Background: Medicare Part D excludes benzodiazepine medications from coverage, and some state Medicaid programs also limit coverage. We assessed whether such policies decrease the risk of fractures in elderly individuals living in nursing homes. Methods: This is a quasi-experimental study with interrupted time-series estimation and extended Cox proportional hazards models comparing changes in outcomes before and after implementation of Medicare Part D in a nationwide sample of nursing home residents in 48 states.
Neumann, P.J., Auerbach, H.R., Cohen, J.T., and D. Greenberg
pp. 280-6
Objectives: To identify potentially low-value services for inclusion in value-based insurance design (VBID) programs and to discuss challenges involved in incorporating such information. Methods: We searched the Tufts Medical Center Cost-Effectiveness Analysis Registry (www.cearegistry.org) to identify examples of low-value services, defined as interventions that make health worse without saving money or those that cost at least $100,000 per quality-adjusted lifeyear gained. We restricted our attention to papers published since 2000.
McCullough, J.S., Casey, M., Moscovice, I. and S. Prasad
pp. 647-54
Health information technology (IT), such as computerized physician order entry and electronic health records, has potential to improve the quality of health care. But the returns from widespread adoption of such technologies remain uncertain. We measured changes in the quality of care following adoption of electronic health records among a national sample of U.S. hospitals from 2004 to 2007. The use of computerized physician order entry and electronic health records resulted in significant improvements in two quality measures, with larger effects in academic than nonacademic hospitals.
Adams, J.L., Mehrotra, A., Thomas, J.W., and E.A. McGlynn
pp. 1014-21
BACKGROUND: Insurance products with incentives for patients to choose physicians classified as offering lower-cost care on the basis of cost-profiling tools are increasingly common. However, no rigorous evaluation has been undertaken to determine whether these tools can accurately distinguish higher-cost physicians from lower-cost physicians. METHODS: We aggregated claims data for the years 2004 and 2005 from four health plans in Massachusetts.
I model the interaction of flexible spending accounts (FSAs) and conventional insurance in a simple discrete loss setting with asymmetric information. I show that FSA availability can break a separating equilibrium, even when one would otherwise exist, because high-risk types might prefer the lower-coverage contract supplemented with FSA funds. In this case there may exist a Pareto-inferior separating equilibrium. It is also shown that FSA availability alters the optimal pooling contract.
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