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Maya Vadiveloo, L. Beth Dixon and Brian Elbel. 2011. Consumer Purchasing Patterns in Response to Calorie Labeling Legislation in NYC. International Journal of Behavioral Nutrition and Physical Activity. In Press.
Elizabeth Bradley, Benjamin Elkins, Jeph Herrin and Brian Elbel. 2011. Health and Social Service
Expenditures: Associations with Health Outcomes. BMJ - Quality and Safety. Mar 29 epub, In Press.
Objective To examine variations in health service expenditures and social services expenditures across Organisation for Economic Co-operation and Development (OECD) countries and assess their association with five population-level health outcomes.
Design A pooled, cross-sectional analysis using data from the 2009 release of the OECD Health Data 2009 Statistics and Indicators and OECD Social Expenditure Database.
Setting OECD countries (n=30) from 1995 to 2005.
Main outcomes Life expectancy at birth, infant mortality, low birth weight, maternal mortality and potential years of life lost.
Results Health services expenditures adjusted for gross domestic product (GDP) per capita were significantly associated with better health outcomes in only two of five health indicators; social services expenditures adjusted for GDP were significantly associated with better health outcomes in three of five indicators. The ratio of social expenditures to health expenditures was significantly associated with better outcomes in infant mortality, life expectancy and increased potential life years lost, after adjusting for the level of health expenditures and GDP.
Conclusion Attention to broader domains of social policy may be helpful in accomplishing improvements in health envisioned by advocates of healthcare reform.
Elbel, B., Gyamfi, J. & Kersh, R. 2011. Child and Adolescent Fast Food Choice and the Influence of Calorie Labeling. International Journal of Obesity.
Objective:Obesity is an enormous public health problem and children have been particularly highlighted for intervention. Of notable concern is the fast-food consumption of children. However, we know very little about how children or their parents make fast-food choices, including how they respond to mandatory calorie labeling. We examined children's and adolescents' fast-food choice and the influence of calorie labels in low-income communities in New York City (NYC) and in a comparison city (Newark, NJ).
Kersh, R. & Elbel, B. 2010. "Childhood Obesity; public health impact and policy responses". "Global View On Childhood Obesity: Current Status, Consequences, and Prevention" Debasis Bagchi, Editor.
Understanding the complex factors contributing to the growing childhood obesity epidemic is vital not only for the improved health of the world's future generations, but for the healthcare system. The impact of childhood obesity reaches beyond the individual family and into the public arenas of social systems and government policy and programs. Global Perspectives on Childhood Obesity explores these with an approach that considers the current state of childhood obesity around the world as well as future projections, the most highly cited factors contributing to childhood obesity, what it means for the future both for children and society, and suggestions for steps to address and potentially prevent childhood obesity.
Elbel, B. & Schlesinger, M. 2010. Choice and Medicare: An Experimental Analysis of Health Plan Choice. (Working Paper).
Chan, S. & Elbel, B. 2010. Cognition and Choice: The Case of Medicare. (Working Paper).
Elbel, B. 2010. Consumer Estimation of Calories Purchased from Fast Food and the Influence of Calorie Labeling. (Working Paper).
Schlesinger, M. & Elbel, B. 2010. How Much Choice? Nonlinear Relationships Between The Number of Health Plan Options and the Behavior of Medicare Beneficiaries. (Working Paper).
Sathe, N. & Elbel, B. 2010. Racial and Ethnic Disparities in the Utilization of Health Services Across Insurance Types Among Children. (Working Paper).
Schlesinger, M., Calderas, O. & Elbel, B. 2010. Strangers in a Strange Land: Recent Entrants to the U.S. Confront the Culture of Medical Consumerism. (Working Paper).
Schlesinger, M. & Elbel, B. 2010. The Cognitive-Behavioral Underpinnings of Health Policy: A Road map for Future Research and Policy Development. (Working Paper).
Bradley, E., Elkins, B. & Elbel, B. 2010. The Paradox of Health Care Spending: Getting Less for More. (Working Paper).
Elbel, B., Kersh, R., Brescoll, V.L. & Dixon, L.B. 2009. Calorie Labeling And Food Choices: A First Look At The Effects On Low-Income People In New York City. Health Affairs (Millwood). 2009;28(6):w1110-21 (published online October 6; 10.1377/ hlthaff.28.6.w1110).
We examined the influence of menu calorie labels on fast food choices in the wake of New York City's labeling mandate. Receipts and survey responses were collected from 1,156 adults at fast-food restaurants in low-income, minority New York communities. These were compared to a sample in Newark, New Jersey, a city that had not introduced menu labeling. We found that 27.7 percent who saw calorie labeling in New York said the information influenced their choices. However, we did not detect a change in calories purchased after the introduction of calorie labeling. We encourage more research on menu labeling and greater attention to evaluating and implementing other obesity-related policies.
Schlesinger, M., Stuckler, D. & Elbel, B. 2007. Experience Goods and Expectational Traps: Bounded Rationality and Consumer Behavior in Markets for Medical Care. (Working Paper).
Aims To assess the relative cost-effectiveness of lower versus higher cost prize-based contingency management (CM) treatments for cocaine abuse.
Design Cost-effectiveness analyses based on resource utilization, unit costs and outcomes from a previous CM efficacy trial.
Setting Two community-based treatment centers.
Participants Patients (n = 120) enrolled in out-patient treatment for cocaine abuse.
Intervention Random assignment to one of three 12-week treatment conditions: standard treatment (STD) alone or two variants of STD combined with prize based CM. In CM, drawing for prizes was available to those submitting drug-free urine samples and completing goal-related activities. There were two levels of pay-out (referred to as $80 versus $240) based on the potential value of prizes won.
Measurements Costs per participant associated with counseling utilization, urine and breathalyzer testing, and operation of the prize-drawing procedure were derived from a survey conducted at 16 clinics that had participated in CM studies. The three measures of effectiveness were: (1) longest duration of consecutive abstinence; (2) percentage completing treatment; and (3) percentage of samples drug-free.
Findings The higher magnitude CM produced outcomes at a lower per unit cost than did the lower magnitude prize CM treatment. This was the case for all three outcome measures examined and held across various assumptions in the sensitivity analysis.
Conclusions Cost-effectiveness analyses can inform policy decisions regarding selection of one treatment model over another. Decisions on adoption of new evidence-based treatments would be aided by more information on society's willingness to pay for incremental gains in effectiveness.
Cherlin, E., Helf, B., Elbel, B., Busch, S.H. & Bradley, E.H. 2006. Cultivating Next Generation Leadership: Preceptors’ Rating of Competencies in Post-Graduate Administrative Residents and Fellows.. Journal of Health Administration Education, Fall 2006, pp. 351-365.
Substantial national attention is being directed at enhancing the competency levels of early careerists in healthcare management. In this study, we examined preceptors' ratings of administrative resident/fellow competencies in multiple domains, and we compared those to our previous results of self-rated competency by residents/fellows. In this national sample of preceptors (n=61) of administrative residency/fellowship program listed with the American College of Healthcare Executives, competency in the information management domain was ranked highest, with more than half of preceptors (55.7%) giving their residents/fellows an "A" rating. Fewer preceptors (between 30.0% and 39.2%) gave their residents/fellows an "A" rating in domains of interpersonal and emotional intelligence, analytic and conceptual reasoning, and clinical operations. Less than 20% of preceptors rated competencies as "A" level in the domains of human resources/marketing/public affairs, financial management, fund raising, and facilities management. There were significant differences in preceptor ratings compared with resident/fellow self-ratings, with preceptors often providing lower ratings than provided by resident/fellows. The findings highlight the need not only to enhance competency levels of graduates but also to address the potential mismatch in early careerists' and preceptors' views about required and attained competency levels.
Bradley, E.H., Herrin, J., Elbel, B., McNamara, R.L., Magid, D.J. Brahmajee K…& Krumholz, H.M. 2006. Hospital Quality for Acute Myocardial Infarction: Correlation Among Process Measures and Relationship with Short-Term Mortality. Journal of the American Medical Association, Vol. 296, No. 1, pp. 72-78.
Context The Centers for Medicare & Medicaid Services (CMS) and the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) measure and report quality process measures for acute myocardial infarction (AMI), but little is known about how these measures are correlated with each other and the degree to which inferences about a hospital's outcomes can be made from its performance on publicly reported processes.
Objective To determine correlations among AMI core process measures and the degree to which they explain the variation in hospital-specific, risk-standardized, 30-day mortality rates.
Design, Setting, and Participants We assessed hospital performance in the CMS/JCAHO AMI core process measures using 2002-2003 data from 962 hospitals participating in the National Registry of Myocardial Infarction (NRMI) and correlated these measures with each other and with hospital-level, risk-standardized, 30-day mortality rates derived from Medicare claims data.
Main Outcome Measures Hospital performance on AMI core measures; hospital-specific, risk-standardized, 30-day mortality rates for AMI patients aged 66 years or older.
Results We found moderately strong correlations (correlation coefficients ≥0.40; P values <.001) for all pairwise comparisons between beta-blocker use at admission and discharge, aspirin use at admission and discharge, and angiotensin-converting enzyme inhibitor use, and weaker, but statistically significant, correlations between these medication measures and smoking cessation counseling and time to reperfusion therapy measures (correlation coefficients <0.40; P values <.001). Some process measures were significantly correlated with risk-standardized, 30-day mortality rates (P values <.001) but together explained only 6.0% of hospital-level variation in risk-standardized, 30-day mortality rates for patients with AMI.
Conclusions The publicly reported AMI process measures capture a small proportion of the variation in hospitals' risk-standardized short-term mortality rates. Multiple measures that reflect a variety of processes and also outcomes, such as risk-standardized mortality rates, are needed to more fully characterize hospital performance.
Kronebusch, K. & Elbel, B. 2004. Enrolling Children in Public Insurance: SCHIP, Medicaid, and State Implementation. Journal of Health Politics, Policy & Law; Jun 2004, Vol. 29 Issue 3, p451-489, 39p.
The Balanced Budget Act of 1997 established federal grants to the states to create the State Children's Health Insurance Program (SCHIP). This presented the states with a number of implementation choices concerning administrative models for the new programs, as well as choices about eligibility standards, enrollment simplification, crowd-out, and cost sharing requirements. At the same time, the states were also implementing welfare reform. We describe the most important of these implementation choices, and using data from the Current Population Survey, we estimate the impacts of state policy on enrollment in this multiprogram environment. The results indicate that SCHIP programs that are administered as Medicaid expansions are more successful than either separate SCHIP plans or combination programs in enrolling children. States that remove asset tests and implement presumptive eligibility and self-declaration of income have higher enrollment levels. Continuous eligibility and adoption of mail-in applications have no effect on overall enrollment. Waiting periods and premiums reduce enrollment. Stringent welfare reform reduces children's enrollment, despite federal policy that was intended to protect children from the consequences of welfare reform. The negative impacts of a number of these policy reforms substantially reduce enrollment, potentially offsetting the more favorable impacts of other policy choices. We estimate that if all states adopted the policy options that facilitate program use, enrollment for children with family incomes less than 200 percent of the poverty line could be raised from the current rate of 42 percent to 58 percent.
Kronebusch, K. & Elbel, B. 2004. Simplifying Children's Medicaid And SCHIP. Health Affairs; May/Jun2004, Vol. 23 Issue 3, p233-246, 14p.
The states have implemented the State Children's Health Insurance Program (SCHIP) in a variety of ways. We describe these choices and estimate the resulting enrollment impacts. Many widely adopted policies, including mail-in applications and twelve- month continuous eligibility, have had limited impacts. Other policies that increase enrollment, including presumptive eligibility and self-declaration of income, have not been widely adopted. SCHIP programs administered as Medicaid expansions have been more successful in enrolling children than either separate SCHIP plans or combination programs. Waiting periods, premiums, and welfare reform have had important negative impacts on children's program enrollment.
Schlesinger, M., Mitchell, S. & Elbel, B. 2002. Voices Unheard: Barriers to Expressing Dissatisfaction to Health Plans. Milbank Quarterly, Vol. 80, No. 4, pp. 709-755.
Consumers dissatisfied with their health plan can either "exit" (switch service providers) or "voice" (complain to the current provider). Policymakers' efforts to help consumers voice their dissatisfaction to health plans or external mediators have been disappointing, in part because little is known about the determinants of voice. This article represents the first comprehensive assessment of voicing in response to problematic experiences with health plans. A national consumer survey from 1999 is used to test hypotheses about characteristics of problems, patients, and settings that might inhibit voice and assess state regulations intended to enhance voice. Although problems associated with plans led to more voice than exit, voice is circumscribed by several factors: certain groups, such as racial minorities, do not express their grievances as often; episodes with severe health consequences for patients are not reported as regularly. The findings suggest that even though regulatory initiatives have not increased the frequency of voice, they have made grievances more effective, at least in jurisdictions where citizens know about the laws.