FSI’s researchers assess health and medicine through the lenses of economics, nutrition and politics. They’re studying and influencing public health policies of local and national governments and the roles that corporations and nongovernmental organizations play in providing health care around the world. Scholars look at how governance affects citizens’ health, how children’s health care access affects the aging process and how to improve children’s health in Guatemala and rural China. They want to know what it will take for people to cook more safely and breathe more easily in developing countries.
FSI professors investigate how lifestyles affect health. What good does gardening do for older Americans? What are the benefits of eating organic food or growing genetically modified rice in China? They study cost-effectiveness by examining programs like those aimed at preventing the spread of tuberculosis in Russian prisons. Policies that impact obesity and undernutrition are examined; as are the public health implications of limiting salt in processed foods and the role of smoking among men who work in Chinese factories. FSI health research looks at sweeping domestic policies like the Affordable Care Act and the role of foreign aid in affecting the price of HIV drugs in Africa.
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. The stated reasons for the cuts are that “the United States currently pays more than its fair share,” and to ensure that “foreign aid supports American interests and values.” The budget proposal is not specific on which types of development assistance will undergo the largest budget cuts but, at 20% of all US foreign aid, the health sector may undergo substantial changes if the budget is implemented.
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. Despite original claims that these measures were intended as ostensibly “short-term” solutions, slow economic recovery or worsening economic conditions in many of the countries impacted by financial crisis has led to an increased number and stringency of measures.
In the present study, we sought to elucidate the effect of miR-145 on glioma cell progression and its mechanisms of action. We examined the effects of miR-145 on proliferation and invasion of U87 glioma cells and on capillary tube formation. Our data show that restoration of miR-145 in U87 glioma cells significantly reduced their in vitro proliferation, invasion and angiogenesis. However, decreased miR-145 expression promoted U87 glioma cell proliferation, invasion and angiogenesis, and reduced-expression of miR-145 increased ADAM17 and EGFR expression in U87 cells. Overexpression of miR-145 reduced ADAM17 and EGFR expression. VEGF secretion and VEGF expression were decreased by increased miR-145 expression in U87 cells and were reversed by miR-145 down-regulation in vitro. Nude mice with intracerebral implantation of U87 overexpressing miR-145 cells exhibited significantly reduced tumor growth and promoted survival compared with control groups. Taken together, these results suggest a role for miR-145 as a tumor suppressor which inhibits glioma cell proliferation, invasion and angiogenesis in vitro and reduces glioma growth in vivo.
This analysis uses March Current Population Survey data from 1999-2010 and a differences-in-differences approach to examine how California’s first in the nation paid family leave (PFL) program affected leave-taking by mothers following childbirth, as well as subsequent labor market outcomes. We obtain robust evidence that the California program doubled the overall use of maternity leave, increasing it from an average of three to six weeks for new mothers – with some evidence of particularly large growth for less advantaged groups. We also provide evidence that PFL increased the usual weekly work hours of employed mothers of one-to-three year-old children by 10 to 17% and that their wage incomes may have risen by a similar amount.
A large body of evidence indicates that conditions in-utero and health at birth matter for individuals’ long-run outcomes, suggesting potential value in programs aimed at pregnant women and young children. This paper uses a novel identification strategy and data from birth and administrative records over 2005-2009 to provide causal estimates of the effects of geographic access to the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). My empirical approach uses within-ZIP-code variation in WIC clinic presence together with maternal fixed effects, and accounts for the potential endogeneity of mobility, gestational-age bias, and measurement error in gestation. I find that access to WIC increases food benefit take-up, pregnancy weight gain, birth weight, and the probability of breastfeeding initiation at the time of hospital discharge. The estimated effects are strongest for mothers with a high school education or less, who are most likely eligible for WIC services.
As immigration policy ideas dance around Washington, children’s health rarely enters the discussion. According to Stanford pediatrician Fernando Mendoza, new policies could have a huge impact on the well-being of children with immigrant parents.
“If you make them fearful on a day-to-day basis that their parents are going to be taken away, it causes tremendous stress on children and families,” said Mendoza, a professor of pediatrics at the Lucile Packard Children’s Hospital.
Mendoza has gathered experts across Stanford University and throughout California and the United States to address these issues at the Child Health and Immigration Conference on May 25. The panelists will discuss potential impacts at the federal, state and local level and advise communities on how to navigate the effects on children.
“All immigrants are having their place in this country challenged,” said Mendoza. “Whether or not you have a parent who is undocumented, that is detrimental to the well-being of the children of all immigrants.”
According to a study at the Pew Research Center, one out of every eight children in California lives with an undocumented parent.
“Policies that would remove those parents would probably be the biggest social disruption that we’ve seen in this country,” said Mendoza. “We need to have experts discuss these things so that we can have clarity about what the effects of national immigration policies might be.”
Immigration experts Jeffrey Passel, a senior demographer at the Pew Research Center, and Bill Hing, a professor of law at the University of San Francisco, will kick off the conference by outlining immigrant family demographics and the legal system for enforcing immigration policy.
They will be followed by panels of experts from Stanford and other academic institutions, policy-makers, and leaders in local health and educational systems.
U.S. Rep. Zoe Lofgren (D-San Jose) will bring the on-the-ground Washington perspective with a short appearance via video. A former immigration attorney, she will discuss congressional movement on immigration policy.
Mendoza said, “We all value children. This conference is trying to create common ground around that American value.”
The conference will be held May 25 at Stanford University in Encina Hall’s Bechtel Conference Center from 8:30 a.m. to 5:15 p.m. To attend, please RSVP here.
The conference is sponsored by Stanford’s Division of General Pediatrics; the Center for Policy, Outcomes and Prevention; and the Lucile Packard Foundation for Children’s Health.
When one thinks of the casualties of war, it is easy to imagine severed limbs, bullet holes, shrapnel, perhaps even sarin gas or Agent Orange. But in a recent Daedalus essay, Paul Wise argues that the most damaging health impacts of war are often indirect. Losing access to food supplies, medication and electricity can kill more people than battle itself. In this video by the American Academy of Arts and Sciences, Wise, a professor of pediatrics and Stanford Health Policy core faculty member, explains how fatal the indirect costs of war can be.
Yiqun Chen and Tess Ryckman are the first students in the Stanford Health Policy PhD program to win research grants. Their projects could improve health outcomes in the United States and in the developing world.
“Awards like these are a recognition of the quality of our very young PhD program,” said Corinna Haberland, director of education for the PhD program that launched in 2015.
Chen will study the Hospital Readmission Reduction Program. A component of the Affordable Care Act (ACA), the program encourages hospitals to keep readmission rates low, but the financial incentives do not extend to doctors. Chen will evaluate the program’s effectiveness for Medicare patients.
“Yiqun is well positioned to offer new insights into the ways that the organization of physicians and hospitals will influence quality improvement programs,” said Laurence Baker, chair of the Department of Health Research and Policy and the grant’s primary investigator.
Tess Ryckman, Predoctoral Student
Still in her first year of the PhD program, Ryckman managed to snag a coveted fellowship from the National Science Foundation (NSF). Their Graduate Research Fellowship Program (GRFP) supports outstanding graduate students pursuing degrees in science, technology, engineering and mathematics.
She plans to study nutrition in developing countries, focusing on the cost-effectiveness of programs that address stunting as compared to wasting. Two important public health indicators, stunting measures short height for age and wasting measures low weight for height.
“Wasting is more likely to result in death, but in a lot of countries the prevalence of wasting isn’t actually that high,” said Ryckman. “I suspect that in some cases they’re sacrificing funding that could go for stunting because wasting is more visible.”
The fellowship will allow Ryckman to focus on the research that inspires her. Instead of working as a TA or research assistant, she can pursue her own project while still drawing on faculty expertise.
“All of the faculty are really supportive,” she said. “They’re a helpful sounding board and give good advice.”
"The Effects of Expert Recommendations on Health Insurance Choices: Evidence from a Randomized, Controlled Trial"
Please note: All research in progress seminars are off-the-record unless otherwise noted. Any information about methodology and/or results are embargoed until publication.
Medicare beneficiaries consistently report difficulty choosing a Medicare Part D plan, rarely change their plans and are often not enrolled in the plan providing the most generous coverage for their medications. In this project, we test whether providing personalized information on the financial implications of enrolling in different plans, both with and without expert recommendations, improves decision outcomes for Medicare Part D enrollees relative to directing them to the Medicare.gov website. We describe and report the results of a randomized, controlled trial of the effects of using a patient-centered Medicare Part D decision tool during 2017 open enrollment (October 15 through December 7, 2016) among patients who are members of a large multispecialty group practice.
Encina Commons,
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maria.polyakova@stanford.edu
Associate Professor, Health Policy
MS in Health Policy Program Director
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PhD
Maria Polyakova, PhD, is an Associate Professor of Health Policy at the Stanford University School of Medicine. Her research investigates the impact of government interventions in healthcare markets. She is especially interested in the broad economic impacts of public health insurance systems and the structure of healthcare labor markets. Her work also investigates the drivers of individual decision-making in health care and the roots of socio-economic differences in health outcomes. Dr. Polyakova received a BA degree in Economics and Mathematics from Yale University, and a PhD in Economics from MIT.
"Billing Irregularities by Health Care Providers: Evidence from Anesthesia"
Please note: All research in progress seminars are off-the-record unless otherwise noted. Any information about methodology and/or results are embargoed until publication.
In the United States, physicians exercise tremendous discretion in choosing billing details that determine payment for their services. While understanding the degree to which physicians inappropriately use this discretion has implications for setting payment policies, separating inappropriate discretion from actual differences in patient complexity is empirically challenging. In anesthesia, providers are compensated by self-reported length of time (“anesthesia time”) spent on a case. Therefore, anomalous patterns in a practitioner’s reported times—e.g., an excess number of cases with an anesthesia time ending in five (e.g., 65 minutes)—can objectively identify inappropriate billing when those reported times are also longer than expected. Using a national database of over 6.5 million anesthesia cases from 5,755 anesthesia providers, we found that anomalous patterns are common—nearly one-quarter of providers report an unusually large number of cases with anesthesia times ending in 5 or zero. Providers who were particularly anomalous—those in the top 5th percentile in terms of anesthesia times ending in 5 or zero—also tended to report anesthesia times that were 22 minutes longer than expected, which would net an additional $34 to $98 per case, depending on payer. While inappropriate practices seem confined to a minority of anesthesia providers, our results provide some impetus for ongoing policy efforts aimed at reducing the amount of discretion given to physicians.
Yiqun Chen, Predoctoral Student
Tess Ryckman, Predoctoral Student
