Medicine and Health Sciences Commons^™

States’ Covid-19 Restrictions Were Associated With Increases In Drug Overdose Deaths In 2020, Douglas A. Wolf, Shannon M. Monnat, Jennifer Karas Montez, Emily E. Wiemers, Elyse Grossman

Center for Policy Research

Drug overdoses surged in the U.S. during the COVID-19 pandemic. Public health experts raised concerns in the pandemic’s early months about how the pandemic and the policies enacted to stem it might increase overdose risk. This brief summarizes the findings of a paper that used national data to identify how states’ COVID-19 policies affected drug overdose rates among U.S. adults ages 25-64 during the first year of the pandemic. Results show that counties located in states that adopted more aggressive in-person activity restrictions experienced larger increases in 2020 than counties located in states with fewer limitations. State economic support policies …

Treatment For Mental Health And Substance Use: Spillovers To Police Safety, Monica Deza

Center for Policy Research

We study the effect of community access to mental health and substance use treatment on police officer safety, which we proxy with on-duty assaults on officers. Police officers often serve as first-responders to people experiencing mental health and substance use crises, which can place police officers at risk. Combining agency-level data on police officer on-duty assaults and county-level data on the number of treatment centers that offer mental health and substance use care, we estimate two-way fixed-effects regressions and find that an additional four centers per county (the average annual increase observed in our data) leads to a 1.3% reduction …

Covid-19 Mortality Rates Were Higher In States That Limited Governments From Enacting Public Health Emergency Orders, Xue Zhang, Mildred Warner, Gen Meredith

Center for Policy Research

State and local governments enacted various public health emergency policies during the COVID-19 pandemic that resulted in lower infection and death rates than would have occurred without these policies. However, some states limited emergency public health authority of state executives, state governors, and state and local officials during the pandemic. This brief summarizes the results of a study that used data from the Center for Public Health Law Research and Oxford COVID-19 Government Response Tracker to explore which states passed laws that limited emergency public health authority during the COVID-19 pandemic and the effects of those limitations on COVID-19 death …

Health Policy, Equity, And The Lead Poisoning Crisis: A Conversation With Dr. Mona Hanna-Attisha, Mona Hanna-Attisha

Center for Policy Research

Dr. Mona Hanna-Attisha delivered the 33rd Annual Herbert Lourie Memorial Lecture on Health Policy on Thursday, September 23, 2021. This year's lecture was titled, "Health Policy, Equity, and the Lead Poisoning Crisis: A Conversation with Dr. Mona Hanna-Attisha"

Mona Hanna-Attisha, MD, MPH, FAAP, is founder and director of the Michigan State University and Hurley Children’s Hospital Pediatric Public Health Initiative, an innovative and model public health program in Flint, Michigan.

A pediatrician, scientist, activist, and author, Dr. Hanna-Attisha has testified three times before the United States Congress and was awarded the Freedom of Expression Courage Award by PEN America. She …

Health Have, Health Have Nots In A Time Of Covid-19, Sandro Galea

Center for Policy Research

In this brief, my goal is to talk about something which has animated a lot of my thinking and writing in the past decade. It is how our health is fundamentally socially patterned and reflects the world around us. This has been true for decades in this country, and one could also argue, globally, however this brief will focus on this topic at the national level. As you will see, I will talk mostly of health haves and health have nots in general, but as we progress, show how COVID-19 has made this evermore apparent.

Marijuana Legalization: Beyond Yes Or No., Keith Humphreys

Center for Policy Research

This paper will first go over some basic terms and concepts, then discuss what’s going on in the world around cannabis with a focus on the United States. I will then offer some policy options to consider if New York chooses to legalize recreational cannabis.

Unequal Hopes, Lives, And Lifespans In The Usa: Lessons From The New Science Of Well-Being, Carol Graham

Center for Policy Research

Given that we have had historic increases in inequality, as well as stagnant poverty levels for several decades, I will tell the story of poverty and inequality in the U.S. from the perspective of the metrics of happiness and well-being. My research—and the book that resulted—found that inequality is part of this story, but not the only part. The story was much more complicated than I anticipated. One of the most interesting parts of the story includes different levels of hope and resilience across races and places. Poverty and inequality play a big role, but there is much more to …

The Opioid Epidemic: A Practice And Policy Perspective, Gail D'Onofrio

Center for Policy Research

I will be talking about the escalating opioid epidemic and some innovative solutions my colleagues and I at Yale University and throughout the state of Connecticut, are working on to mitigate the consequences of this public health crisis.

Pregnancy Medicaid Expansions And Fertility: Differentiating Between The Intensive And Extensive Margins, Lincoln H. Groves, Sarah Hamersma, Leonard M. Lopoo

Center for Policy Research

The theoretical and empirical links between public health insurance access and fertility in the United States remain unclear. Utilizing a demographic cell-based estimation approach with panel data (1987-1997), we revisit the large-scale Medicaid expansions to pregnant women during the 1980s to estimate the heterogeneous impacts of public health insurance access on childbirth. While the decision to become a parent (i.e., the extensive margin) appears to be unaffected by increased access to Medicaid, we find that increased access to public health insurance positively influenced the number of high parity births (i.e., the intensive margin) for select groups of women. In particular, …

A Roadmap For Reducing Gun Violence In America, Daniel Webster

Center for Policy Research

How do you reduce gun violence in America? It seems rather daunting. I’m going to take you through some key things I think we can do to have far less gun violence in America

Improving Public Health Safety Nets After An Economic Recession, Sanjay Basu

Center for Policy Research

When we say ‘here’s what’s going on with our nation’s health,’ how do we know the answer? Where is the data coming from? How can we best evaluate our public health system? We’re talking about it every day on CNN given the Ebola scare. What do we mean by our ‘public health system’? I would argue that we should expand our definition to mean something more than hospitals and clinics, or doctors and nurses. In particular, I’ll argue that some of our non-health programs that we have as part of the safety net actually make a bigger health impact than …

Hospital Treatment Rates And Spill-Over Effects: Does Ownership Matter?, Badi H. Baltagi, Yin -Fang Yen

Center for Policy Research

This paper studies the effect of hospital ownership on treatment rates allowing for spatial correlation among hospitals. Competition among hospitals and knowledge spillovers generate significant externalities which we try to capture using the spatial Durbin model. Using a panel of 2342 hospitals in the 48 continental states observed over the period 2005 to 2008, we find significant spatial correlation of medical service treatment rates among hospitals. We also get mixed results on the effect of hospital ownership on treatment rates that depends upon the market structure where the hospital is located and which varies by treatment type.

Health Promotions 2.0: The Future Of Wellness Programs In America, Rajiv Kumar

Center for Policy Research

In no small part because of technology, the way we live and work is being transformed. I believe that those of us who are interested in health policy can play an important role in guiding that transformation. I submit to you that unhealthy living is a social issue; that conditions such as obesity and diabetes are social diseases and that their prevalence is a social problem. If we have a social problem, then we need a social solution. I believe part of that solution can be found in the worksite health promotion and wellness programs that have taken root across …

Medicaid Expansion, Long-Term Care Financing In Retirement States And The Post World War Ii Birth Cohort, Toni P. Miles

Center for Policy Research

This policy brief contains a formal consideration of ideas discussed during a presentation to the 2012 Syracuse Seminar on Aging. Like most briefs, it will appeal to policy makers and academics craving detailed demographic, fiscal and policy data. Before diving into this brief, I would encourage readers to view the presentation video (available at http://www.youtube.com/ watch?v=bsv8K7DdJFY). As you will see, the seminar was informal and the discussion was wide ranging. In contrast, this brief focuses on limitations faced by states as they finance longterm care. It is primarily concerned with the Medicaid expansion and growing need for care as the …

Palliative Care And The Health Care Crisis In The United States: A Candid Conversation With Dr. Diane Meier, Diane E. Meier

Center for Policy Research

This paper is a synthesis of the 2012 Lourie Lecture, framed as a series of questions and responses, and supported by images used in the lecture. I’m going to focus on the growth of this new field called palliative care and will make the connection that the crisis afflicting healthcare in the United States cannot be addressed without widespread scaling and implementation of palliative care across the system. My subject is not end-of-life care, but rather care during serious illness. A serious illness is something a person can live with for many years, such as emphysema, or end-stage renal disease …

Quality Of Life For All Ages, By Design. A Conversation With Patricia Moore, Patricia Moore

Center for Policy Research

On November 3, 2011, Patricia Moore presented the Syracuse Seminar on Aging to a packed audience of over 250 faculty, students, and community members. She delivered an engaging lecture on “Quality of life for all ages, by design”. Afterwards Janet Wilmoth, Director of the Syracuse University Aging Studies Institute, and Patricia Moore had a chance to sit down and talk about her path-breaking career, ability-based design, and aging in America.

Integrating Care: Improving Overall Health By Integrating Behavioral/Mental Health Care Into Primary Care, Macaran A. Baird

Center for Policy Research

Hippocrates noted that the patient must be attended in light of “his” diet, work, home, and community setting. Since that time, we have struggled with the dilemma of how to put the patient’s presenting problems in the context of the patient’s life circumstances. That goal has proven elusive. So how do we sort out where to put the emphasis with our healing arts?

Electronic Health Records; Delivering The Right Information To The Right Health Care Providers At The Right Time., William M. Tierney

Center for Policy Research

No abstract provided.

Palliative Care: A Novel Solution To The Healthcare Crisis, R. Sean Morrison

Center for Policy Research

No abstract provided.

Our Grandparents, Our Parents, Our Future Selves: Optimizing Function In Old Age., Thomas Michael Gill

Center for Policy Research

Most of my research at Yale University School of Medicine over the past several years has focused on identifying older adults at risk of functional decline and disability, identifying events that may precipitate the transition from functional independence to disability, and developing strategies to postpone or reduce frailty and disability. As a result of the Precipitating Events Project (PEP) and other research conducted by the Yale Center on Aging/Pepper Center, we now realize that age is only a proxy for other factors that lead to disability, and that some of these factors can be modified to reduce the risk of …

The Effect Of Disability Insurance On Health Investment: Evidence From The Va Disability Compensation Program, Perry Singleton

Center for Policy Research

I examine whether individuals respond to monetary incentives to detect latent medical conditions. The effect is identified by an amendment to Title 38 that deemed diabetes associated with Agent Orange exposure a compensable disability under the VA’s Disability Compensation program. Since a diagnosis is a requisite for benefit eligibility, and nearly one-third of diabetics remain undiagnosed, the advent of disability insurance may have encouraged the detection of diabetes among the previously undiagnosed population. Evidence from the National Health Interview Survey suggests that the policy increased the prevalence of diabetes by 2.7 percentage points among veterans.

Is It Time To Redesign Hospice? End-Of-Life Care At The User Interface, David J. Casarett

Center for Policy Research

Hospice is a system of end-of-life care that’s not used to its full potential. That is, hospice is not used in the way that would benefit patients and families as much as it could. My argument is that this is an issue of usability, or ergonomics—the science of design. I illustrate how to take what we have learned from the science of usability to make hospice more accessible and approachable, and to increase hospice use among those who would benefit from it. Underneath this discussion, though, there is a more fundamental question: Can we make hospice more usable or do …

Income And The Use Of Prescription Drugs By The Elderly: Evidence From The Notch Cohorts, John R. Moran, Kosali Ilayperuma Simon

Center for Policy Research

We use exogenous variation in Social Security payments created by the Social Security benefits notch to estimate how retirees' use of prescription medications responds to changes in their incomes. In contrast to estimates obtained using ordinary least squares, instrumental variables estimates based on the notch suggest that lower-income retirees exhibit considerable income sensitivity in their use of prescription drugs. Our estimates are potentially useful for thinking about the health implications of changes in transfer payments to the elderly and for evaluating the benefits of the recently enacted Medicare prescription drug benefit.

Duration Data From The National Long-Term Care Survey: Foundation For A Dynamic Multiple-Indicator Model Of Adl Dependency, James N. Laditka, Douglas A. Wolf

Center for Policy Research

This report describes preparation of data from the National Long-Term Care Survey (NLTCS) fur use in a dynamic multiple-indicator model of dependency in Activities of Daily Living (ADLs). The data set described makes use of all functional status information available across four NLTCS waves for six ADLs, including information from screening interviews, detailed interviews in the community, and institutional interviews. Importantly, it also captures all available information elicited from respondents about the *duration* of any impairment in these ADLs. The data was prepared as described in this report to enable the calculation of improved estimates of the probabilities that an …

Social Interaction And The Health Insurance Choices Of The Elderly, Eldar Beiseitov, Jeffrey D. Kubik, John R. Moran

Center for Policy Research

Using data from the 1998 wave of the Health and Retirement Study, we examine the effect of social interactions on the health insurance choices of the elderly. We find that having more social interactions, as measured by contacts with friends and neighbors, reduces the likelihood of enrolling in a Medicare managed care plan relative to purchasing a medigap policy or having coverage through Medicare alone. Our estimates indicate that social networks are an important determinant of the health insurance choices of the elderly and provide suggestive evidence that "word-of-mouth" information sharing may have played a role in the preference of …

Social Integration Of Older Immigrants In 21st Century America, Janet Wilmoth

Center for Policy Research

There are various reasons for the burgeoning interest in detailed research into the determinants of social well-being among older immigrants in this country. As a result of shifting federal government policies, the total volume of immigrants has increased significantly, the countries from which they migrate have changed, and more immigrant families have brought their parents into the United States than ever before. Consequently, the older adult population is becoming more diverse due in part to the aging-in-place of younger immigrants and an increasing number of immigrants who are older upon arrival in the United States. These trends create challenges for …

On The Measurment Of Job Risk In Hedonic Wage Models, Dan Black, Thomas J. Kniesner

Center for Policy Research

We examine the incidence, form, and research consequences of measurement error in measure of fatal injury risk in United States workplaces using both BLS and NIOSH data. We find evidence of substantial measurement errors in the fatality risk researchers attach to individual workers when estimating the implicit price of risk and the value of a statistical life. We first examine possible classical attenuation bias in the fatality risk coefficient. However, because we also find non-classical measurement error that differs across multiple risk measures and is not independent of other regressors, more complex statistical procedures than a standard instrumental variables estimator …

Psychotherapy In Antidepressant Patients, Thomas J. Kniesner, Regina H. Powers, Thomas W. Croghan

Center for Policy Research

Depression is a condition with various modes of treatment, including pharmacotherapy, psychotherapy, and some combination of each. The role of psychotherapy in the treatment of depression relative to the role of pharmacotherapy is not well understood, and guidelines for psychotherapy in the primary care setting differ from guidelines for specialty care. There is little evidence about the circumstances in actual practice that affect the use of psychotherapy in conjunction with pharmacotherapy.

We retrospectively identify the most important factors associated with the use of psychotherapy in combination with pharmacotherapy in the treatment of depression. Specifically, we study provider choice, health plan …

Provider Type And Depression Treatment Adequacy, Thomas J. Kniesner, Regina H. Powers, Thomas W. Croghan

Center for Policy Research

We investigate the effect of initial provider (primary care physician, psychiatrist, or non-physician mental health specialist) on the adequacy of subsequent treatment for persons with depression. Our data are from MarketScan^®, a medical and pharmacy insurance claims database, which we use to estimate models of the likelihood of treatment for depression and the likelihood that any treatment received is adequate. Patients initially seeing psychiatrists are most likely to receive adequate treatment. Provider type has a statistically and medically significant effect on whether any treatment occurs but a smaller effect on treatment adequacy among treated patients. The results show …

Pharmaceuticals: Access, Cost, Pricing, And Directions For The Future, Patricia M. Danzon, Stephen B. Soumerai

Center for Policy Research

Prescription drug expenditures make up less than 10 percent of total personal health care expenditures in the United States, but over the last decade the amount that Americans spend on prescription drugs has grown much faster than any other component of personal health care. For example, between 1999 and 2000, hospital care costs rose about 5 percent, physicians and clinical services 6 percent, while prescription drug expenditures climbed more than 17 percent. In dollar amounts, prescription drug expenditures doubled, from $61 billion to $122 billion, between 1995 and 2000. Is this an unwarranted expense that needs to be controlled, or …