Policy Analysis

Using Comparative Analysis to Address Health System Caricatures

Using Comparative Analysis to Address Health System Caricatures
International Journal of Health Services, Volume 44, Number 3, Pages 547–559, 2014. Baywood Publishing Co., Inc. doi: http://dx.doi.org/10.2190/HS.44.3.g

Michael K. Gusmano, Victor G. Rodwin, and Daniel Weisz
07/29/2014

To learn from health care systems abroad, we must move beyond simplistic characterizations and compare different systems with respect to salient performance measures. Despite findings from recent cross-national studies suggesting that many health care systems outperform the United States, claims by U.S. public officials often fail to acknowledge the actual accomplishments of health care systems abroad. We document significant variation among the United States and France, Germany, and England, which provide universal coverage, albeit in different ways. As previously documented, the United States has the highest rate of mortality amenable to health care. We extend this work by adding two indicators: (a) access to timely and effective primary care as measured by hospital discharges for avoidable hospital conditions; and (b) use of specialty services as indicated by coronary revascularization (bypass surgery and angioplasty), adjusted for the burden of coronary artery disease. Our findings indicate that: (a) the United States suffers the gravest consequences of financial barriers to primary care; (b) in all four countries, older people (65+) receive fewer revascularizations than their younger counterparts once we account for disease burden; and (c) in France, patients receive the most revascularizations, after adjusting for the burden of disease.

What Passes and Fails as Health Policy and Management

What Passes and Fails as Health Policy and Management
Journal of Health Politics, Policy and Law, Vol. 39, No. 5, October 2014 DOI 10.1215/03616878-2813719

Rodwin, Victor G. and David Chinitz
07/18/2014

The field of health policy and management (HPAM) faces a gap between theory, policy and practice. Despite decades of efforts at reforming health policy and health care systems, prominent analysts state that the health system is ‘‘stuck’’ and that models for change remain ‘‘aspirational.’’ We discuss four reasons for the failure of current ideas and models for redesigning health care: (1) the dominance of microeconomic thinking; (2) the lack of comparative studies of health care organizations and the limits of health management theory in recognizing the importance of local contexts; (3) the separation of HPAM from the rank and file of health care, particularly physicians; and (4) the failure to expose medical students to issues of HPAM. We conclude with suggestions for rethinking how the field of HPAM might generate more promising policies for health care providers and managers by abandoning the illusion of context-free theories and, instead, seeking to facilitate the processes by which organizations can learn to improve their own performance.

The State of New York City’s Housing and Neighborhoods in 2013

The State of New York City’s Housing and Neighborhoods in 2013
Furman Center for Real Estate and Urban Policy, New York University

I.G. Ellen et al.
05/28/2014

The State of New York City’s Housing and Neighborhoods in 2013 report , published annually by the NYU Furman Center, provides a compendium of data and analysis about New York City’s housing, land use, demographics, and quality of life indicators for each borough and the city’s 59 community districts.

The report combines timely and expert analysis of NYU Furman Center researchers with data transparency. It is presented in three parts:

Part 1: Focus on Economic Inequality

Each year, the State of New York City’s Housing and Neighborhoods describes, contextualizes, and provides analysis on a pressing and policy-relevant issue affecting New York City. In 2013, the report focuses on economic inequality in New York City, analyzing changes over time in the distribution of the city’s income, economic segregation of city residents, and the neighborhood environments experienced by people of different incomes.

Part 2: City-Wide Analysis

The City-Wide Analysis provides a broad, longitudinal analysis of the New York City's housing and neighborhoods. The chapter is divided into five parts: land use and the built environment; homeowners and their homes; renters and their homes; income and workers; and neighborhood services and conditions.

Part 3: City, Borough, and Community District Data

The data section provides current and historical statistics for over 50 housing, neighborhood, and socioeconomic indicators at the city, borough, and community district levels. It also includes indicator definitions and rankings; methods; and an index of New York City’s Community Districts and Sub-Borough Areas.

‘‘Do Something’’ Politics and Double-Peaked Policy Preferences

‘‘Do Something’’ Politics and Double-Peaked Policy Preferences
Journal of Politics 76(2): 333-349.

Egan, Patrick J.
04/09/2014

When a public problem is perceived to be poorly addressed by current policy, it is often the case that credible alternative policies are proposed to both the status quo’s left and right. Specially designed national surveys show that in circumstances like these, many Americans’ preferences are not single-peaked on the standard left-right dimension. Rather, they simply want the government to ‘‘do something’’ about the problem and therefore prefer both liberal and conservative policies to the moderate status quo. This produces individual and collective preferences that are double-peaked with respect to the left-right dimension. Double-peakedness is less prevalent on issues where no consensus exists regarding policy goals, and it increases when exogenous events raise the public’s concern about the seriousness of a policy problem.

Introduction: Special issue on housing policy in the United States

Introduction: Special issue on housing policy in the United States
J. Housing Econ. (2014), http://dx.doi.org/10.1016/j.jhe.2014.02.001

Bostic, R. and Ellen, I.G
02/22/2014

The recent housing crisis has spawned much reflection among academics, practitioners and policy-makers regarding both the causes and the consequences of this upheaval, especially in the market for owner-occupied homes. But many questions remain. This special issue of the Journal of Housing Economics features a series of articles that seeks to answer some of these questions, with attention given to both the ownership and rental markets. We hope the nine articles in this issue help to provide some insights for both policy makers and researchers.

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.

Hospitalization for Ambulatory-care sensitive conditions (ACSC) in Ile de France: A view from across the Atlantic

Hospitalization for Ambulatory-care sensitive conditions (ACSC) in Ile de France: A view from across the Atlantic
Revue française des affaires sociales 2013/3 (n° 3)

Rodwin, V., Gusmano, M. and Weisz, D.
12/03/2013

This article presents an indicator used in the United States and other OECD nations (hospitalizations for ambulatory-care sensitive conditions – ACSC) to assess access to primary care services and their capacity to handle a set of medical conditions before they require acute hospital treatment. Based on a study of Ile de France, which relies on residence-based hospital discharge data on patient diagnoses and treatments, the indicator identifies areas where hospitalizations for ACSC appear particularly high. Such hospital stays are considered potentially avoidable. Based on data from the Programme de m.dicalisation des syst.mes d’information (PMSI), disparities are measured. We rely on logistic regression analysis to identify a range of individual factors and neighborhood-level factors that explain these disparities. Access to primary care appears to be worse among residents in areas with average household income in the lowest quartile and among those hospitalized in public hospitals. This raises an important question for the future of health policy. Should areas with higher hospital discharge rates of ACSC be understood as having populations with poor health-seeking behaviors or health care systems not well enough organized to target higher-risk populations?

The Price of Liquor is Too Damn High: State Facilitated Collusion and the Implications for Taxes

The Price of Liquor is Too Damn High: State Facilitated Collusion and the Implications for Taxes

Rao, Nirupama S. (with Chris Conlon)
12/02/2013

Alcohol markets are subject to both heavy regulation as well as excise taxes at the federal and state level. We examine the impact of particular state regulations on the structure of the alcohol market. We show that post and hold and meet but not beat pricing regulations at the wholesale level eliminate competitive incentives among whole-sellers and minimum retail markup rules at the retailer level e ectively allow whole-sellers to set retail price floors. Our model suggests that without any competitive incentives at the wholesale level, firms will set prices as if they were a single monopolist. Wholesalers will tend to mark up premium brands relative to call or well products. Regression results indicate that states featuring post and hold regulations consume 4% to 10% less alcohol than other states, suggesting that the regulations may over-restrict quantity. Tabulations suggest that premium products comprise a smaller share of consumption in post and hold states. This output gap due to collusive pricing leads any taxes levied on the liquor market to entail greater deadweight loss relative to a competitive wholesale market. We conduct an empirical analysis, where instead of providing wholesalers with market power, the state increases taxes to keep the overall level of alcohol consumption fixed. We also compute the deadweight loss of increasing taxation under both the existing scheme, and one with a competitive wholesale market. We find that the state of Connecticut could substantially increase taxes and tax revenues without affecting aggregate quantities if it repealed post and hold. Back of the envelope estimates suggest that Connecticut is forgoing over $300M in potential revenue from alcohol taxes in a competitive wholesale market.

Pension Obligation Bonds and Government Spending

Pension Obligation Bonds and Government Spending
Public Budgeting and Finance, 33(4):43-65

Thad Calabrese and Todd Ely
10/29/2013

We examine the use of pension obligation bonds (POBs) as a financing strategy to address the effects of unfunded pension liabilities on government operating budgets. POBs are publicly marketed as money-saving mechanisms that reduce pension system payments while allowing for increased spending on other government priorities. We review general POB usage and examine whether POBs altered school district spending patterns in Oregon and Indiana. Our results indicate that districts issuing POBs have not increased educational spending relative to other districts. Because POBs cost money to issue and manage, decision makers are encouraged to consider annual budgetary effects prior to issuance.

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.

Pages

Subscribe to Policy Analysis