Pauly, Mark V

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Now showing 1 - 10 of 15
  • Publication
    From Hospital to Drugstore: Insurance and the Shift to Outpatient Care
    (2001-10-23) Danzon, Patricia. M; Pauly, Mark V
    As policymakers consider whether and how to add prescription drug coverage to Medicare, they need to understand the relationship between insurance coverage and the adoption of new medical technologies, including drugs. Even the direction of these relationships is not always so clear. In this Issue Brief, Drs. Danzon and Pauly examine the shift from inpatient to outpatient care in the last 20 years, and ask two broad questions: to what extent was this shift encouraged by changes in insurance, and to what extent was insurance coverage influenced by this shift?
  • Publication
    Increasing the Value of Health Care: The Role of Nurses
    (2015-10-15) Lindrooth, Richard C; Yakusheva, Olga; Fairman, Julie A; Naylor, Mary D; Pauly, Mark V
    Increasing health care value has become a central objective of payment policies, insurance design and purchasing, and patient and provider decision-making. The word “value” appeared in the title of seven sections of the Affordable Care Act (ACA), and earlier this year CMS set a goal of having 50 percent of reimbursement based on value. This brief reviews nurses’ contribution to value, highlighting evidence published by researchers in the Interdisciplinary Nursing Quality Research Initiative (INQRI), an 8-year program funded by the Robert Wood Johnson Foundation. It also looks at interventions designed to address outcomes targeted by ACA- or Medicare-related payment policies.
  • Publication
    Is There a Future for Employer- Sponsored Health Insurance?
    (2015-03-01) Pauly, Mark V
    Over the next five years, the effects of the ACA on employer-sponsored insurance will be modest. In the longer run, there is greater potential for disruption, depending on how firms respond to the subsidies available on the exchanges for low-wage workers. In all, only about 15% of the workforce likely will be affected. The impacts of the ACA on firms will vary widely based on three main factors: 1) the size of the firm, 2) the average compensation within the firm, and 3) the degree to which wages within the firm are homogenous or heterogeneous. Keeping in mind that employees pay for all their health insurance, group insurance is not intrinsically superior to private exchanges, and cost trumps choice for consumers, firms will choose the option that maximizes benefits to their workers, takes advantage of the best available subsidies while avoiding tax penalties, and results in the lowest administrative costs. Making all low-wage workers eligible for the same subsidies, whether they acquire coverage on the exchanges or in group plans, would be reasonable and involve less distortions.
  • Publication
    Primary Care Shortages: More Than a Head Count
    (2014-11-21) Pauly, Mark V; Weiner, Janet; Naylor, Mary D
    The existence of a primary care physician shortage, even prior to the ACA, is not universally accepted. A new report by the Institute on Medicine found “no credible evidence” that the nation faces a looming physician shortage in primary care specialties. There is greater consensus about a maldistribution of physicians, in terms of specialty, geography, and practice settings. This new LDI/ Interdisciplinary Nursing Quality Research Initiative (INQRI) research brief reviews the evidence and how the ACA might affect current and future patterns of delivering primary care.
  • Publication
    The new Medicare Drug Benefit: Much ado About Little?
    (2004-02-18) Pauly, Mark V
    After many years of debate, Congress recently approved a new, voluntary “Medicare Part D” benefit that provides some coverage for prescription drugs. The goal of this coverage is to reduce financial barriers that might prevent beneficiaries from obtaining needed drugs. The degree to which this goal is achieved depends on how well the benefit reaches seniors with previously unmet needs; conversely, it may do little to improve seniors’ health if it replaces existing sources of coverage, or encourages overuse of drugs. This Issue Brief reviews data on current patterns of drug spending among Medicare beneficiaries and summarizes aspects of the new benefit. It explores the likely effect of the coverage on overall use of and spending for prescription drugs and considers whether any additional use is likely to represent needed care that had been forgone because of a cost barrier.
  • Publication
    Complementary and Alternative Medicine: Personal Preference or low Cost Option?
    (2005-02-21) Pagán, José A; Pauly, Mark V
    From acupuncture to yoga, Americans’ use of complementary and alternative medicine (CAM) is widespread and growing. The reasons that people give for using CAM are as diverse as the CAM therapies themselves: some perceive that conventional health care is ineffective, while others consider CAM to be more consistent with their own values and beliefs about health. As conventional health care costs rise, it is also possible that some people turn to CAM as a low cost alternative. This Issue Brief summarizes research that evaluates the relationship between CAM use and perceived access to conventional health care.
  • Publication
    Time Preference and Its Relationship with Age, Health, and Longevity Expectations
    (2007-01-01) Chao, Li-wei; Szrek, Helena; Pauly, Mark V; Pereira, Nuno Sousa
    Although theories in both evolutionary biology and economics predict that an individual’s health should be associated with the individual’s time preference, no prior study has been done to empirically support or refute such predictions. By collecting detailed measures of health, time preference, and expected longevity on a sample of individuals in townships around Durban, South Africa, this study breaks new ground by being the first to analyze in detail the relationship between time preference and health, in an area of the world with high mortality and morbidity. Interestingly, we find that both physical health and expectations of longevity have a U-shaped relationship with the person’s subjective discount rate. This suggests that those in very poor health have high discount rates, but those in very good health also have high discount rates. Similarly those with longevity expectations on the extremes have high discount rates. The research question addressed by this pilot project is policy relevant, as the study tries to determine the importance of health in economic development, not from the commonly asserted productivity-gain argument, but from a much broader investment-for-the-future argument.
  • Publication
    Financial Incentives and Drug Spending in Managed Care
    (1999-05-18) Hillman, Alan L; Pauly, Mark V
    Pharmaceutical costs have been rising dramatically since 1995, growing 16.6% in 1998 alone. This rate of increase is more than four times that of all health care spending. Employers, managed care organizations and consumers are looking anew for ways to stem these rising costs, without denying patients effective care. Therefore, this Issue Brief is especially timely because it investigates how patient copayments and financial incentives for physicians affect drug spending in managed care.
  • Publication
    Effects of the ACA on Health Care Cost Containment
    (2017-03-02) Weiner, Janet; Marks, Clifford; Pauly, Mark
    This brief reviews the evidence on how key ACA provisions have affected the growth of health care costs. Coverage expansions produced a predictable jump in health care spending, amidst a slowdown that began a decade ago. Although we have not returned to the double-digit increases of the past, the authors find little evidence that ACA cost containment provisions produced changes necessary to “bend the cost curve.” Cost control will likely play a prominent role in the next round of health reform and will be critical to sustaining coverage. gains in the long term.
  • Publication
    Community Benefits: How do For-Profit and Nonprofit Hospitals Measure up?
    (2001-01-23) Nicholson, Sean; Pauly, Mark V
    The rise of the for-profit hospital industry has opened a debate about the level of community benefits provided by non-profit hospitals. Do nonprofits provide enough community benefits to justify the community’s commitment of resources to them, and the tax-exempt status they receive? If nonprofit hospitals convert to for-profit entities, would community benefits be lost in the transaction? This debate has highlighted the need to define and measure community benefits more clearly. In this Issue Brief, the authors develop a new method of identifying activities that qualify as community benefits, and propose a benchmark for the amount of benefit a nonprofit hospital should provide.