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Health Affairs Examines Alternatives To Malpractice Litigation

January articles explore research-based efforts to identify new approaches



Bethesda, MD- Health Affairs' January issue is being released as major portions of the Affordable Care Act take effect. This variety issue includes several papers reporting new evidence on the effects of early Medicaid expansions and analysis from Tim Jost examining ACA implementation over the last four years.

The issue also contains a cluster of papers exploring alternatives to malpractice litigation. This cluster was supported by a grant from Ascension Health. These papers reflect a research-based effort, administered through the Agency for Healthcare Research and Quality (AHRQ), to identify new approaches to litigation. The cluster includes:

  • Let's Make A Deal: Trading Malpractice Reform For Health Reform, William M. Sage of the University of Texas School of Law and David A. Hyman of the University of Illinois

  • Implementing Hospital-Based Communication-And-Resolution Programs: Lessons Learned in New York City, Michelle M. Mello of Harvard School of Public Health and coauthors

Also in the January issue:

Do orthopedic surgeons know the cost of the devices they're implanting? Orthopedic procedures represent a large expense to the Medicare program, with devices accounting for a large proportion of these procedures' costs. Yet, in one of the first studies to examine this subject, many practitioners were found to have little knowledge of the costs of the devices they use. Kanu Okike, an orthopedic surgeon affiliated with the University of Maryland School of Medicine and the Kaiser Moanalua Medical Center, and coauthors surveyed 503 attending orthopedic physicians and residents at seven US medical institutions between December 2012 and March 2013. They asked participants to estimate the cost of thirteen commonly used orthopedic devices. Attending orthopedic surgeons correctly estimated the costs of only 21 percent of the implants, while residents correctly estimated the costs of only 17 percent of the implants. However, more than 80 percent of the respondents thought that cost should be an important factor in the device selection process. The authors recommend that surgeons be given increased access to device costs, while also being incentivized to learn prices and participate in cost containment effort.

Poorer Americans: depleted food budgets can mean higher risk of hypoglycemia.
For generations, economists have noted that low-income households spend much of their earnings as soon as their paychecks arrive. Since a large proportion of Americans are paid at the beginning of the month, many low-income household s exhaust food budgets by month's end. Hilary K. Seligman of the University of California, San Francisco, and coauthors postulated that this could influence health outcomes, such as heightened risk for low blood sugar (hypoglycemia) among people with diabetes. The authors examined administrative data on inpatient admissions in California for 2000-08 and found that among low-income Californians, risk for hypoglycemia admission increased 27 percent in the last week of a month compared to the first week of the month; no similar temporal pattern existed for the high-income population. The authors conclude that exhausted food budgets late in the month might also influence admission patterns for other diet-sensitive diseases, such as congestive heart failure. This is one of the first studies (perhaps the very first) to study the link between exhausted food budgets and disease increase at the end of the month.

Updates on the implementation of the Affordable Care Act:

  • Entry Point--Implementing Health Reform: Four Years Later, Timothy S. Jost of the Washington and Lee University School of Law

  • New Evidence On The Affordable Care Act: Coverage Impacts Of Early Medicaid Expansions, Benjamin D. Sommers of Harvard School of Public Health, Harvard Medical School, and Brigham and Women's Hospital, and coauthors

  • Moving For Medicaid? Recent Eligibility Expansions Did Not Induce Migration From Other States, Aaron L. Schwartz of Harvard Medical School, and Benjamin D. Sommers
About Health Affairs

Health Affairs is the leading journal at the intersection of health, health care, and policy. Published by Project HOPE, the peer-reviewed journal appears each month in print, with additional Web First papers published periodically at The full text of each Health Affairs Web First paper is available free of charge to all website visitors for a one-week period following posting, after which it switches to pay-per-view for nonsubscribers. Web First papers are supported in part by a grant from The Commonwealth Fund. You can also find the journal on Facebook and Twitter. Read daily perspectives on Health Affairs Blog. Download our podcasts, including monthly Narrative Matters essays, on iTunes. Tap into Health Affairs content with the new iPad app.