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Journal of General Internal Medicine

By Nirav Shah and Jason Wang

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Journal Article

Marketplace Plans Provide Risk Protection, But Actuarial Values Overstate Realized Coverage For Most Enrollees

Maria Polyakova, Lynn M. Hua, M. Kate Bundorf
Health Affairs , 2017

The Affordable Care Act (ACA) has increased the number of Americans with health insurance. Yet many policy makers and consumers have questioned the value of Marketplace plan coverage because of the generally high levels of cost sharing. We simulated out-of-pocket spending for bronze, silver, or gold Marketplace plans (those having actuarial values of 60 percent, 70 percent, and 80 percent, respectively).

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Journal Article

Validation of Risk Equations for Complications of Type 2 Diabetes (RECODe) Using Individual Participant Data From Diverse Longitudinal Cohorts in the U.S.

Sanjay Basu, Jeremy B. Sussman, Seth A. Berkowitz, Rodney A. Hayward, Alain G. Bertoni, Adolfo Correa, Stanford Mwasongwe, John S. Yudkin
American Diabetes Association , 2017
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Journal Article

PCSK9 Inhibitors Economics and Policy

Mark A. Hlatky, Dhruv S. Kazi
Journal of the American College of Cardiology , 2017

Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors substantially reduce low-density lipoprotein cholesterol, but it is presently unclear whether they also reduce mortality. The list prices of PCSK9 inhibitors in the United States (>$14,500 per year) are >100× higher than generic statins, and only a small fraction of their higher cost is likely to be recovered by prevention of cardiovascular events.

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Journal Article

Supplemental Nutrition Assistance Program (SNAP) Participation and Health Care Expenditures Among Low-Income Adults

Seth A. Berkowitz, Hilary K. Seligman, Joseph Rigdon, James B. Meigs, Sanjay Basu
JAMA Internal Medicine , 2017

Objective

To determine whether the Supplemental Nutrition Assistance Program (SNAP), which addresses food insecurity, can reduce health care expenditures.

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Journal Article

Drug-Free Interventions to Reduce Pain or Opioid Consumption After Total Knee Arthroplasty A Systematic Review and Meta-analysis

Dario Tedesco, Davide Gori, Karishma Desai, Steven M. Asch, Ian R. Carroll, Catherine Curtin, Kathryn M. McDonald, Maria P. Fantini, Tina Hernandez-Boussard
JAMA Surgery , 2017

To systematically review and meta-analyze evidence of nonpharmacological interventions for postoperative pain management after total knee arthroplasty.

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Journal Article

Social Isolation and Medicare Spending: Among Older Adults, Objective Isolation Increases Expenditures While Loneliness Does Not

Jonathan Shaw, Monica Farid, Claire Noel-Miller, Neesha Joseph, Ari Houser, Steven M. Asch, Jay Bhattacharya, Lynda Flowers
SAGE Journals , 2017

Objective: The purpose of this study was to evaluate the impact of objective isolation and loneliness on Medicare spending and outcomes. Method: We linked Health and Retirement Study data to Medicare claims to analyze objective isolation (scaled composite of

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Working Paper

Family Ruptures, Stress, and the Mental Health of the Next Generation

Maya Rossin-Slater, Maya Rossin-Slater, Petra Persson
American Economic Review , 2017

This paper studies how in utero exposure to maternal stress from family ruptures affects later mental health. We find that prenatal exposure to the death of a maternal relative increases take-up of ADHD medications during childhood and anti-anxiety and depression medications in adulthood. Further, family ruptures during pregnancy depress birth outcomes and raise the risk of perinatal complications necessitating hospitalization. Our results suggest large welfare gains from preventing fetal stress from family ruptures and possibly from economically induced stressors such as unemployment.

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Journal Article

High Levels Of Capitation Payments Needed To Shift Primary Care Toward Proactive Team And Nonvisit Care

Sanjay Basu, Russell S. Phillips, Zirui Song, Asaf Bitton, Bruce E. Landon
Health Affairs , 2017
Capitated payments in the form of fixed monthly payments to cover all of the costs associated with delivering primary care could encourage primary care practices to transform the way they deliver care. Using a microsimulation model incorporating data from 969 US practices, we sought to understand whether shifting to team- and non-visit-based care is financially sustainable for practices under traditional fee-for-service, capitated payment, or a mix of the two.
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Journal Article

Tuskegee and the Health of Black Men

Marcella Alsan, Marianne Wanamaker
The Quarterly Journal of Economics , 2017

For forty years, the Tuskegee Study of Untreated Syphilis in the Negro Male passively monitored hundreds of adult black males with syphilis despite the availability of effective treatment.

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Journal Article

Childhood Illness and the Gender Gap in Adolescent Education in Low- and Middle-Income Countries

Anlu Xing, Paul H. Wise, Gary L. Darmstadt, Eran Bendavid
Pediatrics , 2017

Achieving gender equality in education is an important development goal.  We tested the hypothesis that the gender gap in adolescent education is accentuated by illnesses among young children in the household.

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Journal Article

The Evolving Story of Overlapping Surgery

Michelle Mello, Edward H. Livingston, Edward H. Livington
JAMA , 2017

In December 2015, a Boston Globe investigation of Massachusetts General Hospital (MGH) sparked investigations into concurrent and overlapping surgery. Overlapping surgery refers to operations performed by the same primary surgeon such that the start of one surgery overlaps with the end of another. A qualified practitioner finishes noncritical aspects of the first operation while the primary surgeon moves to the next operation.

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Journal Article

Implementation science for ambulatory care safety: a novel method to develop context-sensitive interventions to reduce quality gaps in monitoring high-risk patients.

Kathryn M. McDonald, George Su, Sarah Lisker, Emily S. Patterson, Urmimala Sarkar
Implementation Science , 2017

Missed evidence-based monitoring in high-risk conditions (e.g., cancer) leads to delayed diagnosis. Current technological solutions fail to close this safety gap. In response, we aim to demonstrate a novel method to identify common vulnerabilities across clinics and generate attributes for context-flexible population-level monitoring solutions for widespread implementation to improve quality.

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Journal Article

Ten years after the financial crisis: The long reach of austerity and its global impacts on health

Sanjay Basu, Megan Carney, Nora J. Kenworthy
Social Science & Medicine , 2017

The global financial crisis starting in 2007 prompted national governments around the world, and notably many within the European Union, to implement austerity measures. Similar to structural adjustment programs (SAPs) implemented throughout the developing world since the 1980s, much of the pressure to adopt and enforce austerity measures has been levied by global financial institutions such as the IMF.

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Journal Article

Malaria control adds to the evidence for health aid effectiveness

Eran Bendavid
Public Library of Science , 2017

The new United States administration’s first budget proposal, previewed in March and released in May, 2017, includes deep cuts to foreign aid, cycling this thorny issue back into the American limelight.

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Journal Article

Every Breath You Take — Every Dollar You’ll Make: The Long-Term Consequences of the Clean Air Act of 1970

Adam Isen, Maya Rossin-Slater, W. Reed Walker
Journal of Political Economy , 2017

This paper examines the long-term impacts of early childhood exposure to air pollution on adult outcomes using U.S. administrative data. We exploit changes in air pollution driven by the 1970 Clean Air Act to analyze the difference in outcomes between cohorts born in counties before and after large improvements in air pollution relative to those same cohorts born in counties that had no improvements. We find a significant relationship between pollution exposure in the year of birth and later life outcomes.

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Journal Article

Sidestepping the Elephant in the Classroom: Using Culturally Localized Technology To Teach Around Taboos

Piya C. Sorcar, Benjamin Strauber, Prashant Loyalka, Neha Kumar, Shelley Goldman
Proceedings of the SIGCHI Conference on Human Factors in Computing Systems, 2792–2804 , 2017

Cultural taboos can restrict student learning on topics of critical importance. In India, such taboos have led multiple states to ban materials intended to educate youth about HIV, putting millions at risk. We present the design of TeachAIDS, a software application that leverages cultural insights, learning science, and affordances of technology to provide comprehensive HIV education while circumventing taboos.

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Journal Article

Signing Up New Fathers: Do Paternity Establishment Initiatives Increase Marriage, Parental Investment, and Child Well-Being?

Maya Rossin-Slater
America Economic Journal: Applied Economics , 2017

With nearly half of U.S. births occurring out of wedlock, understanding how parents navigate their relationship options is important. This paper examines the consequences of a large exogenous change to parental relationship contract options on parental behavior and child well-being. Identification comes from the staggered timing of state reforms that substantially lowered the cost of legal paternity establishment. I show that the resulting increases in paternity establishment are partially driven by reductions in parental marriage.

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Journal Article

Development and Validation of the Agency for Healthcare Research and Quality Measures of Potentially Preventable Emergency Department (ED) Visits: The ED Prevention Quality Indicators for General Health Conditions

Sheryl Davies, Ellen Schultz, Maria Raven, Nancy Ewen Wang, Carol Stocks, Mucio Kit Delgado, Kathryn McDonald
Health Services Research , 2017

Objective

To develop and validate rates of potentially preventable emergency department (ED) visits as indicators of community health.

Data Sources

Agency for Healthcare Research and Quality, Healthcare Cost and Utilization Project 2008–2010 State Inpatient Databases and State Emergency Department Databases.

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Working Paper

Technological Progress and Health Convergence: The Case of Penicillin in Post-War Italy

Grant Miller, Marcella Alsan, Vincenzo Atella, Jay Bhattacharya, Valentina Conti
2017
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Commentary

Medical Liability — Prospects for Federal Reform

Michelle Mello, Allen Kachalia, David Studdert
The New England Journal of Medicine , 2017

Medical malpractice reform appears to be back on the federal policy agenda. The appointment of Tom Price, a long-time proponent of tort reform, as secretary of health and human services, in conjunction with Republican control of both houses of Congress, has created fertile conditions for several Republican proposals that have languished for years without the requisite support. Although it has been debated many times, a major federal foray into medical liability, a state-based area of law, would be unprecedented. The prospect raises several questions: Which reforms are on the table?

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Working Paper

Municipal Water Disinfection and Mortality Decline in Developing Countries: Evidence from Mexico’s Programa Agua Limpia

Sonia R. Bhalotra, Alberto Diaz-Cayeros, Grant Miller, Alfonso Miranda, Atheendar S. Venkataramani
National Bureau of Economic Research , 2017

Historically, improvements in the quality of municipal drinking water made important contributions to mortality decline in wealthy countries. However, water disinfection often does not produce equivalent benefits in developing countries today. We investigate this puzzle by analyzing an abrupt, large-scale municipal water disinfection program in Mexico in 1991 that increased the share of Mexico’s population receiving chlorinated water from 55% to 85% within six months.

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