The essential scan: Top findings in health policy research


What’s the latest in health policy research? The Essential Scan, produced by the Schaeffer Initiative for Innovation in Health Policy, aims to help keep you informed on the latest research and what it means for policymakers. If you’d like to receive the biweekly Essential Scan by email, you can sign up here.

Increased aspirin use by high-risk older Americans would generate $692 billion in net health benefits by 2036

David Agus, Etienne Gaudette, Dana Goldman, and Andrew Messali find that over 40 percent of men and 10 percent of women aged 50 to 79 with high cardiovascular risk are not taking a daily aspirin as prescribed and if they were it would improve national life expectancy at age 50 by 0.28 years and would add 900,000 people to the US population by 2036. They estimate the economic value of this improvement, taking into account the potential risks associated with long-term aspirin use, would be $692 billion in net health benefits. The authors use the Future Elderly Model, a microsimulation housed at the USC Schaeffer Center, to project the lifetime health and spending under two scenarios. Given the recent change made by the US Preventative Services Task Force in April 2016 to scale back the recommendation, this research provides evidence that benefits of this low-cost therapy outweigh risks at the population level. Full article here.

Timely, relevant data on performance is key to primary care-specialist collaboration in new payment models

Steven A. Farmer, Margaret L. Darling, Meaghan George, and coauthors find that one of the early lessons from primary care physician-specialist collaboration in alternative payment models (APMs) is that near real-time data on cost and quality performance is essential to supporting their collaboration to improve care efficiency. They examine the implementation of one bundle and three population-based APMs that engage cardiologists, finding that employed cardiologists were often unaware of APM participation when it was administratively driven but that physician-led ACOs and other programs that provided performance feedback to clinicians were more aware and engaged. This suggests that the Centers for Medicare and Medicaid Services may better support such involvement of cardiologists and specialties in APMs, as well as the overall proliferation of its payment models, by improving the quality, timeliness and relevancy of data to clinicians to support the expansion of their value-based contracts, as some commercial insurers have done. Full article here.

Medicaid dental coverage increases dentist participation while modestly increasing visits, wait times

Thomas Buchmueller, Sarah Miller, and Marko Vujicic find that providing full dental benefits—coverage for all major preventative and restorative treatments—for adults in Medicaid increases the probability that a dentist accepts any Medicaid patients by 5 percentage points while only modestly increasing the number of days previously established patients wait for an appointment by 0.6 to 0.7 days. However, they found that the effect on wait times varied significantly by state based on scope of practice restrictions for dental hygienists. The authors use data from a nationally representative annual survey of approximately 3,000 dentists in private practice from 1999 to 2011 to evaluate the effect of Medicaid dental coverage on dentist participation, quantity of services by coverage type, labor supply, and other supply-side outcomes. The finding that the market for dental care was largely flexible enough to meet demand should be encouraging for policymakers weighing Medicaid coverage of dental benefits with less restrictive scope of practice laws, and similar analysis surrounding states’ overall expansion of Medicaid would elucidate how well this flexibility translates to markets for medical care. Full article here.

Greater patient choice in England led to higher quality hospital care

Martin Gaynor, Carol Propper, and Stephan Seiler find that a 2006 reform to increase patient choice in the English National Health Service led to higher quality hospital care, at least for elective procedures. The reform mandated that patients be offered a choice of five hospitals when referred by their physicians to hospitals for treatment. The mortality rate for patients receiving non-emergency coronary artery bypass grafts (CABG) dropped from a mean of 1.330 per 1,000 procedures pre-reform to 0.935 post-reform, and CABG patients who chose not to visit the nearest hospital saw a drop in mortality rate double that of patients who did. The authors find evidence that with more choice, patients seek better hospitals and hospitals tend to improve the quality of their care. Following the reform, the study estimates that 3.3 lives in the study population are saved per year as a result, highlighting the potential value of reforms that increase patient choice. Full article here.

The Essential Scan is produced by the Schaeffer Initiative for Innovation in Health Policy, a collaboration between the  Center for Health Policy at the Brookings Institution and the USC Schaeffer Center for Health Policy & Economics.