Abstract: The U.S. health care system is undergoing significant changes. Two prominent shifts include millions added to Medicaid and greater integration and consolidation among firms. We empirically assess if these two industry trends may have implications for each other. Using experimentally derived (“secret shopper”) data on primary care physicians' real-world behavior, we observe their willingness to accept new privately insured and Medicaid patients across 10 states. We combine this measure of patient acceptance with detailed information on physician and commercial insurer market structure and show that insurer and provider concentration are each positively associated with relative improvements in appointment availability for Medicaid patients. The former is consistent with a smaller price discrepancy between commercial and Medicaid patients and suggests a beneficial spillover from greater insurer market power. The findings for physician concentration do not align with a simple price bargaining explanation but do appear driven by physician firms that are not vertically integrated with a health system. These same firms also tend to rely more on nonphysician clinical staff.
Daniel Polsky, Zuleyha Cidav, Ashley Swanson (2016), Marketplace Plans with Narrow Physician Networks Feature Lower Monthly Premiums than Plans with Larger Networks, Health Affairs, 35 (10), pp. 1842-1848.
Daniel Polsky, Guy David, Bruce Kinosian, Jianing Yang, Rachel M. Werner (2014), The Effect of Entry Regulation in the Health Care Sector: the Case of Home Health, Journal of Public Economics.
Rachel Werner, Jonathan Kolstad, Elizabeth Stuart, Daniel Polsky (2013), The Effect of Pay for Performance in Hospitals: Lessons for Quality Improvement, Health Affairs, 30 (4), pp. 690-698.
Abstract: The payment approach known as “pay-for-performance” has been widely adopted with the aim of improving the quality of health care. Nonetheless, little is known about how to use the approach most effectively to improve care. We examined the effects in 260 hospitals of a pay-for-performance demonstration project carried out by the Centers for Medicare and Medicaid Services in partnership with Premier Inc., a nationwide hospital system. We compared these results to those of a control group of 780 hospitals not in the demonstration project. The performance of the hospitals in the project initially improved more than the performance of the control group: More than half of the pay-for performance hospitals achieved high performance scores, compared to fewer than a third of the control hospitals. However, after five years, the two groups’ scores were virtually identical. Improvements were largest among hospitals that were eligible for larger bonuses, were well financed, or operated in less competitive markets. These findings suggest that tailoring pay-for-performance programs to hospitals’ specific situations could have the greatest effect on health care quality.
K. Armstrong, TC Randall, Daniel Polsky, E Moye, Jeffrey H. Silber (2011), Racial differences in surgeons and hospitals for endometrial cancer treatment, Med Care, 49(2):207-14.
HCMG101 - HEALTH CARE SYSTEMS
This introductory course takes a policy and politics angle to health care's three persistent issues - access, cost and quality. The roles of patients, physicians, hospitals, insurers, and pharmaceutical companies will be established. The interaction between the government and these different groups will also be covered. Current national health care policy initiatives and the interests of class members will steer the specific topics covered in the course. The course aims to provide skills for critical and analytical thought about the U.S. health care system and the people in it.
HCMG901 - SEM:HLTH CARE COST BEN
The purpose of this doctoral level course is to investigate the theory and practice of cost-benefit and cost-effectiveness analysis as applied to health care. The three techniques to be examined are cost-effectiveness analysis with single dimensional outcomes, cost effectiveness analysis with multiple attributes (especially in the form of Quality Adjusted Life Years), and economic cost-benefit analysis. Valuation of mortality and morbidity relative to other goods will be emphasized. Students will be expected to develop written critiques of articles in the literature, and to design a new application of one of the techniques as a term project.