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Economic Dimensions of Personalized and Precision Medicine
Personalized and precision medicine (PPM)—the targeting of therapies according to an individual’s genetic, environmental, or lifestyle characteristics—is becoming an increasingly important approach in health care treatment and prevention. The advancement of PPM is a challenge in traditional clinical, reimbursement, and regulatory landscapes because it is costly to develop and introduces a wide range of scientific, clinical, ethical, and socioeconomic issues. PPM raises a multitude of economic issues, including how information on accurate diagnosis and treatment success will be disseminated and who will bear the cost; changes to physician training to incorporate genetics, probability an...
Health Status and Medical Treatment of the Future Elderly
To help the Centers for Medicare and Medicaid Services more accurately predict future health care costs, RAND Health developed the Future Elderly Model (FEM). A demographic-economic model of health spending projections, the FEM enables the user to answer "what-if" questions about the effects of changes in health status and disease treatment on future health care costs. This report describes the development of the FEM and its application in four key clinical areas.
The Impact of Regulation and Financial Incentives on Cost-of-illness
Economic costs will vary with the health care environment, yet a cost-of-illness estimate necessarily depends on the status quo. This intransigence may limit policymakers' ability to draw meaningful inferences from such a study. This paper considers the behavioral and regulatory assumptions that underlie cost-of-illness estimates. The authors present several case studies which reveal the extent to which cost-of-illness can vary across regulatory regimes, and they show that costs can be quite sensitive to patient and provider financial incentives.
Are the Young Becoming More Disabled?
A fair amount of research suggests that health has been improving among the elderly over the past 10 to 15 years. Comparatively little research effort, however, has been focused on analyzing disability among the young. In this paper, we argue that health among the young has been deteriorating, at the same time that the elderly have been becoming healthier. Moreover, this growth in disability may end up translating into higher disability rates for tomorrow's elderly. Using data from the National Health Interview Survey, we find that, from 1984 to 1996, the rate of disability among those in their 40s rose by one full percentage point, or almost forty percent. Over the same period, the rate of disability declined for the elderly. The recent growth in disability has coincided with substantial growth in asthma and diabetes among the young. Indeed, the growth in asthma alone seems more than enough to explain the change in disability. Therefore, we argue that the growth in disability stems from real changes in underlying health status.
Commentary
Estimates of the burden of out-of-pocket expenses among the elderly are very sensitive to the methods used. This arises because burden, as measured by the share of income devoted to health expenses, is noisily measured at the individual level. Methods that do not account for these errors will give biased results. Using data from the Medicare Current Beneficiary Survey, we show that the flawed methods used in a previous study substantially dramatically overstates the burden on the elderly, especially the poor elderly.
The Cost of Cancer Treatment Study's Design and Methods
Traditionally, the cost of conducting cancer clinical trials has been supported by a combination of research sponsors, institutions, and third-party payers. However, health insurers and other payers are increasingly reluctant to reimburse for direct patient care provided as part of a clinical trial. These policies--driven in part by a perception that patients enrolled in trials incur substantial additional costs--might impede efforts to enroll patients in clinical trials. Yet there is little evidence regarding the costs of treating patients in clinical trials.
Comparing Medical Productivity Between Germany and the US
The present study was conducted by the RAND Health Division on behalf of the German health insurance fund "Techniker Krankenkasse." By presenting two different disease patterns, the book shows how the quality of treatment in the German and U.S. health care systems can be improved and how efficiency can be increased.
Market Evidence of Misperceived Prices and Mistaken Mortality Risks
We construct and implement a test of rational consumer behavior in a highstakes financial market. In particular, we test whether consumers make systematic mistakes in perceiving their mortality risks. We implement this test using data from secondary life insurance markets where consumers with a lifethreatening illness sell their life insurance policies to firms in return for an up-front payment. We compare predictions from two models: one with consumers who correctly perceive their mortality risk, and one with consumers who are misguided about their life expectancy, and find that our data are most consistent with the predictions made by the second model.
Health Care Spending
Over the last five decades, broad changes in the US health care system have dramatically influenced growth in health care expenditures. These structural changes have also influenced the trajectory of the health economics research. This paper reviews some of the seminal health economics papers (measured by citations) and identifies the salient factors driving the growth of medical expenditures. We find that the research identified - and was strongly influenced by - four eras of expenditure growth: (1) coverage expansion; (2) experimentation with financial incentives; (3) the managed care backlash; and (4) a golden era of declining expenditure growth. We conclude by discussing some themes from this research suggesting optimism that, going forward, we can curb excess expenditure growth above GDP growth without harming population health.
