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Diagnostic Imaging for Low Back Pain: Advice for High-value Health Care from the American College of Physicians
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Diagnostic imaging is indicated for patients with low back pain only if they have severe progressive neurologic deficits or signs or symptoms that suggest a serious or specific underlying condition. In other patients, evidence indicates that routine imaging is not associated with clinically meaningful benefits but can lead to harms. Addressing inefficiencies in diagnostic testing could minimize potential harms to patients and have a large effect on use of resources by reducing both direct and downstream costs. In this area, more testing does not equate to better care. Implementing a selective approach to low back imaging, as suggested by the American College of Physicians and American Pain Society guideline on low back pain, would provide better care to patients, improve outcomes, and reduce costs.
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High-value, Cost-Conscious Health Care: Concepts for Clinicians to Evaluate Benefits, Harms, and Costs of Medical Interventions
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Health care costs in the United States are increasing unsustainably, and further efforts to control costs are inevitable and essential. Efforts to control expenditures should focus on the value, in addition to the costs, of health care interventions. Whether an intervention provides high value depends on assessing whether its health benefits justify its costs. High-cost interventions may provide good value because they are highly beneficial; conversely, low-cost interventions may have little or no value if they provide little benefit.
Thus, the challenge becomes determining how to slow the rate of increase in costs while preserving high-value, high-quality care. A first step is to decrease or eliminate care that provides no benefit and may even be harmful. A second step is to provide medical interventions that provide good value: medical benefits that are commensurate with their costs.
This article discusses 3 key concepts for understanding how to assess the value of health care interventions. First, assessing the benefits, harms, and costs of an intervention is essential to understand whether it provides good value. Second, assessing the cost of an intervention should include not only the cost of the intervention itself but also any downstream costs that occur because the intervention was performed. Third, the incremental cost-effectiveness ratio estimates the additional cost required to obtain additional health benefits and provides a key measure of the value of a health care intervention.
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Private Health Insurance in South Korea: An International Comparison
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In this event, Dr. Jaeun Shin will discuss the historical and policy background of expanded
private health insurance in South Korea. Looking at the public-private mix of
health care financing and its impacts, Shin
conducted a comparative study of thirty member countries of the Organization for
Economic Co-operation and Development (OECD) during the period 1980 to 2007 to ask
whether private health insurance can counterbalance limited government
financing, high out-of-pocket payments, and the persistent financial deficit of
South Korea’s National Health Insurance system.
The panel analyses of OECD
Health Data from 2009 suggest that private health insurance financing is unlikely to
reduce government spending on health care and social security. Also, Shin found little
evidence that out-of-pocket payments will be replaced by private health
insurance payments. Private health insurance payments, however, are found to
have a statistically significant positive association with total spending on
health care, which indicates that the coverage effect of private health
insurance—in addition to national health insurance—may exceed the efficiency
gain through the market competition that private insurers may deliver to the
health care sector. These findings leave it unclear whether private initiatives in health care financing will be as
effective as the policy advocates hope for, in dealing with the challenges of
national health insurance in South Korea. Shin suggests that further studies of how public and
private insurers, and providers and consumers interplay in response to a given structure of private-public mix
in financing are warranted to decide the right balance between private coverage
and publicly provided universal coverage.
Daniel and Nancy Okimoto Conference Room
Jaeun Shin
Associate Professor of Economics
Speaker
KDI School of Public Policy and Management, South Korea
Seminars
Qiulin Chen
Shorenstein APARC
Stanford University
Encina Hall, Room C335
Stanford, CA 94305-6055
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qlchencn@stanford.edu
2011 Shorenstein-Spolgi Fellow in Comparative Health Policy
Qiulin Chen is a postdoctoral fellow of Shorenstein APARC and a member of the center's Asia Health Policy Program. His main interest of research is health economics and public finance, focusing on policy and outcome comparison of health care systems and Chinese health reform. His dissertation focused on performance comparison between public (or governmental) and private health care financing, between local and central government responsibility on health care, between contracted and integrated health care system. In particular, his dissertation examined under Chinese-style decentralization, known as fiscal decentralization with political centralization, how economic competition affect local government's behaviour on health investment, and why public contracted system obstructs health performance and provides one channel of such effects in terms of preventive care and public health. He is currently involved in a comparative research project on demographic change in East Asia based on the National Transfer Accounts data and analysis.
Chen's recent publication is "The changing pattern of China's public services" (with Ling Li and Yu Jiang) in Population Aging and the Generational Economy: A Global Perspective (Ronald Lee and Andrew Mason, editors), forthcoming 2011. Before studying in Stanford, he has published more than 10 papers in academic journals in Chinese, such as Jing Ji Yan Jiu (Economic Research) and Zhong Guo Wei Sheng Jing Ji (Chinese Health Economics), and 5 book chapters. He has participated in about 20 research projects, such as A Design of Framework for Healthcare Reform in China which is commissioned by the State Council Working Party on Health Reform, Strategy Planning Study of "Healthy China 2020" which is commissioned by the Minister of Health, and Health Challenge in the Aging Society and It's Policy Implication funded by Chinese National Natural Science Foundation.
Chen earned his Ph.D. in Economics from Peking University in 2010, and earned a B.A. in Business Administration from Nanjing University in 2001. From 2004 through 2008, he was Executive Assistant of the Director of the China Centre for Economic Research at Peking University (CCER). He is also a postdoctoral fellow of National School of Development at Peking University (Its predecessor is CCER).
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Private Health Insurance in South Korea: An International ComparisonPrivate Health Insurance in South Korea: An International Comparison
In this study, we discuss the historical and policy background of expanded private health insurance in South Korea. Looking at the public-private mix of health care financing and its impacts, we conduct a comparative study of 30 member countries of the Organisation for Economic Co-operation and Development (OECD) over the period 1980–2007 to ask whether private health insurance can counterbalance limited government financing, high out-of-pocket payments, and the persistent financial deficit of South Korea’s National Health Insurance system. The panel analyses of OECD Health Data 2009 suggest that private health insurance financing is unlikely to reduce government spending on health care and social security. Also we find little evidence that out-of-pocket payments will be replaced by private health insurance payments. Private health insurance payments, however, are found to have a statistically significant positive association with total spending on health care, which indicates that the coverage effect of private health insurance—in addition to national health insurance—may exceed the efficiency gain through the market competition that private insurers may deliver to the health care sector. These findings leave it unclear whether private initiatives in health care financing will be as effective as the policy advocates hope for, in dealing with the challenges of national health insurance in South Korea. Further studies of how public and private insurers, and providers and consumers interplay in response to a given structure of private-public mix in financing are warranted to decide the right balance between private coverage and publicly provided universal coverage.
Philippines Conference Room
Jaeun Shin
Associate Professor of Economic
Speaker
KDI School of Public Policy and Management
John (Jack) W. Rowe
Columbia University, MSPH
Dept. of Health Policy & Mgmt.
600 West 168th Street, 6th Fl.
New York, NY 10032
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Professor, Department of Health Policy and Management, Joseph Mailman School of Public Health, Columbia University
Dr. John Rowe is the Julius B. Richmond Professor of Health Policy and Aging at the Columbia University Mailman School of Public Health. Previously, from 2000 until his retirement in late 2006, Dr. Rowe served as Chairman and CEO of Aetna, Inc., one of the nation's leading health care and related benefits organizations. Before his tenure at Aetna, from 1998 to 2000, Dr. Rowe served as President and Chief Executive Officer of Mount Sinai NYU Health, one of the nation’s largest academic health care organizations. From 1988 to 1998, prior to the Mount Sinai-NYU Health merger, Dr. Rowe was President of the Mount Sinai Hospital and the Mount Sinai School of Medicine in New York City.
Before joining Mount Sinai, Dr. Rowe was a Professor of Medicine and the founding Director of the Division on Aging at the Harvard Medical School, as well as Chief of Gerontology at Boston’s Beth Israel Hospital. He was Director of the MacArthur Foundation Research Network on Successful Aging and is co-author, with Robert Kahn, Ph.D., of Successful Aging (Pantheon, 1998). Currently, Dr. Rowe leads the MacArthur Foundation’s Network on An Aging Society .
Dr. Rowe was elected a Fellow of the American Academy of Arts and Sciences and a member of the Institute of Medicine of the National Academy of Sciences. He serves on the Board of Trustees of the Rockefeller Foundation and is Chairman of the Board of Trustees at the Marine Biological Laboratory in Woods Hole, Massachusetts and the Board of Overseers of Columbia University’s Mailman School of Public Health. He is Chair of the Advisory Council of Stanford University’s Center on Longevity, and was a founding Commissioner of the Medicare Payment Advisory Commission ( Medpac) and Chair of the board of Trustees of the University of Connecticut.
Adjunct Affiliate at the Center for Health Policy and the Department of Health Policy
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The effects of offering health plan choice within employment-based purchasing groups
- Read more about The effects of offering health plan choice within employment-based purchasing groups
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Over the last two decades, employers have increasingly offered workers a choice of health plans. The availability of choice has the potentially beneficial effects of lowering the cost and increasing the quality of health care through greater competition among health plans for enrollees as well as allowing consumers to enroll in the type of coverage that most closely matches their preferences. On the other hand, concerns about the potential for adverse selection within employment-based purchasing in response to the availability of choice exist. In this paper, I examine the effects of offering choice in employment-based purchasing groups on access to and the cost of employer-sponsored coverage. I find that greater availability of choice was associated with a reduction in the premium of employer-sponsored coverage and an increase in the proportion of workers covered by the plans offered by employers. However, most of the premium reductions were due to a shift from family to single coverage within employment-based purchasing groups and a reduction in the generosity of the plans in which employees were enrolled. The results are not consistent with the availability of choice leading to lower premiums through greater competition among plans for workers.
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Journal of Risk and Insurance
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