Health affairs
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Insurers are well positioned to support their enrollees in shopping for care because of their ability to analyze complex data--reflecting both their negotiated discounts and the enrollee's benefit structure--should they decide to commit resources to this task. Government transparency initiatives can help those who are uninsured or want to use out-of-network providers with data on prices and all patients by gathering and disseminating data on quality. But clumsy requirements to disclose insurer-provider contracts could lead to higher prices. Greater price transparency might help curb rising costs, but many overstate the likely magnitude of its contribution.
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Despite the urgent call to action made by the Institute of Medicine's (IOM's) Crossing the Quality Chasm report in 2001, several fundamental issues in health care remain largely unaddressed. Although a number of organizations have addressed many of the system-level factors cited in the report, we have much to learn about practice and patient factors that affect clinical outcomes. Now we have new opportunities to further improve health care by learning from the data available in electronic health record databases and, perhaps more importantly, to better understand the human behavior of caregivers and patients necessary to improve health care quality.
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This study reviews Medicaid policies to restrict access to psychiatric medications. Policies on prior authorization, preferred drug lists, limitations on the number of prescriptions, fail-first requirements, and use of generics are reviewed. All states apply one or more of those policies to medications for mental illness, and many apply several. ⋯ Other psychiatric medications are less well protected. Some states appear to restrict access severely. Questions have been raised as to whether these policies actually save money in the long term.
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Socioeconomic status (SES) underlies three major determinants of health: health care, environmental exposure, and health behavior. In addition, chronic stress associated with lower SES may also increase morbidity and mortality. ⋯ Lessons for U. S. policy approaches are taken from the Acheson Commission in England, which was charged with reducing health disparities in that country.
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The period from the 1980s to the present has witnessed a lively and unsettled debate concerning the legalization of marijuana, cocaine, heroin, and other illicit substances in the United States. Proponents of legalization argue that the demand for these harmful and potentially addictive substances is not responsive to price. Opponents argue that prices will fall tremendously in a regime characterized by legalization and that the option of legalization and taxation is not feasible. In this paper we summarize theoretical and empirical evidence suggesting that none of these propositions is correct.