Association for Public Policy Analysis & Management

Panel: Innovation in the Healthcare Delivery System: Consequences of Recent Developments

(Health Policy)

The healthcare system in the United States is experimenting with a range of alternative approaches to delivering health services. Some of these changes are primarily concerned with the cost, quality, and accessibility of health care. Others are intended to make certain parts of the system more transparent to patients. The papers in this session examine several distinct but important new features of the health care system. In each case, the papers uses novel data sources to measure and evaluate the consequences of some of the most dynamic parts of the health care delivery system. The first paper is concerned with the way that so-called “narrow networks” affect the amount and type of health services that people consume. Narrow networks are a central feature of a growing number of private health insurance plans and so this paper provides early insights into the consequences of an important institutional change in the health insurance market. The second paper examines the way that electronic medical records are affecting the medical procedures chosen by physicians working in hospital settings. The goal is to rigorously evaluate whether EMR can reduce the (perceived) over utilization of expensive medical procedures. To study the issue, the paper focuses on Cesarean section deliveries, which are often considered an over utilized procedure when performed on low acuity mothers. The third paper is concerned with the relationship between drug and medical device companies and health care providers. It uses Open Payments data made available under the Affordable Care Act (ACA) to describe the landscape of financial relationships and estimate the effect of these financial relationships on prescription drug utilization. The fourth paper in the session examines the growing role that retail pharmacies play in the provision of a basic preventive health service: vaccinations. Specifically, the paper studies the effects of occupational regulations that give pharmacists the legal authority to perform vaccinations in retail settings, and how these regulations affect the retail vaccination rates and also overall vaccination rates for influenza.