Issue Briefs

Since 1967, Penn's Leonard Davis Institute of Health Economics (LDI) has been the leading university institute dedicated to data-driven, policy-focused research that improves our nation’s health and health care. LDI’s Issue Briefs synthesize the research evidence around key topics and provide relevant and usable information to policymakers. For more information, please contact Penn LDI (




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Now showing 1 - 10 of 154
  • Publication
    Could a Public Health Insurance Option Lead to More Competitive Markets?
    (2019-12-10) Pauly, Mark V.
    Calls for the establishment of a “public option,” which emerged during the debate on the Affordable Care Act, have reemerged in this election season. Some proposals base the public option on Medicare, while others on Medicaid. In this article, Wharton professor and LDI Senior Fellow Mark Pauly discusses the likely effects of a public option on private markets, using experience in Medicare Advantage as a guide. Will the public option become the preferred one, sweeping away the private market? Or can the public and private options peacefully coexist?
  • Publication
    Substance Use Disorder in America: Research to Practice, and Back Again
    (2017-08-01) Miclette, Matthew; Cuan, Isabella; Meisel, Zachary F.
    These proceedings summarize the insights shared by nationally renowned panels of experts and overall themes discussed throughout a substance use disorder conference held at the University of Pennsylvania. The conference included experts from academia and public and private sectors, who came together to discuss the gaps in evidence-based substance use policy and practice, with particular emphasis on the opioid epidemic. The day concluded with an interactive session focused on the exchange of ideas and solutions to curb the opioid epidemic. Those ideas are included in these proceedings
  • Publication
    Transforming Mental Health Care Through Implementation of Evidence-Based Practices
    (2020-05-21) Glickman, Aaron; Weiner, Janet; Beidas, Rinad
    Changing clinical practice is hard, and changing practices within larger organizations is even harder. Increasingly, policymakers are looking to implementation science—the study of why some changes prove more durable than others—to understand the dynamics of successful transformation. In this brief, we summarize the results of an ongoing community-academicpartnership to increase the uptake of evidence-based practices in Philadelphia’s public behavioral health care system. Over five years, researchers found that widescale initiatives did successfully change the way care was delivered, albeit modestly and slowly. The evidence suggests that organizational factors, such as a proficient work culture, are more important than individual therapist factors, like openness in change, in influencing successful practice change. Furthermore, organizations must address staff turnover and burnout, and employees must feel supported in general in order for managers to expect them to change. In short, while practice transformation is possible—even in highly stressed and under-resourced public health settings—it requires focusing on underlying problems within organizations as well as championing new policies.
  • Publication
    Opportunities for Precision Cancer: Reflections from the Gant Consortium
    (2018-09-20) Glickman, Aaron; Weiner, Janet
    There is substantial interest in targeted cancer therapies, spurred by recent biomedical research in genomics and oncology. Targeted cancer therapies, in which prevention and treatment of cancer are based on genomic and biologic analyses, hold promise for cancer care. However, the rising costs of such therapies may threaten that promise. In an effort to meet the future challenges of targeted cancer medicine head-on, the University of Pennsylvania convened the Gant Family Precision Cancer Medicine Consortium, a multidisciplinary work group of experts from health care economics, policy, law, regulation, cancer research and medicine, patient advocacy, and the pharmaceutical and insurance industry. The Gant Consortium sought answers to a central question: what approaches should stakeholders take to foster the economic viability and sustainability of targeted cancer drugs? The Consortium literature review was conducted from August through November 2016. The expert committee met regularly from October 2016 to May 2017 to identify points of contention and consensus, outline the issues at the core of sustainable targeted cancer medicine, and inform potential policy recommendations. The literature presented in this report does not include therapies developed afterwards, such as CAR-T. The views expressed in this White Paper reflect the discussions of the Gant Consortium but do not necessarily represent the views of either any individual member or of the Consortium as a whole.
  • Publication
    Supply of Primary Care Providers and Appointment Availability for Philadelphia's Medicaid Population
    (2018-10-23) Candon, Molly; Andreyeva, Elena; Rosenquist, Rebecka; Grande, David
    This brief analyzes the supply of primary care providers serving the Medicaid population in Philadelphia, and the geographic variability of this measure across the city. It also examines important measures of access – appointment availability and wait time for an initial appointment – that highlight challenges faced by Medicaid patients.
  • Publication
    Show Me the Money: Economic Evaluations of Opioid Use Disorder Interventions
    (2016-05-25) Murphy, Sean; Polsky, Daniel; Meisel, Zachary; Mitchell, Julia
    This brief summarizes a new systematic review of economic evaluations of treatments for substance use disorders. The review reveals strong evidence that methadone maintenance therapy is an economically advantageous form of treatment; the economic evidence for buprenorphine and naltrexone treatments is more limited.
  • Publication
    Hospital Nurse Staffing, Education, and Patient Mortality
    (2003-10-22) Aiken, Linda H; Clarke, Sean P; Silber, Jeffrey H; Sloane, Douglas M
    A serious shortage of hospital nurses in the U.S., evident in the past decade, is expected to continue and worsen in the next 15 years. Increasingly, the public and the health professions are acknowledging that nurse understaffing represents a serious threat to patient safety in U.S. hospitals. Although anecdotal evidence has linked patient deaths to inadequate nurse staffing, the numbers and kinds of nurses needed for patient safety is unknown. This Issue Brief highlights two studies that clarify the impact of nurse staffing levels on surgical patient outcomes, and examine the effect of nurses’ experience and educational level on patient mortality in the 30 days after a surgical admission.
  • Publication
    The Effect of Firearm Deaths on Life Expectancy and Insurance Premiums in the United States
    (2005-10-27) Lemaire, Jean
    Despite recent gains, the U.S. remains behind most other affluent countries in life expectancy. Even within the U.S., the gap between the life expectancies of Caucasians and African-Americans remains significant. At the same time, firearm deaths in the U.S. far exceed peer nations, and disproportionately affect African-American males. In this Issue Brief, Dr. Lemaire explores whether deaths from firearms explain some of these international and racial disparities in life expectancy. He uses actuarial techniques to calculate the “cost” of firearm deaths in the U.S., both in terms of reduced life expectancy and increased life insurance premiums.
  • Publication
    How the Newly Insured Use Health Services: a Lesson for the U.S. from Medicare
    (2012-02-01) Polsky, Daniel
    The Congressional Budget Office estimates that about 32 million previously uninsured people will gain coverage by 2016, when health care reforms are fully implemented. But will these newly insured people use the health care system in the same ways as others? Is insurance enough to change patterns of use? The example of Medicare may provide some insight. This Issue Brief summarizes research that investigates how health care use and patterns change among the uninsured and insured once they gain Medicare coverage at age 65.
  • Publication
    How Managed Care Growth Affects Where Physicians Locate Their Practices
    (2000-11-14) Polsky, Daniel; Escarce, Jose J
    Managed care has had a profound effect on physician practice. It has altered patterns in the use of physician services, and consequently, the practice and employment options available to physicians. But managed care growth has not been uniform across the United States, and has spawned wide geographic disparities in earning opportunities for generalists and specialists. This Issue Brief summarizes new information on how managed care has affected physicians’ labor market decisions and the impact of managed care on the number and distribution of physicians across the country.