Health Care
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Alyce S. Adams, PhD 
Professor of Medicine, Stanford's Center for Health Policy & Center for Primary Care and Outcomes Research
Professor of Epidemiology and Population Health in the Stanford School of Medicine 
Associate Director for Health Equity and Community Engagement in the Stanford Cancer Institute 

Title: Health Policy and the Fight for Equitable Healthcare Outcomes: Why Access Isn’t Enough

Abstract: Using evidence from evaluations of natural experiments, Alyce Adams will discuss the intended and unintended consequences of changes in prescription drug policy at the state and federal level of low income and minority individuals with multiple chronic conditions. We will explore the potential for policy effects to have an immediate and dramatic increase in access to clinically essential treatments. However, she will also discuss where such policies can widen, rather than reduce disparities in treatment. We concluded that increasing access (while critical) is not sufficient to address inequities in treatment use and outcomes among high risk populations. Importantly, new strategies are needed to inform the design of policy interventions that promote access, while simultaneously advancing health equity.

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https://stanford.zoom.us/meeting/register/tJcsf-6pqDwtH93u_yfFbEkV_XIbJ2gai0FV  

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Stanford Medicine Innovation Professor
alyce_profile_2022.jpg PhD, MPP

Alyce Adams is the inaugural Stanford Medicine Innovation Professor and Professor of Health Policy, Epidemiology and Population Health and of Pediatrics (by Courtesy). She also serves as Associate Chair for Community Outreach and Engagement for Stanford Health Policy, and as Associate Director for Partnership and Community Engagement in the Stanford Cancer Institute. Focusing on pharmaceutical treatments for cancer and diabetes, Dr. Adams' research evaluates health system and policy level interventions to improve access, balance the benefits and harms of treatment, improve patient-valued outcomes, and reduce disparities.

Professor, Epidemiology and Population Health
Professor, Health Policy
Professor, Pediatrics (by courtesy)
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Authors
Noa Ronkin
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News
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Technological progress boosts productivity and has made societies wealthier, but the impact of new digital technologies could be different from anything seen before. Some experts predict a future with robots and other forms of automation increasingly replacing workers, contributing to stagnant income, and worsening inequality. Yet it is difficult to pinpoint the net impact of advanced technologies on labor. There is anecdotal evidence that robotics and automation reduce manufacturing employment and wages, but evidence from the service sector remains scant. Collaborative research by APARC experts is now starting to fill this gap.

The researchers — including Karen Eggleston, APARC deputy director and director of the Asia Health Policy Program (AHPP), Yong Suk Lee, the deputy director of the Korea Program, and University of Tokyo health economist Toshiaki Iizuka, a former AHPP visiting scholar — set out to probe the impact of robots on services provided in nursing homes in Japan. Their study, one of the first investigations of service sector robots, offers an offset to the dystopian predictions of robot job replacement.

Published by the National Bureau of Economic Research, the study suggests that robot adoption has increased employment opportunities for non-regular care workers, helped mitigate the turnover problem that plagues nursing homes, and provided greater flexibility for workers. It is also published in AHPP's working paper series and is part of a broader research project by Eggleston, Lee, and Iizuka, that explores the impact of robots on nursing home care in Japan and the implications of robotic technologies adoption in aging societies.

Since we are currently still in the early phase of robot diffusion in the service sector, researchers and policymakers need to continue to monitor and assess the extent to which robots complement or augment some types of labor while substituting for others.
Eggleston, Lee, and Iizuka

[Subscribe to APARC's newsletters for the latest analysis from our experts.]

Japan has been on the front lines of a demographic crisis, grappling with a declining overall population, increasing proportion of seniors, and aversion to large-scale immigration. It has also been an early adopter of robots to address the shortage of care workers relative to a growing demand for long-term care services. Japan’s experience is especially instructive as more countries face aging populations, helping shed light on how demographics interact with new automation technologies.

In a VoxEU.org article, Eggleston, Lee, and Iizuka describe their study, its findings, and its implications. Examining the relationship between robot adoption and nursing home staffing in Japan, they find that robot-adopting nursing homes had between 3% and 8% more staff than their non-adopting counterparts. The increases in staffing occurred entirely among the non-regular employees. Nursing homes with robots also appeared to have higher management quality and were better able to reduce the burden on care workers. The results suggest “that the wave of technologies that inspires fear in many countries could help remedy the social and economic challenges posed by population aging in others.”

The Financial Times Magazine has recently featured the study by Eggleston, Lee, and Iizuka, calling it “groundbreaking in several ways but perhaps most clearly for setting its sights not on manufacturing but on the services sector, where robots are only just beginning to make their mark.” The great value of the study, the article notes, is that it lays the foundation for an empirical debate “on a subject that will be deluged with human emotion as robots continue their march into the services sector.”

You can also listen to a Financial Times podcast that features the new study (the segment starts at 4:52).

Read More

Male Japanese doctor showing senior patient records on a clipboard
News

Health Signals Increase Preventive Care, Improve Health Outcomes for Individuals at High Risk of Diabetes, Evidence from Japan Shows

Among the general population, however, researchers including Asia Health Policy Program Director Karen Eggleston find no evidence that additional care improves health outcomes.
Health Signals Increase Preventive Care, Improve Health Outcomes for Individuals at High Risk of Diabetes, Evidence from Japan Shows
A man with interacts with 'Emiew,' a humanoid robot.
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“Co-Bots,” Not Overlords, Are the Future of Human-Robot Labor Relationships

Yong Suk Lee and Karen Eggleston’s ongoing research into the impact of robotics and AI in different industries indicates that integrating tech into labor markets adjusts, but doesn’t replace, the long-term roles of humans and robots.
“Co-Bots,” Not Overlords, Are the Future of Human-Robot Labor Relationships
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A Japanese robot prototype lifts a dummy patient
Ri-man, a Japanese robot prototype under development to help assist nurses to lift patients from their bed. As Japan's society ages and nursing shortage increases, there will be a need for a robot to do the heavy lifting, especially since nurses themselves are aging. | Karen Kasmauski via Getty Images
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Subtitle

In one of the first studies of service sector robotics, APARC scholars examine the impacts of robots on nursing homes in Japan. They find that robot adoption may not be detrimental to labor and may help address the challenges of rapidly aging societies.

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Stanford Medicine Innovation Professor
alyce_profile_2022.jpg PhD, MPP

Alyce Adams is the inaugural Stanford Medicine Innovation Professor and Professor of Health Policy, Epidemiology and Population Health and of Pediatrics (by Courtesy). She also serves as Associate Chair for Community Outreach and Engagement for Stanford Health Policy, and as Associate Director for Partnership and Community Engagement in the Stanford Cancer Institute. Focusing on pharmaceutical treatments for cancer and diabetes, Dr. Adams' research evaluates health system and policy level interventions to improve access, balance the benefits and harms of treatment, improve patient-valued outcomes, and reduce disparities.

Professor, Epidemiology and Population Health
Professor, Health Policy
Professor, Pediatrics (by courtesy)
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Title: Research in Progress: Doug Owens - Development of the New USPSTF Guidelines on Screening for Lung Cancer and Colorectal Cancer

Brief Abstract: 

Discuss the development of the two new draft guidelines from the U.S. Preventive Services Task Force.  Screening for lung cancer and colorectal cancer are two of the most complex and important cancer screening guidelines in the USPSTF portfolio.  Describing the methods the USPSTF uses, including the evidence reviews and modeling that helped us create these new recommendations.

 

Zoom Meeting 

Register in advance for this meeting: 
https://stanford.zoom.us/meeting/register/tJcuf-2sqzkoE93jEPn9deZKTTBJoze-2d6u 

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Encina Commons, Room 201 
615 Crothers Way Stanford, CA 94305-6006 

Executive Assistant: Soomin Li, soominli@stanford.edu
Phone: (650) 725-9911

(650) 723-0933 (650) 723-1919
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Henry J. Kaiser, Jr. Professor
Professor, Health Policy
Senior Fellow, Freeman Spogli Institute for International Studies
Professor, Management Science & Engineering (by courtesy)
doug-headshot_tight.jpeg MD, MS

Douglas K. Owens is the Henry J. Kaiser, Jr. Professor, Chair of the Department of Health Policy in the Stanford University School of Medicine and Director of the Center for Health Policy (CHP) in the Freeman Spogli Institute for International Studies (FSI). He is a general internist, a Professor of Management Science and Engineering (by courtesy), at Stanford University; and a Senior Fellow at the Freeman Spogli Institute for International Studies.

Owens' research includes the application of decision theory to clinical and health policy problems; clinical decision making; methods for developing clinical guidelines; decision support; comparative effectiveness; modeling substance use and infectious diseases; cardiovascular disease; patient-centered decision making; assessing the value of health care services, including cost-effectiveness analysis; quality of care; and evidence synthesis.

Owens chaired the Clinical Guidelines Committee of the American College of Physicians for four years. The guideline committee develops clinical guidelines that are used widely and are published regularly in the Annals of Internal Medicine. He was a member and then Vice-Chair and Chair of the U.S. Preventive Services Task Force, which develops national guidelines on preventive care, including guidelines for screening for breast, colorectal, prostate, and lung cancer. He has helped lead the development of more than 50 national guidelines on treatment and prevention. He also was a member of the Second Panel on Cost Effectiveness in Health and Medicine, which developed guidelines for the conduct of cost-effectiveness analyses.

Owens also directed the Stanford-UCSF Evidence-based Practice Center. He co-directs the Stanford Health Services Research Program, and previously directed the VA Physician Fellowship in Health Services Research, and the VA Postdoctoral Informatics Fellowship Program.

Owens received a BS and an MS from Stanford University, and an MD from the University of California-San Francisco. He completed a residency in internal medicine at the University of Pennsylvania and a fellowship in health research and policy at Stanford. Owens is a past-President of the Society for Medical Decision Making. He received the VA Undersecretary’s Award for Outstanding Achievement in Health Services Research, and the Eisenberg Award for Leadership in Medical Decision Making from the Society for Medical Decision Making. Owens also received a MERIT award from the National Institutes on Drug Abuse to study HIV, HCV, and the opioid epidemic. He was elected to the American Society for Clinical Investigation (ASCI) and the Association of American Physicians (AAP.)

Chair, Department of Health Policy, School of Medicine
Director, Center for Health Policy, Freeman Spogli Institute for International Studies
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With vaccines against SARS-CoV-2, the virus that causes Covid-19, on the near-term horizon, U.S. policymakers are focusing on how to ensure that Americans get vaccinated. This challenge has been compounded by reports that White House officials are exerting undue influence over the agencies that would ordinarily lead such efforts, the Food and Drug Administration and the Centers for Disease Control and Prevention.

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Publication Type
Commentary
Publication Date
Journal Publisher
STAT News
Authors
Michelle Mello
Number
2020
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Few issues in the policy response to the coronavirus disease 2019 (COVID-19) pandemic have inspired as impassioned debate as school reopening. There is broad agreement that school closures involve heavy burdens on students, parents, and the economy, with profound equity implications, but also that the risk of outbreaks cannot be eliminated even in a partial reopening scenario with in-school precautions. Consensus largely ends there, however: the approaches states and localities have taken to integrating these concerns into school reopening plans are highly variable.

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Journal Articles
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Journal Publisher
JAMA Network
Authors
Jeremy Goldhaber-Fiebert
David Studdert
Michelle Mello
Number
2020
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Abstract

The economic and mortality impacts of the COVID-19 pandemic have been widely discussed, but there is limited evidence on their relationship across demographic and geographic groups. We use publicly available monthly data from January 2011 through April 2020 on all-cause death counts from the Centers for Disease Control and Prevention and employment from the Current Population Survey to estimate excess all-cause mortality and employment displacement in April 2020 in the United States. We report results nationally and separately by state and by age group. Nationally, excess all-cause mortality was 2.4 per 10,000 individuals (about 30% higher than reported COVID deaths in April) and employment displacement was 9.9 per 100 individuals. Across age groups 25 y and older, excess mortality was negatively correlated with economic damage; excess mortality was largest among the oldest (individuals 85 y and over: 39.0 per 10,000), while employment displacement was largest among the youngest (individuals 25 to 44 y: 11.6 per 100 individuals). Across states, employment displacement was positively correlated with excess mortality (correlation = 0.29). However, mortality was highly concentrated geographically, with the top two states (New York and New Jersey) each experiencing over 10 excess deaths per 10,000 and accounting for about half of national excess mortality. By contrast, employment displacement was more geographically spread, with the states with the largest point estimates (Nevada and Michigan) each experiencing over 16 percentage points employment displacement but accounting for only 7% of the national displacement. These results suggest that policy responses may differentially affect generations and geographies.

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Publication Type
Journal Articles
Publication Date
Journal Publisher
Proceedings of the National Academy of Sciences
Authors
Maria Polyakova
Number
2020
Paragraphs

When an experienced provider opts to leave a healthcare workforce (attrition), there are significant costs, both direct and indirect. Turnover of healthcare providers is underreported and understudied, despite evidence that it negatively impacts care delivery and negatively impacts working conditions for remaining providers. In the Veterans Affairs (VA) healthcare system, attrition of women’s health primary care providers (WH-PCPs) threatens a specially trained workforce; it is unknown what factors contribute to, or protect against, their attrition.

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Publication Type
Journal Articles
Publication Date
Journal Publisher
Journal of General Internal Medicine
Authors
Number
2020
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