follette School of Public Affairs

Ph.D.

About

224
Publications
53,014
Reads
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7,440
Citations
Citations since 2017
48 Research Items
2541 Citations
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Introduction

Publications

Publications (224)
Article
Whose costs and benefits should count in cost-benefit analysis (CBA)? This is an important practical question requiring answers for analysts because most government agencies offer only permissive or vague guidance. Drawing primarily on foundational CBA principles, we present a conceptual framework for specifying standing to answer three important b...
Article
Objectives: Within the context of a single study, assess the relative importance of the 6 factors identified in a 2019 systematic review as associated with the likelihood that family members will visit nursing home residents. Design: Retrospective statistical analysis of an existing survey data set. Settings and participants: A national survey...
Article
Health insurance regulators often set minimum ratios of provider = per‐enrollee for health insurance plans to try to ensure that their provider networks offer enrollees adequate access to medical care. However, plan‐specific ratios only have an unambiguous interpretation when each provider participates in only one single network. Based on network d...
Article
For a quarter‐century, the Organ Procurement and Transplantation Network (OPTN) has confronted the role of geography in the allocation of deceased‐donor livers for transplantation. An historical legacy of a geographical hierarchy giving priority to patients within the same local Donor Service Area (DSA) as the donor gradually evolved to give some r...
Article
Objectives To assess (1) the relationship of consumers' assessment of overall nursing home quality to their assessment of specific dimensions of quality; and (2) the implications of this relationship for composite quality measures in Nursing Home Compare. Design A survey conducted in 2017 elicited respondents' assessments of the quality of overall...
Article
Full-text available
Some issues in the application of benefit–cost analysis (BCA) remain contentious. Although a strong conceptual case can be made for taking account of the marginal excess tax burden (METB) in conducting BCAs, it is usually excluded. Although a strong conceptual case can be made that BCA should not include distributional values, some analysts continu...
Article
Full-text available
Context: The practical accessibility to medical care facilitated by health insurance plans depends not just on the number of providers within their networks but also on distances consumers must travel to reach the providers. Long travel distances inconvenience almost all consumers and may substantially reduce choice and access to providers for some...
Article
Full-text available
Importance The Centers for Medicare & Medicaid Services (CMS) Five-Star measure for nursing homes is designed with input from expert panels about the importance of multiple quality indicators. Consumers may assign different values to these indicators, creating different 5-star ratings. Objective To compare nursing homes’ rankings based on the CMS...
Article
Monetizing Bowser: A Contingent Valuation of the Statistical Value of Dog Life – Corrigendum - Deven Carlson, Simon Haeder, Hank Jenkins-Smith, Joseph Ripberger, Carol Silva, David Weimer
Article
Cost‐benefit analysis, as a tool of general use in policy analysis or as a mandated analytical process in some rulemaking, provides protocols for assessing the relative efficiency of policy alternatives. However, inconsistent and apparently irrational decisions by consumers in some situations call into question the validity of inferring the values...
Article
Households in the USA spend about $70 billion annually on pets. Dogs, the most common pet, can be found in nearly half of American households. An important shadow price in the analysis of policies affecting human mortality is the value of statistical life (VSL), which is imputed from how people make decisions involving tradeoffs between small morta...
Article
We assessed the effect of provider networks on access to four medical specialties for Affordable Care Act Marketplace enrollees in California. Our approach incorporated a crucial consumer-focused attribute, travel distance, and identified the restrictions on provider access resulting from network design. Our analysis indicated that Marketplace plan...
Article
Full-text available
One way for jurisdictions with limited analytic resources to increase their capability for doing cost–benefit analysis (CBA) is to use existing shadow prices, or “plug-ins”, for important social impacts. This article contributes to the further development of one important shadow price: the value of an additional high school graduation in the United...
Article
Intellectual and practical endeavors almost always demand theory to help make sense of the complex world. Descriptive theories seek to predict what will happen, or at least understand what has happened, in particular circumstances. Normative theories seek to inform agents about what they should want or do in particular circumstances. As professiona...
Article
Full-text available
Background: Recovery high schools (RHS) provide a supportive educational and therapeutic environment for students subsequent to treatment for substance use disorders (SUDs). Most students served by RHSs have concurrent mental health disorders and are at risk for school failure or dropout and substance use relapse. Aims of the study: The central...
Article
In order to increase access to medical services, expanding coverage has long been the preferred solution of policymakers and advocates alike. The calculus appeared straightforward: provide individuals with insurance, and they will be able to see a provider when needed. However, this line of thinking overlooks a crucial intermediary step: provider n...
Chapter
Full-text available
Commonly defined as observations inconsistent with general patterns in a data set, researchers often consider outliers to be undesirable because they do not fit well with hypothesized generalizations or because they exert disproportionate influence in commonly-used statistical estimation techniques. Less commonly, outliers are viewed as providing v...
Article
Objective The current 5‐Star composite measure for nursing homes uses expert‐driven weights to combine elements of quality into a single score. We assessed the feasibility of using the contingent valuation method (CVM) to derive consumers’ preference‐based weights for the Nursing Home Compare report card as a potential alternative approach. Data S...
Book
Cost-Benefit Analysis provides accessible, comprehensive, authoritative, and practical treatments of the protocols for assessing the relative efficiency of public policies. It provides thorough treatments of the essential concepts from microeconomics; time discounting; dealing with contingent uncertainty using expected surpluses and option prices;...
Article
Full-text available
In 2016, the Centers for Medicare & Medicaid Services (CMS) introduced 3 new quality measures (QMs) to its report card, Nursing Home Compare (NHC). These measures—rehospitalizations, emergency department visits, and successful discharges to the community—focus on short-stay residents. We offer a first analysis of nursing homes’ performance in terms...
Article
Policy Analysis in the United States brings together contributions from some of the world’s leading scholars and practitioners of public policy analysis including Beryl Radin, David Weimer, Rebecca Maynard, Laurence Lynn, and Guy Peters. This volume is part of the International Library of Policy Analysis series, enabling scholars to compare cross-n...
Article
Full-text available
What is comparative public policy? How can it contribute to better public policy? These questions seem fundamental to the mission of the Journal of Comparative Policy Analysis. Some scholars have addressed the first question, which usually places comparative policy analysis in an institutional context, emphasizing comparisons across countries. Howe...
Article
Full-text available
Purpose of study: A currently proposed rule by the Centers for Medicare & Medicaid Services would require providers to devote more resources to discharge planning from hospitals to ensure the prioritization of patient preferences and goals in the discharge planning process. Annually, more than 3 million persons enter a nursing home in the United S...
Book
How should policy analysts assess 'benefit validity' when behavioral anomalies appear relevant? David L. Weimer provides thoughtful answers through practical guidelines. Behavioral economists have identified a number of situations in which people appear not to behave according to the neoclassical assumptions underpinning welfare economics and its a...
Book
Often described as a public policy “bible,” Weimer and Vining remains the essential primer it ever was. Now in its sixth edition, Policy Analysis provides a strong conceptual foundation of the rationales for and the limitations to public policy. It offers practical advice about how to do policy analysis, but goes a bit deeper to demonstrate the app...
Article
Full-text available
Objective: To test whether use of a personalized report card, Nursing Home Compare Plus (NHCPlus), embedded in a reengineered discharge process, can lead to better outcomes than the usual discharge process from hospitals to nursing homes. Data sources/setting: Primary data collected in the Departments of Medicine and Surgery at a University Medi...
Article
The adequacy of provider networks for plans sold through insurance Marketplaces established under the Affordable Care Act has received much scrutiny recently. Various studies have established that networks are generally narrow. To learn more about network adequacy and access to care, we investigated two questions. First, no matter the nominal size...
Article
Full-text available
Unhealthy substance use in the USA results in significant mortality and morbidity. This study measured the effectiveness of paraprofessional-administered substance use screening, brief intervention, and referral to treatment (SBIRT) services on subsequent healthcare utilization and costs. The pre-post with comparison group study design used a popul...
Article
Allocation of scarce heterogeneous life-saving goods confronts society with profound challenges that are analytically complex and morally laden. Deceased-donor kidneys for transplant are heterogeneous in terms of relational and intrinsic quality. In 2014, the Organ Procurement and Transplantation Network implemented a new allocation system that mor...
Article
From a public policy perspective, the social value of privatization depends on the aggregate efficiency benefits over the long term. However, most privatization studies that examine the efficiency impacts of privatization employ relatively short time frames: usually 3-years before and 3-years after the privatization. In contrast, this study examine...
Article
Full-text available
Report cards currently published by the Centers for Medicare and Medicaid Services (CMS) offer composite (summary) quality measures based on a five-star ratings system, such as the one featured on the Nursing Home Compare website. These ratings are 'one size fits all patients' measures. Nursing Home Compare Plus is an alternative that allows patien...
Article
Background: Annually more than 3million people are admitted to one of the 15,965 skilled nursing facilities (SNFs) in the United States with 90% of admissions occurring from a hospital. Although the Centers for Medicare and Medicaid Services (CMS) publishes several web-based report cards, including one for nursing homes (Nursing Home Compare, NHC)...
Article
Public policy analysis seeks to promote social values by informing participants in the policy-making process. It typically involves framing problems as inefficiencies resulting from market and government failures or undesirable distributions of opportunities or outcomes. In its most general mode, multi-goal analysis, analysts identify and justify r...
Article
In Reply The ACA deserves credit for bringing new emphasis to the debate about network adequacy standards—many types of insurance in many states are currently not subject to any adequacy standards at all. We remain convinced of the potential for narrow networks to improve the quality of care and contain costs.However, as Dr Weiss notes, they equall...
Article
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Much has been written in the popular press and academic journals about the Affordable Care Act (ACA). It has been characterized by its supporters as the biggest expansion of coverage since the Great Society, and by its detractors as government overreach and socialism. Even aft er the president’s signature, two major Supreme Court verdicts upholding...
Article
This Viewpoint explains the concept of narrow networks and the Affordable Care Act. Much has been written about the Affordable Care Act (ACA) in the 5 years since its inception, both in scholarly journals and the popular press. Initial interest focused on states’ decisions about whether to implement their own insurance marketplaces and accept Medi...
Article
Four demands have driven the development of policy analysis in the United States. First, reformers have sought evidence to support their efforts. Beginning with the municipal bureaus of the Progressive Era, advocacy groups have sought supportive policy analysis, eventually resulting in the current proliferation of ideologically differentiated think...
Article
Do insurance plans offered through the Marketplace implemented by the State of California under the Affordable Care Act restrict consumers' access to hospitals relative to plans offered on the commercial market? And are the hospitals included in Marketplace networks of lower quality compared to those included in the commercial plans? To answer thes...
Article
Policy designers seeking to harness profit-driven efficiency for public purposes are increasingly creating organizations with fractionalized property rights that distribute “ownership” among public and private actors. The resulting hybrids are quite diverse, including mixed enterprises, public-private partnerships, social entrepreneurship organizat...
Article
Full-text available
Cuatro demandas han impulsado el desarrollo del análisis de políticas en Estados Unidos. Primero, los reformadores han buscado evidencia para sustentar sus esfuerzos. Comenzando con las oficinas municipales de la Era Progresista, los grupos que apoyan han buscado análisis de políticas de apoyo, lo que conduce a la proliferación de grupos de reflexi...
Article
Cuatro demandas han impulsado el desarrollo del análisis de políticas en Estados Unidos. Primero, los reformadores han buscado evidencia para sustentar sus esfuerzos. Comenzando con las oficinas municipales de la Era Progresista, los grupos que apoyan han buscado análisis de políticas de apoyo, lo que conduce a la proliferación de grupos de reflexi...
Article
The Affordable Care Act (ACA) seeks to change fundamentally the US health care system. The responses of states have been diverse and changing. What explains these diverse and dynamic responses? We examine the decision making of states concerning the creation of Pre-Existing Condition Insurance Plan programs and insurance marketplaces and the expans...
Article
Full-text available
We explore the economic welfare effects of direct and indirect government-induced changes in employment under varying market conditions. Webegin with a discussion of those policy-induced employment changes that seamlessly reshuffle workers among jobs in an efficient (i.e., full-employment, fullinformation) economy; generally such changes create few...
Article
Policy analysis often demands quantitative prediction—especially cost-benefit analysis, which requires the comprehensive quantification and monetization of all valued impacts. Using parameter estimates and their precisions, analysts can apply Monte Carlo simulation to create distributions of net benefits that convey the levels of certainty about th...
Conference Paper
The Nursing Home Compare (NHC) report card published by CMS includes 19 clinical quality-measures (QMs), staffing, and citation information. These measures are not correlated, making the choice of a nursing-home a difficult task. NHCPlus is an iPad application designed to be used at the hospital bedside. It simplifies the choice by allowing patient...
Conference Paper
Full-text available
31 diverse primary care clinics and two hospital-based sites in Wisconsin expanded delivery of alcohol and drug screening, brief intervention and referral to treatment (SBIRT) services with trained, dedicated, protocol-guided paraprofessionals. Site staff attempted to administer annual written screens to all adult patients. Of 166,647 eligible pati...
Article
Although governments worldwide are increasingly choosing to deliver services through organisations with greater autonomy than traditional bureaus, the implicit assumption that such agencification contributes to long-run efficiency remains largely untested. Agencification gives agency managers more autonomy and access to incentive mechanisms that le...
Chapter
Strategic petroleum reserves, also referred to as strategic petroleum stocks, are quantities of crude oil or petroleum products held either to facilitate draw downs to reduce the economic impacts of crude oil supply disruptions or to deter purposeful reductions in crude oil supply for political ends. They reduce the vulnerability of the world econo...
Article
Full-text available
The high cost of the US health care system does not buy uniformly high quality of care. Concern about low quality has prompted two major types of public policy responses: regulation, a top-down approach, and report cards, a bottom-up approach. Each can result in either functional provider responses, which increase quality, or dysfunctional response...
Article
The Patient Protection and Affordable Care Act (ACA) of 2010 has been one of the most controversial laws in decades. The ACA relies extensively on the cooperation of states for its implementation, offering opportunities for both local adaptation and political roadblocks. Health insurance exchanges are one of the most important components of the ACA...
Article
Full-text available
Objectives: To determine what factors contribute to successful appeals of nursing home deficiencies in the Informal Dispute Resolution (IDR) process. Design: We merged Centers for Medicare and Medicaid Services' data about IDRs with Online Survey, Certification, and Reporting data about nursing home characteristics. We performed multivariate sta...
Conference Paper
Full-text available
Prior studies found that nursing homes located in states with more stringent regulations experience higher costs. This study investigates the complementary hypothesis that more stringent regulation is associated with better quality by examining all 15,511 Medicare and Medicaid certified nursing homes nationally using Medicare cost reports and the M...
Article
To test the hypothesis that more stringent quality regulations contribute to better quality nursing home care and to assess their cost-effectiveness. Primary and secondary data from all states and U.S. nursing homes between 2005 and 2006. We estimated seven models, regressing quality measures on the Harrington Regulation Stringency Index and contro...
Article
Full-text available
How Information Matters: Networks and Public Policy Innovation. By HaleKathleen. Washington, DC: Georgetown University Press, 2011. 240p. $29.95. - Volume 10 Issue 2 - David L. Weimer
Article
Nursing homes that are not meeting quality standards are cited for deficiencies. Before 1995, the only recourse for a nursing home was a formal appeal process, which is lengthy and costly. In 1995, the Centers for Medicare & Medicaid Services instituted the Informal Dispute Resolution (IDR) process. This study presents for the first time national s...
Article
How well do the craft skills of policy analysis travel? The basic skills of assessing problems and structuring comparisons of policy alternatives in terms of relevant goals seem universal. However, the specific political, social, and economic contexts in which analysts work help determine the set of feasible alternatives and appropriate tradeoffs a...
Article
Federal advisory committees are commonplace in the administrative state and often play a critical informational role in policymaking. Public administration scholars have yet to explore fully the implications of the institutional design and intra-committee dynamics that influence the advice produced by advisory committees. Using the Medicare Evidenc...
Conference Paper
Nursing-homes are inspected annually by states and those not meeting minimum quality standards are cited for deficiencies. They can appeal these citations through the Informal Dispute Resolution (IDR) process, a precursor to a more costly, formal appeal. There are no studies examining the use of IDRs by nursing-homes. This study was designed to det...
Conference Paper
Quality of nursing-home care is regulated by federal and state governments through the survey process. This study was designed to estimate the costs that quality regulations impose on nursing-homes. Data included information about 11,168 free standing nursing-homes nationally in 2004-2006 from the Medicare cost reports, the MDS, OSCAR and a survey...
Article
Full-text available
Transplantation is generally the treatment of choice for those suffering from kidney failure. Not only does transplantation offer improved quality of life and increased longevity relative to dialysis, it also reduces end-stage renal disease program expenditures, providing savings to Medicare. Unfortunately, the waiting list for kidney transplants i...
Article
Government regulation is intended to enhance quality, safety, fairness, or competition in the regulated industry. Such regulation entails both direct and indirect costs. To estimate the costs associated with the regulation of quality of the nursing home industry. This study includes 11,168 free-standing nursing homes nationally, between 2004 and 20...
Conference Paper
The publication of the nursing home report card has allowed consumers to assess clinical quality, placing it on par with hotel quality. As a result, nursing homes faced changes in the demand for their services leading to incentives to reallocate resources from hotel to clinical activities. To test this hypothesis we analyzed Medicare cost reports...
Article
Nursing Home Compare first published clinical quality measures at the end of 2002. It is a quality report card that for the first time offers consumers easily accessible information about the clinical quality of nursing homes. It led to changes in consumers' demand, increasing the relative importance of clinical versus hotel aspects of quality in t...
Article
Medical governance should secure and apply appropriate expertise, accommodate stakeholder interests, and promote social values. The most common form of governance, public (agency) rulemaking by government agencies, usually involves supplementing in-house expertise through advisory committees. An alternative, private (stakeholder) rulemaking, involv...
Article
The Centers for Medicare and Medicaid Services provides a report card on nursing homes at a Web site called Nursing Home Compare (NHC) that includes information on 19 clinical quality measures (QMs). The information is intended to inform consumer choice, to provide a focus for state regulatory initiatives, and to promote nursing home quality improv...
Article
Policy makers in the US federal government regularly consult advisory committees, but there is little systematic research on how committee advice influences executive branch policy making. We investigate the Food and Drug Administration's (FDA) use of advisory committees when deciding whether or not to approve pharmaceutical drugs and medical devic...
Article
Many indigenous populations are experiencing rural-to-urban migration. In making this transition, indigenous peoples are entering industrial societies where most income derives from wages or salaries, and formal educational achievement is crucial in determining economic prospects. This research analyzes the gap in test score results between Aborigi...
Article
Benefit-cost analysis (BCA) provides a framework for systematically assessing the efficiency of public policies. Increasingly, BCA is being applied to social policies, ranging from preschool interventions to prison reentry programs. These applications offer great potential for helping to identify policies that offer the best returns on public inves...
Article
Governments throughout the industrialized world make decisions that fundamentally affect the quality and accessibility of medical care. In the United States, despite the absence of universal health insurance, these decisions have great influence on the practice of medicine. In Medical Governance, David Weimer explores an alternative regulatory appr...
Article
The author explores whether an evidence-based governance arrangement based on the Organ Procurement and Transplantation Network be applied to Medicare through a sketch of MedSAVE, an organization that would set reimbursement rates and reporting requirements for surgeries paid for by Medicare.
Article
Full-text available
A national quality report card for nursing homes, Nursing Home Compare, has been published since 2002. It has been shown to have some, albeit limited, positive impact on quality of care. The objective of this study was to test empirically the hypothesis that nursing homes have responded to the publication of the report by adopting cream skimming ad...
Article
Alzheimer's disease (AD) is a progressive neurodegenerative disease that places substantial burdens on those who provide support for family members with declining cognitive and functional abilities. Many AD patients eventually require formal long-term care services because of the absence, exhaustion, or inability of family members to provide care....

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Projects (2)
Project
Families of nusring home residents are being surveyed to find their overall assessments of the nursing homes. These overall assessments will be related to data provided by Nursing Home Compare to find the implicit weights families are placing on various dimensions of quality. The survey will also include contingent valuation questions to assess willingness to pay in terms of travel time for improvements in specific dimensions of quality.