Health Policy

Promotion of Healthy Eating through Public Policy: A Controlled Experiment

Promotion of Healthy Eating through Public Policy: A Controlled Experiment
American Journal of Preventative Medicine. 2013; 45(1): 49-55. http://dx.doi.org/10.1016/j.amepre.2013.02.023

Elbel B, Taksler G, Mijanovich T, Abrams C, Dixon LB
02/13/2014

Background
To induce consumers to purchase healthier foods and beverages, some policymakers have suggested special taxes or labels on unhealthy products. The potential of such policies is unknown.

Purpose
In a controlled field experiment, researchers tested whether consumers were more likely to purchase healthy products under such policies.

Methods
From October to December 2011, researchers opened a store at a large hospital that sold a variety of healthier and less-healthy foods and beverages. Purchases (N=3680) were analyzed under five conditions: a baseline with no special labeling or taxation, a 30% tax, highlighting the phrase “less healthy” on the price tag, and combinations of taxation and labeling. Purchases were analyzed in January–July 2012, at the single-item and transaction levels.

Results
There was no significant difference between the various taxation conditions. Consumers were 11 percentage points more likely to purchase a healthier item under a 30% tax (95% CI=7%, 16%, p<0.001) and 6 percentage points more likely under labeling (95% CI=0%, 12%, p=0.04). By product type, consumers switched away from the purchase of less-healthy food under taxation (9 percentage point decrease, p<0.001) and into healthier beverages (6 percentage point increase, p=0.001); there were no effects for labeling. Conditions were associated with the purchase of 11–14 fewer calories (9%–11% in relative terms) and 2 fewer grams of sugar. Results remained significant controlling for all items purchased in a single transaction.

Conclusions
Taxation may induce consumers to purchase healthier foods and beverages. However, it is unclear whether the 15%–20% tax rates proposed in public policy discussions would be more effective than labeling products as less healthy.

How States Stand to Gain or Lose Federal Funds by Opting In or Out of the Medicaid Expansion

How States Stand to Gain or Lose Federal Funds by Opting In or Out of the Medicaid Expansion
The Commonwealth Fund Vol 32, December 2013

Sherry Glied and Stephanie Ma
12/05/2013

Following the Supreme Court's decision in 2012, state officials are now deciding whether to expand their Medicaid programs under the Affordable Care Act. While the states' costs of participating in the Medicaid expansion have been at the forefront of this discussion, the expansion has much larger implications for the flow of federal funds going to the states. This issue brief examines how participating in the Medicaid expansion will affect the movement of federal funds to each state. States that choose to participate in the expansion will experience a more positive net flow of federal funds than will states that choose not to participate. In addition to providing valuable health insurance benefits to low-income state residents, and steady sources of financing to state health care providers, the Medicaid expansion will be an important source of new federal funds for states.

Dispelling An Urban Legend: Frequent Emergency Department Users Have Substantial Burden Of Disease

Dispelling An Urban Legend: Frequent Emergency Department Users Have Substantial Burden Of Disease
Health Affairs, 32, no.12 (2013):2099-2108

Billings, John and Maria C. Raven
12/01/2013

Urban legend has often characterized frequent emergency department (ED) patients as mentally ill substance users who are a costly drain on the health care system and who contribute to ED overcrowding because of unnecessary visits for conditions that could be treated more efficiently elsewhere. This study of Medicaid ED users in New York City shows that behavioral health conditions are responsible for a small share of ED visits by frequent users, and that ED use accounts for a small portion of these patients’ total Medicaid costs. Frequent ED users have a substantial burden of disease, and they have high rates of primary and specialty care use. They also have linkages to outpatient care that are comparable to those of other ED patients. It is possible to use predictive modeling to identify who will become a repeat ED user and thus to help target interventions. However, policy makers should view reducing frequent ED use as only one element of more-comprehensive intervention strategies for frequent health system users.

Calorie Labeling, Fast Food Purchasing and Restaurant Visits

Calorie Labeling, Fast Food Purchasing and Restaurant Visits
Obesity, 21: 2172–2179. doi: 10.1002/oby.20550

Elbel, B., Mijanovich, T., Dixon, L. B., Abrams, C., Weitzman, B., Kersh, R., Auchincloss, A. H. and Ogedegbe, G.
10/17/2013

Objective
Obesity is a pressing public health problem without proven population-wide solutions. Researchers sought to determine whether a city-mandated policy requiring calorie labeling at fast food restaurants was associated with consumer awareness of labels, calories purchased and fast food restaurant visits.

Design and Methods
Difference-in-differences design, with data collected from consumers outside fast food restaurants and via a random digit dial telephone survey, before (December 2009) and after (June 2010) labeling in Philadelphia (which implemented mandatory labeling) and Baltimore (matched comparison city). Measures included: self-reported use of calorie information, calories purchased determined via fast food receipts, and self-reported weekly fast-food visits.

Results
The consumer sample was predominantly Black (71%), and high school educated (62%). Postlabeling, 38% of Philadelphia consumers noticed the calorie labels for a 33% point (P < 0.001) increase relative to Baltimore. Calories purchased and number of fast food visits did not change in either city over time.

Conclusions
While some consumers report noticing and using calorie information, no population level changes were noted in calories purchased or fast food visits. Other controlled studies are needed to examine the longer term impact of labeling as it becomes national law.

Potentially avoidable hospitalizations: how to estimate the costs?

Potentially avoidable hospitalizations: how to estimate the costs?
Gestion Hospitalière (529) October, 2013

Rodwin, V., A. Sommer, and D. Weisz
10/01/2013

Based on the number of hospitalizations for ambulatory-care sensitive conditions in the Paris region (Ile-de-France), and the DRG-based rates for these hospital stays, we estimate the hospital expenditures that could be avoided if patients had access to primary care services that successfully manage their chronic conditions and avoid exacerbations that lead to necessary hospitalizations when they occur. In addition, we caution policymakers about what inferences can legitimately be drawn from such estimates for the expenditures averted on hospital care do not represent a net gain as there would likely be additional expenditures needed to upgrade ambulatory care to manage a host of complex chronic diseases.

Democratization and Universal Health Coverage: A comparison of the experiences of Ghana, Kenya, and Senegal

Democratization and Universal Health Coverage: A comparison of the experiences of Ghana, Kenya, and Senegal
Global Health Governance, 6(2): 1-27.

Grépin, Karen and Kim Yi Dionne
09/23/2013

This article identifies conditions under which newly established democracies adopt Universal Health Coverage. Drawing on the literature examining democracy and health, we argue that more democratic regimes – where citizens have positive opinions on democracy and where competitive, free and fair elections put pressure on incumbents – will choose health policies targeting a broader proportion of the population. We compare Ghana to Kenya and Senegal, two other countries which have also undergone democratization, but where there have been important differences in the extent to which these democratic changes have been perceived by regular citizens and have translated into electoral competition. We find that Ghana has adopted the most ambitious health reform strategy by designing and implementing the National Health Insurance Scheme (NHIS). We also find that Ghana experienced greater improvements in skilled attendance at birth, childhood immunizations, and improvements in the proportion of children with diarrhea treated by oral rehydration therapy than the other countries since this policy was adopted. These changes also appear to be associated with important changes in health outcomes: both infant and under-five mortality rates declined rapidly since the introduction of the NHIS in Ghana. These improvements in health and health service delivery have also been observed by citizens with a greater proportion of Ghanaians reporting satisfaction with government handling of health service delivery relative to either Kenya or Senegal. We argue that the democratization process can promote the adoption of particular health policies and that this is an important mechanism through which democracy can improve health.

Helping Without Harming: The Instructor’s Feedback Dilemma in Debriefing—A Case Study

Helping Without Harming: The Instructor’s Feedback Dilemma in Debriefing—A Case Study
Stimulation in Healthcare: The Journal of the Society for Simulation in Healthcare. October 2013 - Volume 8 - Issue 5 - p 304-316. doi: 10.1097/SIH.0b013e318294854e

Rudolph, J. W., Foldy, E. G. et al.
09/18/2013

Introduction

Simulation instructors often feel caught in a task-versus-relationship dilemma. They must offer clear feedback on learners’ task performance without damaging their relationship with those learners, especially in formative simulation settings. Mastering the skills to resolve this dilemma is crucial for simulation faculty development.

Methods

We conducted a case study of a debriefer stuck in this task-versus-relationship dilemma. Data: The “2-column case” captures debriefing dialogue and instructor’s thoughts and feelings or the “subjective experience.” Analysis: The “learning pathways grid” guides a peer group of faculty in a step-by-step, retrospective analysis of the debriefing. The method uses vivid language to highlight the debriefer’s dilemmas and how to surmount them.

Results

The instructor’s initial approach to managing the task-versus-relationship dilemma included (1) assuming that honest critiques will damage learners, (2) using vague descriptions of learner actions paired with guess-what-I-am-thinking questions, and (3) creating a context she worried would leave learners feeling neither safe nor clear how they could improve. This case study analysis identified things the instructor could do to be more effective including (1) making generous inferences about the learners’ qualities, (2) normalizing the challenges posed by the simulation, (3) assuming there are different understandings of what it means to be a team.

Conclusions

There are key assumptions and ways of interacting that help instructors resolve the task-versus-relationship dilemma. The instructor can then provide honest feedback in a rigorous yet empathic way to help sustain good or improve suboptimal performance in the future.

Enforcing food quality and safety standards in Brazil: The case of COBRACANA

Enforcing food quality and safety standards in Brazil: The case of COBRACANA
The Annals of the American Academy of Political and Social Science 2013, 649 (1), pp.122-138

Coslovsky, Salo
09/16/2013

Globalization of production has been complemented by increasingly stricter product quality and safety regulations. This trend is particularly acute in the food and beverage sectors, which puts enormous strain on producers from developing nations. This paper examines the trajectory of a cooperative of sugarcane, sugar and ethanol producers from Brazil that, once confronted with this challenge, failed to meet the standards but ultimately came around. It credits the coop’s turnaround to three variables: (a) a new cost accounting methodology that monetized some of the differences in product quality and attenuated tensions among the membership; (b) a low-cost but high-powered system of regulatory incentives that subverted rigid hierarchies and empowered middle-managers vis-à-vis top-executives; and (c) the action of external auditors who acted not as police-officers or consultants, but as conduits who reestablished information flows and helped create a business atmosphere conducive to productive change.

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