All research in progress seminars are off-the-record. Any information about methodology and/or results are embargoed until publication.

Dr. Halpern’s research combines empirical approaches from the fields of epidemiology, health services research, and the decision-making sciences with conceptual work grounded in moral philosophy. He applies these approaches across three fields.

First, he examines the allocation of scarce healthcare resources including ICU beds and services and solid-organ transplants. He seeks to understand how tradeoffs are made when the interests of individuals conflict with the interests of groups, and how these tradeoffs could be made more efficiently, equitably, and transparently. Second, he examines the use of behavioral economic approaches, including framing effects, default options, and financial incentives, to improve patients’ and providers’ decisions, particularly those related to end-of-life care. Third, he seeks to improve the ethics and efficiency of randomized clinical trials (RCTs) by examining the intended and unintended consequences of incentives for research participation, and by developing new patient-centered outcome measures and methods for analyzing them.

Dr. Halpern’s research is supported by the National Cancer Institute, National Institute on Aging, Agency for Healthcare Research and Quality, American Thoracic Society, and by a Greenwall Foundation Faculty Scholar Award in Bioethics. He is the Founding Director of the Fostering Improvement in End-of-Life Decision Science (FIELDS) program, and Deputy Director of the Center for Health Incentives and Behavioral Economics (CHIBE), both housed within the Leonard Davis Institute of Health Economics at Penn.

All research in progress seminars are off-the-record. Any information about methodology and/or results are embargoed until publication.

Abstract:

How a government chooses to finance a health intervention has consequences in multiple domains. The choice of financing mechanisms can affect the uptake of health interventions and lead to widespread health gains. In addition to health gains, certain policies like public finance can insure against the need to make expenditures which would otherwise throw households into poverty. We present methods of extended cost-effectiveness analysis (ECEA) for evaluating the consequences of health policies on health, impoverishment and equity which estimate health gains (deaths averted), financial risk protection afforded (cases of poverty averted), and distributional consequences of health policies. The ECEA approach incorporates financial risk protection and equity into the systematic evaluation of health policy. ECEA allows policymakers to determine the efficient purchase of both financial risk protection and equity in addition to health for a given benefits package, toward universal health coverage.

All research in progress seminars are off-the-record. Any information about methodology and/or results are embargoed until publication.

Co-authored with: Mark R. Cullen, Michael Baiocchi, Pooja Loftus, Victor Fuchs

Abstract:

Sex differences in mortality (SDIM) vary over time and place as a function of social and medical conditions. The magnitude of these variations, and their abruptness in response to large socioeconomic changes, suggest that biological differences alone cannot fully account for observed sex differences in survival. We document “stylized facts” about SDIM with which any theory will ultimately have to contend, drawing from a wide swath of available mortality data, including variation in probability of survival to age 70 by county in the United States, to Human Mortality Database data for 18 high-income countries since 1900, to mortality data within and between developing countries over the time periods for which reasonably reliable data are available. We show that, in each of the periods of economic development after the onset of demographic and epidemiologic transition, cross-sectional variation in SDIM exhibits a consistent pattern of female resilience to mortality under adversity. Moreover, as societies develop, M/F survival first declines and then increases, a “SDIM transition” embedded within the demographic and epidemiologic transitions.
 

All research in progress seminars are off-the-record. Any information about methodology and/or results are embargoed until publication.

Abstract:

Nearly half of total health care expenditures in the Veterans Affairs (VA) system are generated by 5% of its patients. These patients generally have complex health and health care needs, including multiple chronic conditions, comorbid mental health conditions, and social stressors, all of which contribute to high rates of hospitalization, urgent care visits, and outpatient encounters. In recent years, a number of intensive primary care models have emerged outside the VA that focus on health systems’ high-risk, high-cost patients. Early evaluations suggest that these models have the potential to improve quality of care and enhance patients’ care experience, while simultaneously keeping utilization in check and using resources more wisely. However, there are few rigorous evaluations of these programs, and studies of their applicability inside the VA are lacking. In 2013, the Palo Alto VA launched a quality improvement (QI) program for high-risk, high-cost patients to augment the VA’s patient centered medical home (Patient Aligned Care Team, or PACT) with Intensive management (ImPACT). ImPACT’s multidisciplinary team offers patients enhanced access, chronic disease management, support during health deteriorations, and social work and recreation therapy. Although ImPACT was designed as a QI program, Palo Alto VA leadership chose to enroll a random sample of eligible patients, providing an opportunity for a randomized controlled evaluation. We will describe this unique QI/research partnership, as well as early findings from the ImPACT pilot study, and discuss implications for future services for high-risk, high-cost patients within the VA system.