Social Policy

Valuing Improvement in Value Based Purchasing

Valuing Improvement in Value Based Purchasing
Circulation:  Cardiovascular Quality and Outcomes.  5:163-170  

Borden, William and Jan Blustein.
03/01/2012

Background

Medicare will soon implement hospital value-based purchasing (VBP), using a scoring system that rewards both achievement (absolute performance) and improvement (performance increase over time).  However, improvement is defined so as to give less credit to initial low performers than initial high performers.  Since initial low performers are disproportionately hospitals in socioeconomically disadvantaged areas, these institutions stand to lose under Medicare’s VBP proposal. 

 

Methods

We developed an alternative improvement scale, and applied it to hospital performance throughout the US.   Using 2005-2008 Medicare process measures for acute myocardial infarction (AMI) and heart failure (HF), we calculated hospital scores using Medicare’s proposal and our alternative.  Hospital performance scores were compared across 5 locational dimensions of socioeconomic disadvantage: poverty, unemployment, physician shortage, high school and college graduation rates.

 

Results

Medicare’s proposed scoring system yielded higher overall scores for the most locationally advantaged hospitals for 4 out of 5 dimensions in AMI and 2 out of 5 for HF.  Using our alternative, differences in overall scores between hospitals in the most and least advantaged areas were attenuated, with locationally advantaged hospitals having higher overall scores for 3 out of 5 dimensions in AMI and 1 out of 5 dimensions for HF. 

 

Conclusions

Using an alternative VBP formula that reflects the principle of “equal credit for equal improvement,” resulted in a more equitable distribution of overall payment scores, which could allow hospitals in both socioeconomically advantaged and disadvantaged areas to succeed under VBP.

 

 

The Greatest Grid: The Master Plan of Manhattan, 1811-2011

The Greatest Grid: The Master Plan of Manhattan, 1811-2011
January 2012

Ballon, Hilary
01/01/2012

Laying out Manhattan's street grid and providing a rationale for the growth of New York was the city's first great civic enterprise, not to mention a brazenly ambitious project and major milestone in the history of city planning. The grid created the physical conditions for business and society to flourish and embodied the drive and discipline for which the city would come to be known. Published to coincide with an exhibition at the Museum of the City of New York celebrating the bicentennial of the Commissioners' 1811 Plan of Manhattan, this volume does more than memorialize such a visionary effort, it serves as an enduring reference full of rare images and information.

The Greatest Grid shares the history of the Commissioners' plan, incorporating archival photos and illustrations, primary documents and testimony, and magnificent maps with essential analysis. The text, written by leading historians of New York City, follows the grid's initial design, implementation, and evolution, and then speaks to its enduring influence. A foldout map, accompanied by explanatory notes, reproduces the Commissioners' original plan, and additional maps and prints chart the city's pre-1811 irregular growth patterns and local precedent for the grid's design. Constituting the first sustained examination of this subject, this text describes the social, political, and intellectual figures who were instrumental in remaking early New York, not in the image of old Europe but as a reflection of other American cities and a distinct New World sensibility. The grid reaffirmed old hierarchies while creating new opportunities for power and advancement, giving rise to the multicultural, highly networked landscape New Yorkers thrive in today.

 

Resetting our priorities in environmental health: An example from the south-north partnership in Lake Chapala, Mexico

Resetting our priorities in environmental health: An example from the south-north partnership in Lake Chapala, Mexico
Environ Res. 2011 Aug;111(6):877-80.

Cifuentes E, Lozano Kasten F, Trasande L, Goldman RH.
08/01/2011

Lake Chapala is a major source of water for crop irrigation and subsistence fishing for a population of 300,000 people in central Mexico. Economic activities have created increasing pollution and pressure on the whole watershed resources. Previous reports of mercury concentrations detected in fish caught in Lake Chapala have raised concerns about health risks to local families who rely on fish for both their livelihood and traditional diet. Our own data has indicated that 27% of women of childbearing age have elevated hair mercury levels, and multivariable analysis indicated that frequent consumption of carp (i.e., once a week or more) was associated with significantly higher hair mercury concentrations. In this paper we describe a range of environmental health research projects. Our main priorities are to build the necessary capacities to identify sources of water pollution, enhance early detection of environmental hazardous exposures, and deliver feasible health protection measures targeting children and pregnant women. Our projects are led by the Children's Environmental Health Specialty Unit nested in the University of Guadalajara, in collaboration with the Department of Environmental Health of Harvard School of Public Health and Department of Pediatrics of the New York School of Medicine. Our partnership focuses on translation of knowledge, building capacity, advocacy and accountability. Communication will be enhanced among women's advocacy coalitions and the Ministries of Environment and Health. We see this initiative as an important pilot program with potential to be strengthened and replicated regionally and internationally.

Are Land Use Planning and Congestion Pricing Mutually Supportive? Evidence From a Pilot Mileage Fee Program in Portland, OR

Are Land Use Planning and Congestion Pricing Mutually Supportive? Evidence From a Pilot Mileage Fee Program in Portland, OR
Journal of American Planning Association, Vol. 77, 3, 232-250

Guo, Zhan, Asha W. Agrawal & Jennifer Dill
05/09/2011

Congestion pricing and land use planning have been proposed as two promising strategies to reduce the externalities associated with driving, including traffic congestion, air pollution, and greenhouse gas emissions. However, they are often viewed by their proponents as substitutive instead of complementary to each other. Using data from a pilot mileage fee program run in Portland, OR, we explored whether congestion pricing and land use planning were mutually supportive in terms of vehicle miles traveled (VMT) reduction. We examined whether effective land use planning could reinforce the benefit of congestion pricing, and whether congestion pricing could strengthen the role of land use planning in encouraging travelers to reduce driving.

VMT data were collected over 10 months from 130 households, which were divided into two groups: those who paid a mileage charge with rates that varied by congestion level (i.e., congestion pricing) and those who paid a mileage charge with a flat structure. Using regression models to compare the two groups, we tested the effect of congestion pricing on VMT reduction across different land use patterns, and the effect of land use on VMT reduction with and without congestion pricing. With congestion pricing, the VMT reduction is greater in traditional (dense and mixed-use) neighborhoods than in suburban (single use, low-density) neighborhoods, probably because of the availability of travel alternatives in the former. Under the same land use pattern, land use attributes explain more variance of household VMT when congestion pricing is implemented, suggesting that this form of mileage fee could make land use planning a more effective mechanism to reduce VMT. In summary, land use planning and congestion pricing appear to be mutually supportive.

For policymakers considering mileage pricing, land use planning affects not only the economic viability but also the political feasibility of a pricing scheme. For urban planners, congestion pricing provides both opportunities and challenges to crafting land use policies that will reduce VMT. For example, a pricing zone that overlaps with dense, mixed-use and transit-accessible development, can reinforce the benefits of these development patterns and encourage greater behavioral changes.

 

Climate Change and Urban Transportation Systems

Climate Change and Urban Transportation Systems
in Urban Climate Change Research Network (UCCRN), First UCCRN Assessment Report on Climate Change in Cities (ARC3), edited by C. Rosenzweig, W. D. Solecki, S. A. Hammer, and S. Mehrotra. New York, NY: Cambridge University Press, 2011, forthcoming, pp. 143- 182.

S. Mehrotra (Nairobi, Mexico City), B. Lefevre (Paris), R. Zimmerman (New York City, Coordinating Lead Authors and H. Gercek, K. Jacob, and S. Srinivasan.
05/01/2011

Fine particulate matter pollution linked to respiratory illness in infants and increased hospital costs

Fine particulate matter pollution linked to respiratory illness in infants and increased hospital costs
Health Aff (Millwood). 2011 May;30(5):871-8.

Sheffield P, Roy A, Wong K, Trasande L.
05/01/2011

There has been little research to date on the linkages between air pollution and infectious respiratory illness in children, and the resulting health care costs. In this study we used data on air pollutants and national hospitalizations to study the relationship between fine particulate air pollution and health care charges and costs for the treatment of bronchiolitis, an acute viral infection of the lungs. We found that as the average exposure to fine particulate matter over the lifetime of an infant increased, so did costs for the child's health care. If the United States were to reduce levels of fine particulate matter to 7 percent below the current annual standard, the nation could save $15 million annually in reduced health care costs from hospitalizations of children with bronchiolitis living in urban areas. These findings reinforce the need for ongoing efforts to reduce levels of air pollutants. They should trigger additional investigation to determine if the current standards for fine-particulate matter are sufficiently protective of children's health.

The Oxford Handbook of Health Economics

The Oxford Handbook of Health Economics
Oxford University Press.

Glied, Sherry and Peter C. Smith
04/07/2011

The Oxford Handbook of Health Economics provides an accessible and authoritative guide to health economics, intended for scholars and students in the field, as well as those in adjacent disciplines including health policy and clinical medicine. The chapters stress the direct impact of health economics reasoning on policy and practice, offering readers an introduction to the potential reach of the discipline. Contributions come from internationally-recognized leaders in health economics and reflect the worldwide reach of the discipline. Authoritative, but non-technical, the chapters place great emphasis on the connections between theory and policy-making, and develop the contributions of health economics to problems arising in a variety of institutional contexts, from primary care to the operations of health insurers. The volume addresses policy concerns relevant to health systems in both developed and developing countries. It takes a broad perspective, with relevance to systems with single or multi-payer health insurance arrangements, and to those relying predominantly on user charges; contributions are also included that focus both on medical care and on non-medical factors that affect health. Each chapter provides a succinct summary of the current state of economic thinking in a given area, as well as the author's unique perspective on issues that remain open to debate. The volume presents a view of health economics as a vibrant and continually advancing field, highlighting ongoing challenges and pointing to new directions for further progress.

Mind the Map! The Impact of Transit Maps on Path Choice in Public Transit

Mind the Map! The Impact of Transit Maps on Path Choice in Public Transit
Transportation Research Part A: Policy and Practice, Vol. 45, 7, 625–639

Guo, Zhan
04/01/2011

This paper investigates the impact of schematic transit maps on passengers' travel decisions. It does two things: First, it proposes an analysis framework that defines four types of information delivered from a transit map: distortion, restoration, codification, and cognition. It then considers the potential impact of this information on three types of travel decisions: location, mode, and path choices.1 Second, it conducts an empirical analysis to explore the impact of the famous London tube map on passengers' path choice in the London Underground (LUL). Using data collected by LUL from 1998 to 2005, the paper develops a path choice model and compares the influence between the distorted tube map (map distance) and reality (travel time) on passengers' path choice behavior. Results show that the elasticity of the map distance is twice that of the travel time, which suggests that passengers often trust the tube map more than their own travel experience on deciding the ‘‘best'' travel path. This is true even for the most experienced passengers using the system. The codification of transfer connections on the tube map, either as a simple dot or as an extended link, could affect passengers' transfer decisions. The implications to transit operation and planning, such as trip assignments, overcrowding mitigation, and the deployment of Advanced Transit Information System (ATIS), are also discussed.

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