Growth and Distribution of Child Psychiatrists in the United States: 2007-2016.

Background: Historically, there has been a shortage of child psychiatrists in the United States, undermining access to care. This study updated trends in the growth and distribution of child psychiatrists over the past decade.

Methods: Data from the Area Health Resource Files were used to compare the number of child psychiatrists per 100 000 children ages 0 to 19 between 2007 and 2016 by state and county.

A National Examination of Child Psychiatric Telephone Consultation Programs' Impact on Children's Mental Health Care Utilization.

Estimates are that half of children with mental health problems do not receive needed treatment. One of the barriers they face is that there are not enough child mental health specialty providers to meet their needs. Pediatric providers, who might partially fill this gap, often feel they lack the training to treat children's mental health disorders without consulting a specialist.

Geographic variation in surgical outcomes and cost between the United States and Japan.

Objectives: Unwarranted geographic variation in spending has received intense scrutiny in the United States. However, few studies have compared variation in spending and surgical outcomes between the United States healthcare system and those of other nations. In this study, we compare the geographic variation in postsurgical outcomes and cost between the United States and Japan.

Employment and Adverse Selection in Health Insurance.

We construct and test a new model of employer-provided health insurance provision in the presence of adverse selection in the health insurance market. In our model, employers cannot observe the health of their employees, but can decide whether to offer insurance. Employees sort themselves among employers who do and do not offer insurance on the basis of their current health status and the probability distribution over future health status changes.

The Option Value of Innovation.

Standard techniques of cost effectiveness analysis measure a technology's benefits in terms of expected life years (or quality-adjusted life years) gained at today's life expectancies. However, this approach ignores the gains which derive from the possibility that a health technology allows an individual to survive long enough to benefit from other technological innovations which raise life expectancy (and quality of life) in the future. Borrowing a term from the finance literature, we refer to this source of value as the "option value" of innovation.

Medicaid cost control measures aimed at second-generation antipsychotics led to less use of all antipsychotics.

"Atypical" or second-generation antipsychotics are a class of drug introduced in the 1990 s for the treatment of schizophrenia. Given their growing use and rising cost, these and other psychotherapeutic drugs are increasingly subject to prior authorization and other restrictions in state Medicaid programs. To evaluate the effects of these policies, we collected drug-level information on their use and on utilization management strategies--for example, requirements for prior authorization, quantity limits, and so-called step therapy--in thirty state Medicaid programs between 1999 and 2008.

Hospital prices and market structure in the hospital and insurance industries.

There has been substantial consolidation among health insurers and hospitals, recently, raising questions about the effects of this consolidation on the exercise of market power. We analyze the relationship between insurer and hospital market concentration and the prices of hospital services. We use a national US dataset containing transaction prices for health care services for over 11 million privately insured Americans.

Beta-blocker compliance, mortality, and reinfarction: validation of clinical trial association using insurer claims data.

Although randomized controlled trials show that long-term beta-blocker use post acute myocardial infarction (AMI) reduces mortality and subsequent cardiovascular events, and that increased compliance lowers mortality, there is limited published research on the effects of long-term beta-blocker compliance in observational community settings. The authors retrospectively study the effect of beta -blocker compliance on mortality and repeat reinfarction using claims records from a major health insurer of all patients who were discharged alive after AMI between January 2003 and June 2004, covered by that health insurer's prescription drug coverage, and prescribed beta-blockers (n = 3923). Using Cox proportional hazards regressions, they estimate both survival and AMI-free survival rates by compliance quartile.

Medicare part D after 2 years.

Objective: To assess the broad impacts of Medicare Part D and the extent to which prior concerns have been realized.

Methods: We used administrative data to summarize beneficiary enrollment and plan participation in Part D, and compared pharmaceutical use and out-of-pocket spending before and after the introduction of Part D. We characterized the benefit designs of the 10 largest Part D plans in 2006 and compared them with the benefit designs of 7 non-Part D plans often cited as examples of low-cost or comprehensive drug benefits.

Hormone replacement therapy and cardiovascular health in the United States.

Background: Hormone replacement therapy (HRT) was widely used among postmenopausal women until 2002 because observational studies suggested that HRT reduced cardiovascular risk. The Women's Health Initiative randomized trial reported opposite results in 2002, which caused HRT use to drop sharply.

Objective: We examine the relationship between HRT use and cardiovascular outcomes (deaths and nonfatal hospitalizations) in the entire US population, which has not been studied in prior clinical trials or observational studies.

How do households choose their employer-based health insurance?

Using the 1996 Medical Expenditure Panel Survey, this study estimates a model of household demand for employer-based health insurance to investigate the set of plan and household characteristics that influence coverage choices. Overall, we find that households are sensitive to price with respect to their coverage decisions, and that price sensitivity varies by marital status, wealth, and the number of offers of employer coverage available to the household. We also find that lower-income households are less likely to select an option that provides coverage for all household members.

Does the profit motive make Jack nimble? Ownership form and the evolution of the US hospital industry.

We examine the evolving structure of the US hospital industry since 1970, focusing on how ownership form influences entry and exit behavior. We develop theoretical predictions based on the model of Lakdawalla and Philipson, in which for-profit and not-for-profit hospitals differ regarding their objectives and costs of capital. The model predicts for-profits would be quicker to enter and exit than not-for-profits in response to changing market conditions.

How has hospital consolidation affected the price and quality of hospital care?

During the 1990s, the hospital industry was transformed by mergers and acquisitions. This synthesis looks at why this rapid consolidation occurred and what impact it had on the price and quality for patients, and the cost of care for hospitals. Key findings include: Managed care was not a main driver of consolidation, but fear of managed care may have played a part.

Economics of nerve block pain management after anterior cruciate ligament reconstruction: potential hospital cost savings via associated postanesthesia care unit bypass and same-day discharge.

Background: Anterior cruciate ligament reconstruction is a complex outpatient surgical procedure often associated with pain. Traditionally, the procedure is performed under general anesthesia and often requires the use of the PACU. Refractory pain and/or nausea/vomiting occasionally leads to an unplanned hospital admission.

Competition among hospitals.

We examine competition in the hospital industry, in particular the effect of ownership type (for-profit, not-for-profit, government). We estimate a structural model of demand and pricing in the hospital industry in California, then use the estimates to simulate the effect of a merger. California hospitals in 1995 face an average price elasticity of demand of -4.