News Release

Special issue of Medicare Care supports the need to study economic impacts on patient outcomes

Invited manuscripts provide ideas for expanding relevant data collection and infrastructure

Peer-Reviewed Publication

Wolters Kluwer Health

November 14, 2023 — A special supplemental issue of Medical Care, sponsored by the Assistant Secretary for Planning and Evaluation (ASPE) in the U.S. Department of Health and Human Services, supports the growing recognition that economic factors often affect health outcomes, patient decision-making, and equity in health care. Medical Care, the official journal of the Medical Care Section of the American Public Health Association, is published in the Lippincott portfolio by Wolters Kluwer

The scope of patient-centered outcomes research (PCOR) was expanded to include economic outcomes in the 2019 reauthorization of the Patient-Centered Outcomes Research Trust Fund.  Congress recognized the importance of the "potential burdens and economic impacts of medical treatments, items, and services" in PCOR studies, Scott R. Smith, PhD and colleagues explain in an introduction to the supplement. Dr. Smith is the Director of the Division of Health Care Quality and Outcomes in the ASPE Office of Health Policy. 

In response to the new mandate, ASPE and its partner agencies set the objective of "improving the availability, quality, and relevance of data on economic outcomes." The eleven invited papers in the special issue draw on themes that emerged from an ASPE-sponsored symposium.  

Data on trade-offs in family decision-making about health care is a key need 

One paper reports on telephone interviews with 59 commercially insured adults who had asthma and/or had a child with asthma, conducted by Alison A. Galbraith, MD, MPH, a health researcher at the Harvard Pilgrim Health Care Institute, and colleagues. They found participants reported paying for asthma care sometimes at the expense of their family's overall financial well-being. 

Specifically, participants described making trade-offs between asthma care and other needs based on short-term needs versus longer-term financial health, needs of children over adults, acuity of the condition, effectiveness of treatment, and availability of lower-cost alternatives. 

PCOR studies "should include family members and consider intrafamilial trade-offs," the authors conclude. Quantitative measurement “requires linking individual patient data into family units based on shared insurance, address, or birth records, or using household panel surveys.” 

Other implications of these findings, Dr. Galbraith's group says, are the need to measure nonmedical economic outcomes (e.g., unpaid bills, debt, depleted savings, missed housing payments, and food insecurity); measure out-of-pocket health care costs; use longitudinal micro-costing to capture temporary financial crises; and track economic well-being over longer periods. 

Some of the other papers in the supplement discuss: 

  • Collecting economic outcomes data on people with intellectual disabilities and cancer patients 

  • Linking federally funded administrative and survey data sources to Medicare fee-for-service claims to increase the range of potential outcomes in PCOR studies 

  • Coupling Medicare and Medicaid databases in North Carolina to facilitate evaluation of health equity  

  • Developing a Medicare dataset for studying medication nonadherence due to cost 

  • Linking a state-level all-payer claims database in Colorado with a cancer registry 

  • Efforts to strengthen the National Patient-Centered Clinical Research Network (PCORnet) 

  • A synthesis of the discussions at the symposium, including initial recommendations 

Dr. Smith and his co-authors comment that although the articles in the special issue highlight the potential benefits from improved data capacity for economic outcomes in PCOR, "they also make it clear that much work needs to be done—particularly in supporting the paradigm shift within health economics research to include the perspectives of patients and families." 

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About Medical Care 

Rated as one of the top ten journals in healthcare administration, Medical Care is devoted to all aspects of the administration and delivery of healthcare. This scholarly journal publishes original, peer-reviewed papers documenting the most current developments related to the research, planning, organization, financing, provision, and evaluation of health services. 

About The American Public Health Association 

The American Public Health Association is the only organization that combines a 150-year perspective, a broad-based member community, and the ability to influence policy to improve the public's health. The Member Care section advocates for strengthening the social, economic, and environmental conditions that preserve and enhance health as well as a medical care system that assures high-quality care, accessible preventive medicine, and cultural sensitivity for all. 

About Wolters Kluwer  

Wolters Kluwer (EURONEXT: WKL) is a global leader in professional information, software solutions, and services for the healthcare, tax and accounting, financial and corporate compliance, legal and regulatory, and corporate performance and ESG sectors. We help our customers make critical decisions every day by providing expert solutions that combine deep domain knowledge with specialized technology and services. Wolters Kluwer reported 2022 annual revenues of €5.5 billion. The group serves customers in over 180 countries, maintains operations in over 40 countries, and employs approximately 20,000 people worldwide. The company is headquartered in Alphen aan den Rijn, the Netherlands. 

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