health economists’ view of policy questions
DESCRIPTION
Health Economists’ View of Policy Questions. AcademyHealth Annual Meeting – Seattle, WA June 24, 2006. Michael A. Morrisey University of Alabama at Birmingham and John Cawley Cornell University. AcademyHealth iHEA. Advisory Committee: Roger Feldman Richard Arnould Kate Bundorf - PowerPoint PPT PresentationTRANSCRIPT
Health Economists’ Health Economists’ View of Policy View of Policy
QuestionsQuestions
Michael A. MorriseyMichael A. MorriseyUniversity of Alabama at BirminghamUniversity of Alabama at Birmingham
andandJohn CawleyJohn Cawley
Cornell UniversityCornell University
AcademyHealth Annual Meeting – Seattle, WA June 24, 2006
Thanks to:Thanks to:
AcademyHealtAcademyHealthh
iHEAiHEA
Advisory Advisory Committee:Committee: Roger FeldmanRoger Feldman Richard ArnouldRichard Arnould Kate BundorfKate Bundorf Michael HaganMichael Hagan David KnutsonDavid Knutson Kristine MetterKristine Metter Sharron ArnoldSharron Arnold
Survey Issues:Survey Issues: Web based survey:Web based survey:
Invitation & two follow-up emails issuedInvitation & two follow-up emails issued October 21 – November 21, 2005October 21 – November 21, 2005
Sample Universe:Sample Universe: All U.S. members of iHEA All U.S. members of iHEA All members of AcademyHealth All members of AcademyHealth Health Economics Interest GroupHealth Economics Interest Group Unduplicated total . . . . . . . . . . . . . . . . . . . . . 1,439Unduplicated total . . . . . . . . . . . . . . . . . . . . . 1,439
Response Rate. . . . . . . . . . . . . . . . . . . . . . 32 Response Rate. . . . . . . . . . . . . . . . . . . . . . 32 %%
Do You Consider Yourself To Be:Do You Consider Yourself To Be:
A.A. A health economistA health economist 53%53%B.B. An economist who works in healthAn economist who works in health
21%21%C.C. NeitherNeither 26%26%
For this presentation we exclude For this presentation we exclude those answering neither.those answering neither.
OutlineOutline
Report policy views of health economistsReport policy views of health economists
Use factor analysis and probit Use factor analysis and probit regression to identify patterns of regression to identify patterns of responsesresponses
Identify the extent to which health Identify the extent to which health economists participate in policy economists participate in policy discussionsdiscussions
We asked 19 Questions About Views on We asked 19 Questions About Views on Health Policy Questions or the Effects Health Policy Questions or the Effects of Open Empirical Questions in Health of Open Empirical Questions in Health
EconomicsEconomics
We substantially agree on We substantially agree on 88
We modestly agree on 4We modestly agree on 4 We substantially disagree We substantially disagree
on 7on 7
Substantial AgreementSubstantial Agreement
““Workers pay for employer-Workers pay for employer-sponsored health insurance in the sponsored health insurance in the
form of lower wages or reduced form of lower wages or reduced benefits”benefits”
90.7
5.3 3.90
25
50
75
100
Agree Don't Know Disagree
Percent
““Education has a causal impact on Education has a causal impact on health”health”
80.6
6.812.6
0
25
50
75
100
Agree Don't Know Disagree
Percent
““Recent horizontal and vertical Recent horizontal and vertical integration in the health care integration in the health care
sector is driven by the pursuit of sector is driven by the pursuit of market power”market power”
77.3
5.1
17.7
0
25
50
75
100
Agree Don't Know Disagree
Percent
““Health insurance premiums charged to Health insurance premiums charged to individuals born with genetic defects individuals born with genetic defects that result in above-average use of that result in above-average use of medical care should be higher than medical care should be higher than those charged to individuals without those charged to individuals without
such defects.”such defects.”
9.414.4
76.2
0
25
50
75
100
Agree Don't Know Disagree
Percent
““Health insurance premiums Health insurance premiums should be higher for those who should be higher for those who engage in unhealthy behaviors engage in unhealthy behaviors (e.g., smoking, excess drinking, (e.g., smoking, excess drinking,
obesity)”obesity)”
73.7
16.69.7
0
25
50
75
100
Agree Don't Know Disagree
Percent
““Rapidly advancing medical Rapidly advancing medical technology is the most important technology is the most important
cause of rising health care cause of rising health care spending in the U.S.”spending in the U.S.”
67.6
25.1
7.2
0
25
50
75
Agree Don't Know Disagree
Percent
46% in 1989
““Insurance markets suffer Insurance markets suffer significantly from adverse significantly from adverse
selection”selection”
67.1
17.0 15.9
0
25
50
75
Agree Don't Know Disagree
Percent
““Third-party payment results in Third-party payment results in patients using services whose costs patients using services whose costs
exceed their benefits, and this excess of exceed their benefits, and this excess of costs over benefits amounts to at least 5 costs over benefits amounts to at least 5
% of total health care expenditures”% of total health care expenditures”65.5
13.720.9
0
25
50
75
Agree Don't Know Disagree
Percent
Modest AgreementModest Agreement
““The U.S. should permit ‘re-The U.S. should permit ‘re-importation’ of pharmaceuticals”importation’ of pharmaceuticals”
55.3
16.0
28.7
0
25
50
75
Agree Don't Know Disagree
Percent
““Physicians induce substantial Physicians induce substantial demand for their services”demand for their services”
55.0
15.6
29.4
0.0
25.0
50.0
75.0
Agree Don't Know Disagree
Percent
81% in 1989
““Controlling for the average Controlling for the average income in an area, greater income income in an area, greater income
inequality worsens health”inequality worsens health”
51.4
25.9 22.7
0
25
50
75
Agree Don't Know Disagree
Percent
““The U.S. should continue to The U.S. should continue to subsidize graduate medical subsidize graduate medical
education”education”
51.3
19.4
29.2
0
25
50
75
Agree Don't Know Disagree
Percent
Substantial DisagreementSubstantial Disagreement
““The U.S. should continue the The U.S. should continue the current tax treatment of employer-current tax treatment of employer-
sponsored health insurance”sponsored health insurance”
30.8
19.9
49.3
0
25
50
75
Agree Don't Know Disagree
Percent
““The U.S. should adopt a The U.S. should adopt a Canadian-style system of universal Canadian-style system of universal and compulsory health insurance”and compulsory health insurance”
47.1
9.7
43.2
0
25
50
Agree Don't Know Disagree
Percent
52% in 1989
““The U.S. should require The U.S. should require employers to provide a minimum employers to provide a minimum level of health insurance for their level of health insurance for their
workers”workers”
37.5
17.5
45.1
0
25
50
Agree Don't Know Disagree
Percent
38% in 1989
““The U.S. should implement a The U.S. should implement a refundable tax credit to encourage refundable tax credit to encourage
people to buy private health people to buy private health insurance”insurance”
43.0
22.4
34.7
0.0
25.0
50.0
Agree Don't Know Disagree
Percent
““The current profits of The current profits of pharmaceutical companies are pharmaceutical companies are
necessary to give them incentives necessary to give them incentives for optimal R&D”for optimal R&D”
38.9
18.0
43.2
0
25
50
Agree Don't Know Disagree
Percent
““The benefits of the Medicare The benefits of the Medicare prescription drug benefit exceed prescription drug benefit exceed
the costs”the costs”
23.5
38.6 37.9
0
25
50
Agree Don't Know Disagree
Percent
““If a payer (e.g., an HMO) If a payer (e.g., an HMO) negotiates a lower price for negotiates a lower price for
hospital services, the hospital will hospital services, the hospital will raise prices to other payers”raise prices to other payers”
46.9
22.4
30.7
0
25
50
Agree Don't Know Disagree
Percent
63% in 1989
Factor Analysis of Disagreement Factor Analysis of Disagreement and Modest Agreement Issuesand Modest Agreement Issues
Views do not particularly “lump” Views do not particularly “lump” Factor 1Factor 1
Agree on cost shiftingAgree on cost shifting Agree on employer mandatesAgree on employer mandates Agree on Canadian systemAgree on Canadian system Agree that income inequality affects healthAgree that income inequality affects health
Factor 2Factor 2 Disagree on profits and Pharm R&DDisagree on profits and Pharm R&D Agree on drug re-importationAgree on drug re-importation Agree on Canadian systemAgree on Canadian system
Probit Descriptive Analysis of Probit Descriptive Analysis of Disagreement and Modest Disagreement and Modest
AgreementAgreement Agree = f (degree type, training, Agree = f (degree type, training,
experience, experience, demographics, and demographics, and employment employment setting)setting)
No consistent pattern of responses No consistent pattern of responses across issuesacross issues
Few statistically significant Few statistically significant associationsassociations
Health Economists’ Impact on Health Economists’ Impact on Policy DiscussionsPolicy Discussions
85.5% of health economists report 85.5% of health economists report having some impact on policy having some impact on policy discussionsdiscussions
Measured as responding affirmatively to Measured as responding affirmatively to at least one of the 7 questions we asked at least one of the 7 questions we asked about involvementabout involvement
296 respondents to these questions
Health Economists’ Impact on Health Economists’ Impact on Policy DiscussionsPolicy Discussions
I have testified before a state or I have testified before a state or federal agency or committeefederal agency or committee 34.134.1
%%I have discussed my research with I have discussed my research with agency or legislative staffagency or legislative staff 60.560.5
%%Agency or legislative staff have Agency or legislative staff have attended presentations of my workattended presentations of my work 57.157.1
%%Agency or legislative staff have asked Agency or legislative staff have asked for copies of my researchfor copies of my research 61.561.5
%%
Health Economists’ Impact on Health Economists’ Impact on Policy DiscussionsPolicy Discussions
I have discussed my research with I have discussed my research with private sector organizations such as private sector organizations such as firms, unions, trade associations, firms, unions, trade associations, advocacy groupsadvocacy groups
59.559.5%%
My research and/or expertise has led My research and/or expertise has led to consulting or related activities with to consulting or related activities with private sector organizationsprivate sector organizations
49.049.0%%
My work has been cited by My work has been cited by proponents or opponents of proponents or opponents of legislationlegislation
41.941.9%%
Who Participates?Who Participates?
Using the same descriptive probit Using the same descriptive probit model used with the views on policy…model used with the views on policy…
Those with MDs Those with MDs moremore likely to participate likely to participate Those with master’s degrees Those with master’s degrees lessless likely likely Those with less than 4 years of experience Those with less than 4 years of experience
are are less less likely to participatelikely to participate
OverallOverall
Health economists agree on a number of Health economists agree on a number of important policy questionsimportant policy questions
We disagree on many topics as well, but We disagree on many topics as well, but there seems to be little systematic there seems to be little systematic disagreementdisagreement
We are active in promoting our research We are active in promoting our research in the policy arenain the policy arena