U.S. Health Care Expenditures: Costs, Lessons, and Opportunities Proceedings of a Workshop (2023) / Chapter Skim
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5 Research Priorities
5 Research Priorities
Pages 51-66
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From page 51... ...
• Researchers can play a policy role in providing decision makers with data on benefits, costs, and opportunity costs as well as communicating the inherent values and assumptions involved. (Thornton, Walker, White)
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From page 52... ...
She explained that using these decompositions can be helpful in making comparisons within a crosssection or between different locations, but their utility for guiding policy is limited because of the complex interaction of factors that lead to bad health outcomes. For example, if a person died of HIV in the United States in 2020, one could attribute the death to multiple factors: the behavior of sharing needles or having unprotected sex; the social circumstance of limited access to pre-exposure prophylaxis therapy; genetics, in being more susceptible to HIV infection; and medical care that provided an insufficient response or limited the person's access to antiretroviral therapy.
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From page 53... ...
. Clinical and Social Aspects of Patient-Centered Care Meena Seshamani, the vice president of clinical care transformation at MedStar Health, said that her position at a health system with 10 hospitals and 300 outpatient centers involves creating connections among hospitals, ambulatory sites, the community, post-acute care, and home health in an effort to provide patient-centered care.
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From page 54... ...
For example, countries may have a Ministry of Health responsible for improving population health, a Ministry of Criminal Justice responsible for maintaining law and order, and a Ministry of Social Welfare responsible for ensuring that no one is living within poverty. Walker said that analysts should consider policies from these various perspectives and inform decision makers with evidence relevant to their particular responsibilities.
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J Thornton, an associate professor in the Division of General Pediatrics and Adolescent Medicine at Johns Hopkins University, described three sentinel research contributions relevant to health spending and also her own research trajectory.
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. He reported that his research indicates that people living in locations redlined by the federal government nearly a century ago tend to experience increased segregation, wider racial wealth gaps, lower levels of upward economic mobility, and more difficulty in obtaining mortgage credit today.
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From page 57... ...
The federal budget is deeply shaped by health care policy, and, among its many other tasks, the CBO examines the financial ramifications of preventive health care, opioid use disorder, prescription drug pricing, and health insurance expansions. However, the agency's analysis is limited to the impact of a policy on the federal deficit and does not consider projected health outcomes or health equity.
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From page 58... ...
Data Collection Challenges Hughes asked how Maryland has approached data collection, given the challenges in collecting data on a policy that relies on multiple decision makers with differing objectives. Seshamani responded that much of her work at MedStar Health involves community health, palliative care, primary care, geriatric care, and chronic disease management -- areas of medicine that do not fit neatly into a specific office visit or billing code -- and that siloes can make it difficult to develop a clear picture of value and
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From page 59... ...
White remarked that it is relatively straightforward to determine the financial impacts of expanded access to medical care or child care tax credits, but it is complex to consider the effects on improved well-being. For example, an evidence base is emerging on the long-term effects that 2 TheAmerican Rescue Plan Act of 2021 increased the child tax credit from $2,000 to $3,600 for children under age 6 and $3,000 for children 6–17 years of age, and these credits will be made available through advance periodic payments, https://www.congress.gov/117/ plaws/publ2/PLAW-117publ2.pdf (accessed November 8, 2021)
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From page 60... ...
Although the plan was ceased once Nixon learned of it, it serves as an antiracist housing policy model. It included investment in previously redlined neighborhoods and the creation of affordable housing and opportunities for home ownership for African Americans in affluent white neighborhoods, and it would have granted the federal government the power to undo local zoning provisions.
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From page 61... ...
Research that identifies the key social conditions that potentiate and perpetuate positive health trajectories is also needed, Thornton said, commenting on in-progress and recently completed research on ancillary benefits for Supplemental Nutrition Assistance Program (SNAP) recipients (see, for example, You et al., 2021)
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From page 62... ...
Glied replied that health care spending increases each year without any analysis indicating the expenditures lead to better outcomes. The racial wealth gap was created over generations, so addressing it should not be dependent on generating health care savings: moral imperatives should not be tied to decreasing health care spending, Glied said.
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From page 63... ...
She emphasized the opportunity to put a different lens on science and thinking, with this new lens translating to action moving forward. CLOSING REMARKS AND REFLECTIONS Kirsten Bibbins-Domingo, professor and chair in the Department of Epidemiology and Biostatistics; the Lee Goldman, M.D., Endowed Professor of Medicine; and the vice dean for Population Health and Health Equity
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From page 64... ...
She noted that public goods such as housing, transportation, or early childhood education have value outside of longterm health care consequences. The research standards appropriate for social interventions may be different than those for health care systems; thus, holding interventions to narrowly focused health care standards may not accurately reflect the overall impact of these interventions.
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From page 65... ...
These problems are related in terms of budgets, but linking these concepts in messaging and in implementation may not be effective. Bibbins-Domingo added that addressing high health care cost and investment in social sectors that drive health will require a variety of communication strategies.
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