Going Below The Surface E-newsletter: September 2020
September 22, 2020
Before diving in, we suggest snuggling up on the couch with a fall-themed beverage to achieve maximum value from your monthly health economics and policy research roundup. If you’d like, you can even go with decaf: the topics this month are lively ones. We look at an article that examined the tension between higher-value care and the need to reduce spending, as well as take a deep dive into the key health intervention drivers and conditions responsible for increasing life expectancy over the past 25 years.
The underlying goal of Going Below The Surface is the examination of the drivers of health spending – it says so right on our home page – so last month’s New England Journal of Medicine article, “Do We Spend Too Much on Health Care?” hit with a special thrill. The article, by the University of Chicago’s Katherine Baicker and Harvard’s Amitabh Chandra, manages to dodge a binary answer to the question posed in the title while opening up an even more important conversation.
Baicker and Chandra make the point that more spending should not automatically be viewed negatively, especially in a high-income country such as the United States, where individuals and government may be willing to pay more, particularly for high-quality care. Instead, the authors suggest a more rigorous focus on whether the care delivered is high value or low value, not high cost or low cost.
Why It Matters: The NEJM article makes clear that a re-thinking of how health care is allocated with a focus on value has clear policy implications. A value-first approach means that there should be great skepticism around what the authors call “crude cost-sharing implementations” such as “across-the-board high deductibles,” coupled with a greater willingness to pay for fewer – but more high-value – services in an effort to cover more Americans. Still, as we’ve documented over the months, it’s not always clear which interventions drive the most value, meaning that Baicker and Chandra’s piece should – at a minimum – be seen as a call to action to build a better evidentiary base.
This month in Health Affairs, Harvard researchers David Cutler, Michael Chernew and co-authors assessed the most significant health interventions that contributed to the 3.3-year life expectancy increase in the United States between 1990 and 2015. Their findings shouldn’t be too surprising. Public health interventions such as smoking reduction and seatbelt usage accounted for 44% of the increase, followed closely by innovative pharmaceuticals, which contributed to 35% of improvements. Medications’ contributions to life expectancy were nearly three times greater than all other medical interventions combined.
The study underscored the important role pharmaceuticals play in preventing leading causes of death, including heart disease and cancer. The authors urged policymakers to consider the “central role of medications overall in explaining reduced mortality.” Although not a direct comparison, a 2018 National Pharmaceutical Council and RTI International survey (described in one of our first GBTS e-newsletters) found similar results. That study compared biopharmaceutical interventions with surgical procedures, diagnostics and medical devices, rather than public health interventions, and also found that biopharmaceutical interventions drove the greater percentage of improvements.
Why it Matters: The Health Affairs study confirms a trend we’ve been observing as the country tackles the COVID-19 pandemic. While we know public health efforts like social distancing and mask-wearing are critical to overcoming the virus, a vaccine is an equal piece of the puzzle. This study affirms the health care system’s need to make strategic investments in biopharmaceutical intervention. As organizations, policymakers and patients assess where to spend limited health care dollars, we should aim to invest in interventions that produce the most “bang for our buck,” and medications provide that.
Of course, understanding when to use specific treatments is equally as important as knowing which services to use. Need a refresher on how to prioritize high value, cost-effective treatments? Check out the Going Below The Surface Forum’s Roadmap for Addressing Low-value Care for a step-by-step guide to reducing wasteful spending and promoting value-driven interventions. Download it. Share it with your staff and colleagues. Maybe include it in your upcoming meeting materials? It’s here for you to use.
COVID-19 has certainly shed light on some of our health system’s shortcomings, but it has also allowed us to apply insights from the pandemic to improve health care delivery.
Looking for a good podcast or webinar to pair with your fall-themed beverage? Check out these suggestions below.