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
    Expanding Scope of Practice After COVID-19
    (2021-02-15) Weiner, Janet
    To expand access to health care during the COVID-19 pandemic, many states relaxed or waived regulations that define the scope of health professional practice. This experience highlights the need to ensure that all health care professionals practice to the full extent of their capabilities—an issue that predates and will outlast the pandemic. In a virtual conference on November 20, 2020, Penn LDI and Penn Nursing brought together experts in law, economics, nursing, medicine, and dentistry to discuss current gaps in health professional scope of practice, what we have learned from COVID-19, and how to rethink scope of practice to better meet community and public health needs.
  • 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
    Designing Health Insurance Exchanges: Key Decisions
    (2012-03-07) Starc, Amanda; Kolstad, Jonathan T
    A cornerstone of health care reform is the establishment of state-level insurance exchanges where individuals and small businesses can purchase health insurance in an online marketplace. This report reviews the experience of Massachusetts in developing a health insurance exchange and offers policymakers guidance on key features and likely consumer responses.
  • Publication
    The Quality of Emergency Medical Services
    (2011-11-21) David, Guy; Harrington, Scott E
    Although Emergency Medical Services (EMS) is a crucial part of the health care system, there is relatively little research on the quality of those services. EMS agencies often measure their performance using criteria such as response time or total prehospital time. But larger scale studies that cross counties and providers are rare. This Issue Brief summarizes two studies that use comprehensive, longitudinal data from one state to assess the demographic, geographic, and professional factors that affect EMS performance.
  • Publication
    Re-engineering Drug Discovery and Development
    (2011-10-10) FitzGerald, Garret A
    The rate of new drug approvals in the US has remained essentially constant since 1950, while the costs of drug development have soared. Many commentators question the sustainability of the current model of drug development, in which large pharmaceutical companies incur markedly escalating costs to deliver the same number of products to market. This Issue Brief summarizes the problem, describes ongoing governmental efforts to influence the process, and suggests changes in regulatory science and translational medicine that may promote more successful development of safe and effective therapeutics.
  • Publication
    Behavioral Economics and Health Annual Symposium
    (2011-09-07) Weiner, Janet; Asch, David A
    The application of behavioral economics to health and health care has captured the imagination of policymakers across the political spectrum. The idea is that many people are irrational in predictable ways, and that this both contributes to unhealthy behaviors like smoking and holds one of the keys to changing those behaviors. Because health care costs continue to increase, and a substantial portion of costs are incurred because of unhealthy behaviors, employers and insurers have great interest in using financial incentives to change behaviors. However, it is in the details that complexity and controversies emerge. Who should the targets be, and what outcomes should be rewarded? How should incentives be structured, to maximize their effectiveness and minimize unintended consequences? In what situations should we be intervening to affect decisions by people who may prefer to be obese or to smoke, and in what situations should we accept their preferences? To begin to answer these questions, the Penn-CMU Roybal P30 Center on Behavioral Economics and Health held its first annual Behavioral Economics and Health Symposium on March 24-25, 2011 with support from the Robert Wood Johnson Foundation. The symposium drew more than 50 researchers, scholars, and health professionals from a variety of disciplines, including medicine, public health, economics, law, management, marketing, and psychology. They heard perspectives on behavioral economics from public and private funders, the CEO of the University of Pennsylvania Health System, and the CEO of, a start-up company that uses online, voluntary commitment contracts to help people achieve their goals. Participants formed eight working groups to review the current state-of-the-art in a variety of clinical contexts and to consider how behavioral economics could inform a research agenda to improve health. This Issue Brief summarizes the findings of these working groups and the symposium.
  • Publication
    Limitations in Access to Dental and Medical Specialty Care for Publicly Insured Children
    (2011-06-24) Rhodes, Karin V; Bisgaier, Joanna
    Medicaid and the state-run Children’s Health Insurance Program (CHIP) cover about 42 million children, many of whom would not have access to care without public insurance. Federal law requires that this access be equivalent to that of privately insured children for covered services, and many states have implemented policies to improve longstanding disparities in primary and preventive care. Reimbursement rates are up, but significant disparities remain, especially for dental and specialty services. It is important to understand the distinct effect of provider-related barriers, because they are potentially more modifiable through health policy than patient-related ones. This Issue Brief summarizes research that directly measures the willingness of dental and medical providers to see publicly-insured children, using research assistants posing as mothers calling for an urgent appointment for their child.
  • Publication
    When Genetic Screening is Useful, but not Used
    (2011-08-03) Bernhardt, Barbara A; Pyeritz, Reed E
    In families with genetic disorders due to a known genetic mutation, presymptomatic genetic testing can lead to early detection and treatment of inherited disorders that may manifest later in life. The health benefits for family members at increased risk, however, is limited by the predictive value of the genetic test, the availability of effective treatments, and individuals’ and families’ willingness to undergo genetic testing in the first place. This Issue Brief describes the case of a genetic condition for which genetic screening of family members is clearly useful, and just as clearly underused. It explores the barriers to the use of genetic screening and has implications for the future as genetic technologies become more complex and produce more uncertainty.
  • Publication
    The Pay-Off on Nursing Home Report Cards
    (2011-05-04) Werner, Rachel M; Polsky, Daniel; Konetzka, R Tamara
    For the past decade, policymakers have used public reporting of quality measures as a strategy to improve quality in nursing homes. In theory, public reporting might improve overall quality in two ways: first, if consumers choose nursing homes with better performance, and second, if public reporting encourages nursing homes to improve their performance. Has public reporting had its intended effects? Does improving quality give nursing homes a competitive advantage in the marketplace, thereby improving their bottom line? This Issue Brief summarizes a series of studies that assess the impact of public reporting on nursing home quality and on the financial performance of these facilities.
  • Publication
    The Changing Geography of Outpatient Procedures
    (2011-03-29) David, Guy; Neuman, Mark D
    Since the early 80s, many surgical procedures have moved from the inpatient to outpatient setting. Outpatient surgical visits now account for about two-thirds of all surgical visits in the U.S. Over the same period, freestanding ambulatory surgery centers (ASCs) have arisen as alternatives to traditional hospital-based outpatient surgical departments. The number of ASCs grew from 240 in 1983 to 5,174 in 2008. The growth of ASCs raises safety concerns about the risk of complications and adequate access to emergency care. This Issue Brief summarizes evidence from one state about the changing geography of outpatient procedures and the possible risks associated with these changes.