The Effect on Healthcare Costs of Treating Comorbid Depressive Disorder with Chronic Disease

Objective: Does the cost of treating depressive disorder comorbidity inflate the cost of treating other chronic conditions?  The answer is important both to payers and to those organizing health care delivery.

Methods: Results from the national Medical Expenditure Panel Survey of 2015 (N≈30,000) provided the data. We estimated costs from medical records and from the self-reported utilization of healthcare. Using the Mental Health Component Summary score of the 12-Item Short Form we estimated the level of depression. We used a general linear model to estimate costs with fixed effects for chronic disease (present or absent) and depression (highest third, middle third, lowest third). Physical health/functional status served as a covariate. We analyzed each of eight different chronic conditions (arthritis, chronic obstructive pulmonary disease, high cholesterol, cancer, diabetes, stroke, coronary heart disease, and asthma) separately.

Results: In each of these analyses, the presence or absence of the chronic condition had a strong impact on cost. In addition, being at the highest level of depression also had a significant impact on cost. However, the interaction between depression and chronic disease diagnoses tended to account for only a small amount of variation in cost.

Conclusion: The combination of depression and chronic disease diagnosis did not have a strong synergistic effect on the cost of medical care. An additive model provides a more parsimonious explanation of data from this national sample.

Robert M. Kaplan, PhD

Clinical Excellence Research Center, Stanford University School of Medicine

Robert M. Kaplan, PhD is research director at CERC.  He has served as Chief Science Officer at the US Agency for Health Care Research and Quality (AHRQ) and Associate Director of the National Institutes of Health, where he led the behavioral and social sciences programs.  He is also a Distinguished Emeritus Professor of Health Services and Medicine at UCLA, where he led the UCLA/RAND AHRQ health services training program and the UCLA/RAND CDC Prevention Research Center. He was Chair of the Department of Health Services from 2004 to 2009.  From 1997 to 2004 he was Professor and Chair of the Department of Family and Preventive Medicine, at the University of California, San Diego. He is a past President of several organizations, including the American Psychological Association Division of Health Psychology, Section J of the American Association for the Advancement of Science (Pacific), the International Society for Quality of Life Research, the Society for Behavioral Medicine, and the Academy of Behavioral Medicine Research. Kaplan is a former Editor-in-Chief of Health Psychology and of the Annals of Behavioral Medicine.  His 20 books and over 500 articles or chapters have been cited more than 30,000 times and the ISI includes him in the listing of the most cited authors in his field (defined as above the 99.5th percentile).  Kaplan is an elected member of the National Academy of Medicine (formerly the Institute of Medicine).  Dr. Kaplan is currently Regenstrief Distinguished Fellow at Purdue University and Adjunct Professor of Medicine at Stanford University.

Lunch will be provided to those who RSVP.

Moving Precision Medicine into Clinical Care and Health Policies: UCSF, Stanford, and Beyond

Precision medicine has evolved from a distant promise to reality, with many genomic tests now used in clinical care. Dr. Phillips will discuss the opportunities for researchers and clinicians to address the health policy implications of precision medicine, with a particular focus on opportunities at UCSF and Stanford. She will discuss a case study of a recent and highly controversial CMS national coverage decision on sequencing tests for cancer patients based on her article in JAMA 4/16/2018 (Phillips KA. Evolving Payer Coverage Policies on Genomic Sequencing Tests: Beginning of the End or End of the Beginning?)

Kathryn A. Phillips, PhD

Professor of Health Economics and Health Services Research and Founding Director, UCSF Center for Translational and Policy Research on Personalized Medicine University of California, San Francisco

Kathryn Phillips’s expertise is in the implementation of new technologies to improve healthcare. In 2007, she founded the UCSF Center for Translational and Policy Research on Personalized Medicine, which focuses on how to develop objective evidence on value and payer coverage of precision/personalized medicine. Dr. Phillips has published ~150 articles in major journals, including JAMA, New England Journal of Medicine, and Health Affairs, and has had continuous funding from the NIH as a Principal Investigator for 25 years. She serves on the editorial boards of the journals Health Affairs and Value in Health as well as all of the leading journals on precision medicine. A distinguishing characteristic of Dr. Phillips’ work is the translation of science into policy by bringing together perspectives across stakeholders. She has worked extensively with health plans, industry, and government agencies across the globe and has served on national and international scientific advisory committees for the National Academy of Medicine, Food and Drug Administration, and the President’s Council of Advisors on Science and Technology. Dr. Phillips is now serving on the Board of Directors for GenomeCanada (a non-profit organization that oversees and funds genomic research in Canada). In 2016, she was awarded a Rockefeller Foundation Bellagio Residency to pursue her work from a global perspective. Dr. Phillips holds degrees from UC-Berkeley, Harvard, and UT-Austin.

Lunch will be provided to those who RSVP.

Organized by the Media & Democracy program at the Social Science Research Council, in collaboration with the Stanford Center on Philanthropy and Civil Society and the Center for Advanced Study in the Behavioral Sciences at Stanford University. 

The 2016 American elections intensified popular as well as scholarly interest in the relationship between media and democracy. The role of social media has featured particularly prominently in debates over fake news, information bubbles, and algorithmic propaganda. Increased scholarly interest is manifested in the numerous conferences that have been held over the last year or so, jointly exploring technological changes in the media, social interactions online, and their relationship to the quality of our democracy.  
 
Social Media and Democracy: Assessing the State of the Field and Identifying Unexplored Questions will convene researchers to take stock and look ahead. In a format of brief remarks and panel discussions, we seek to assess the current literature on social media and democracy together, and to set a research agenda for the field moving forward.  
 
Format: Each panelist will be asked to speak for up to ten minutes. In lieu of preparing traditional research presentations, we encourage attendees to reflect on the field as a whole, and ask themselves where they would like to see scholars go next. After hearing prepared remarks from panelists, each panel will have allotted time for a discussion with audience participation.
 
Panel-specific prompts are included below, geared toward key connecting themes: What gaps exist in current research? What studies would we like to see that do not exist right now? What do we not yet know about the impact of social media on democracy? What partnerships are needed to pursue research that can answer these questions?
 
 

Thursday, April 19   8:30-9:00am             Registration and Breakfast

 
9:00-9:30am             Opening Remarks: Diana Mutz and Nate Persily  Overview of the Literature on Misinformation: Josh Tucker     
 
9:30-11:00am           Inflammatory Speech and Incivility Online
 
Panelists: Susan Benesch Bryan Gervais Diana Mutz Monica Stephens
 
Is social media a medium on which inflammatory speech and uncivil discourse are particularly prevalent? Online incivility may take a range of expressions, from unusually aggressive statements of individual political views to coordinated campaigns of harassment and intimidation. The targets may include out-partisans, professionals such as journalists, politicians, or government employees, and minority or underrepresented groups such as women and ethnic/religious minorities.
 
What, if anything, is different about inflammatory speech in the social media environment? What do we not yet understand about the origins, spread, and consequences of inflammatory speech online? Should we distinguish between different forms of incivility (e.g. direct threats vs. slurs, individual vs. coordinated harassment)? To what extent is online incivility related to real world actions (including, but not limited to, real world violence)?  
 
11:00-11:30am      Coffee Break   
11:30am-1:00pm  Distribution and Effects of Fake News
 
Panelists: Renee DiResta Kelly Garrett David Rand Josh Tucker
 
The distribution of false information - intentional and unintentional - through social media has  become a significant source of anxiety in the media, politics, and public discourse. Exposure to false information can lead to mistaken impressions about the world, and may also deepen partisan divisions.  
 
What do we need to learn about how misinformation spreads online? We already have some research that quantifies exposure to misinformation online; what do we need to learn next about the effects of such exposure (on the individual level and in the aggregate)? Has the spread of social media raised new, unanswered questions about how people process information and classify it as true or false?  
 
1:00-2:00pm       Lunch   2:00-3:30pm            Correcting Disinformation
 
Panelists: Jonathan Albright Matthew Baum Adam J. Berinsky Matthew Gentzkow Emily Thorson
 
Once a person has been exposed to, and accepted as true, an inaccurate piece of information, how can the information be successfully corrected? What do we need to understand next about the possibilities and pitfalls for correcting misinformation?  
 
Do we have reason to suspect that social media changes the difficulty of correcting misperceptions? What do we not yet know about how corrections of factual information lead to changes in political attitudes or behavior? If we want to correct false beliefs, what do we need to learn about who should go about making corrections, and how?   
 
 
 
Friday, April 20th   8:30-9:00am  Breakfast
 
9:00am-10:30am Homophily in the Social Media Sphere
 
Panelists: Damon Centola Annie Franco Shanto Iyengar Jaime Settle
 
Concern about online political discourse taking place in self-selected or algorithmically supported “information bubbles” is common, though there are differing views on how serious this problem is.  
 
Do we know whether social media is exceptional in enabling or limiting exposure to politically heterogeneous information? How do algorithms affect how much political content users see and/or the kind of political content to which they are exposed? What do we not yet understand about the frequency and consequences of political homophily on social media, as distinct from other types of media? What study would you like to see next on the prevalence and consequences of homogeneous political information? 

10:30-10:45am         Coffee Break   10:45am-12:15pm Globalization of the Marketplace of Ideas
 
Panelists: Nina Jankowicz Linda Kinstler Jennifer Pan

The use of social media for political ends is not limited to the United States, nor to traditional state actors. Narratives about politics are circulated online to influence domestic audiences, to drive political perceptions abroad, and to organize as well as suppress citizen unrest.
 
What do we need to learn next about the effectiveness of using social media to push the political interests of state- or non-state actors? What do we not yet understand about the dynamics at play when nation-states get involved in one another’s media ecosystems? How is this any different from when they previously did so using other media? What can we learn from studying the intersection of media and democracy in comparative perspective?
 
12:15-1:30pm Concluding Discussion Over Lunch (to-go available per request

Abstract:

In 2002 and 2003, Americans pointed to Japan after the Second World War as a model which proved that enemy countries could be remade into stable democratic allies through short military occupation. Planners and politicians drew on their understanding of events in Japan to learn "lessons" for a post-Saddam Iraq. In the years since, it has become common to blame the failures of intervention in Iraq on American ignorance and insufficient planning. But is that popular characterization correct? This talk discusses whether and how the planning phases for Japan and Iraq differed, and with what implications for the occupied countries.

Speaker Bio:

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Abstract:

The South African democratic process has crossed two significant milestones. One is political legitimacy in the sense that there is no significant threat to the constitution or political systems that the country adopted in 1996. Secondly, the systemic instability threat arising from the counter-revolutionary apartheid forces is now something of the past. There is simply no imminent threat of a retreat to the country’s authoritarian and racist past. The elusive goals remain in the economic arena – namely inclusive growth, widening inequality and slow development. How is the country shaping up to these challenges?

Speaker Bio:

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Speaker Bio:

Beatriz Magaloni

Abstract:

Financial markets expose individuals to the broader economy. Does participation in financial markets also lead individuals to re-evaluate the costs of conflict, their views on politics and even their votes? Prior to the 2015 Israeli elections, we randomly assigned financial assets from Israeli and Palestinian companies to likely voters and gave them incentives to actively trade for up to seven weeks. Opportunities to trade in financial markets systematically shifted vote choices and increased support for peace initiatives. These effects persist a year after the experiment, and appear consistent with financial market exposure leading to increased awareness of the economic risks of conflict.

Speaker Bio:

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Modern-day markets do not arise spontaneously or evolve naturally. Rather they are crafted by individuals, firms, and most of all, by governments. Thus "marketcraft" represents a core function of government comparable to statecraft and requires considerable artistry to govern markets effectively. Just as real-world statecraft can be masterful or muddled, so it is with marketcraft. 

In his new book, Steven Vogel builds his argument upon the recognition that all markets are crafted then systematically explores the implications for analysis and policy. In modern societies, there is no such thing as a free market. Markets are institutions, and contemporary markets are all heavily regulated. The "free market revolution" that began in the 1980s did not see a deregulation of markets, but rather a re-regulation. Vogel looks at a wide range of policy issues to support this concept, focusing in particular on the US and Japan. He examines how the US, the "freest" market economy, is actually among the most heavily regulated advanced economies, while Japan's effort to liberalize its economy counterintuitively expanded the government's role in practice. 

Marketcraft demonstrates that market institutions need government to function, and in increasingly complex economies, governance itself must feature equally complex policy tools if it is to meet the task. In our era-and despite what anti-government ideologues contend-governmental officials, regardless of party affiliation, should be trained in marketcraft just as much as in statecraft.

SPEAKER

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Steven K. Vogel, Il Han New Professor of Asian Studies and a Professor of Political Science at the University of California, Berkeley

BIO

Steven K. Vogel is the Il Han New Professor of Asian Studies and a Professor of Political Science at the University of California, Berkeley. He specializes in the political economy of the advanced industrialized nations, especially Japan. He recently completed a book, entitled Marketcraft: How Governments Make Markets Work (Oxford, 2018), which argues that markets do not arise spontaneously but rather are crafted by individuals, firms, and most of all by governments.  Thus “marketcraft” represents a core function of government comparable to statecraft.  The book systematically reviews the implications of this argument, critiquing prevalent schools of thought and presenting lessons for policy.  Vogel is also the author of Japan Remodeled: How Government and Industry Are Reforming Japanese Capitalism (Cornell, 2006) and co-editor (with Naazneen Barma) of The Political Economy Reader: Markets as Institutions (Routledge, 2008). His first book, Freer Markets, More Rules: Regulatory Reform in Advanced Industrial Countries  (Cornell, 1996), won the Masayoshi Ohira Memorial Prize. He edited his mother’s book, Suzanne Hall Vogel, The Japanese Family in Transition: From the Professional Housewife Ideal to the Dilemmas of Choice(Rowman & Littlefield, 2013), and a volume on U.S.-Japan Relations in a Changing World(Brookings, 2002).  He won the Northern California Association of Phi Beta Kappa Teaching Excellence Award in 2002, and the UC Berkeley Faculty Award for Outstanding Mentorship of Graduate Student Instructors in 2005.  He has been a columnist for Newsweek-Japan and the Asahi Shimbun, and he has written extensively for the popular press.  He has worked as a reporter for the Japan Times in Tokyo and as a freelance journalist in France. He has taught previously at the University of California, Irvine and Harvard University. He has a B.A. from Princeton University and a Ph.D. in Political Science from the University of California, Berkeley.

Wednesday, April 18, 2018

1:30 – 2:30pm

Encina Hall, Philippines Room

FSI and the Ford Dorsey IPS program will be hosting Mercy Corps as they visit campus to speak about their Global Internship Program.

The Mercy Corps Global Internship Program offers exploration into future careers in international relief and development while supporting our beneficiaries in their local communities in 25 countries around the world. Their internships revolve around a particularly demanding mission - to help people on the ground turn the crises they confront into the opportunities they deserve. Driven by local needs, our programs provide communities in the world’s most challenging places with the tools and support they need to transform their lives.

Mercy Corps is an international relief and development organization working in over 40 countries worldwide helping people build secure, productive and just communities. From poverty and malnutrition to natural disasters and global warming, Mercy Corps sees an opportunity to create transformative change. In crisis, we believe in the power of human potential. Mercy Corps connects people to the resources they need to build better, stronger lives.