Author Archives: Miriam Laugesen

How Much Should Individuals Entering Health Professions Know About Health Policy?

Sep 21, 2012, 10:45 AM, Posted by Miriam Laugesen

The Robert Wood Johnson Foundation Human Capital Blog is asking diverse experts: What is and isn’t working in health professions education today, and what changes are needed to prepare a high-functioning health and health care workforce that can meet the country’s current and emerging needs? Today’s post is by Miriam Laugesen, PhD, an assistant professor of Health Policy and Management at Columbia University's Mailman School of Public Health and the recipient of a Robert Wood Johnson Foundation Investigator Award in Health Policy Research for a study of Medicare physician payment policies.

When people apply to a program to study health policy, their admissions essay sometimes begins "I always wanted to be a physician, but I realized I wanted to impact more people." Health policy students think in terms of systems, and they are therefore different from front-line health care providers. Whereas a nurse may see the uninsured person with uncontrolled diabetes, the health policy student will connect this to failures of public policy; the patient is nested within clinical, social or organizational environments.

To understand that systemic context, our health policy students first need various 'hard' or technical skills such as program evaluation, epidemiology, and health economics, and it's these skills that employers often look for when hiring our graduates. Without a doubt, technical skills are always valuable.

However, one or two years out, and over the long-term, many of our policy students appreciate the 'soft' skills, such as solving problems, lobbying policy-makers, or building new coalitions. Our policy students learn larger lessons about why things happen, and why policies also fail. They become highly attuned to the framing of advocacy messages. They understand how and why Congress punishes federal agency heads when health policies threaten interests such as tobacco farmers, or why Congress enacts unpopular policies even though legislators want to be re-elected.

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What Causes High Health Care Costs in the United States?

Sep 8, 2011, 11:45 AM, Posted by Miriam Laugesen

Miriam J. Laugesen, Ph.D., is an assistant professor of Health Policy and Management at the Mailman School of Public Health at Columbia University. She is a 2009 recipient of a Robert Wood Johnson Foundation Investigator Award in Health Policy Research.

In a Health Affairs paper published in its September issue, Sherry Glied, Ph.D., and I find that Medicare fees paid for office visits are 27 percent higher than public fees in other countries, and fees for office visits paid by private insurers are 70 percent higher, on average, in the United States than in other countries. Fees for hip replacements paid by U.S. Medicare are 70 percent higher in the US and private insurers pay 120 percent more.

We show how higher physician fees, particularly among orthopedic specialists—rather than physicians providing more services or having higher training costs—explain higher incomes of U.S. physicians compared to physicians in other countries.

For some time, there’s been some awareness that prices are higher, on average, in U.S. health care. For example, people say that we pay more for pharmaceuticals than people in other countries. However, understanding the details of the cross-national differences is difficult, especially in the area of physician services. The category of physician services spending varies substantially, even within countries. To try to make this comparison cleaner we focus on just two areas of medicine and two specific physician services: basic office visits provided by primary care physicians, and hip replacements provided by orthopedic surgeons in Australia, Canada, France, Germany, the United Kingdom (England), and the United States.

One important difference between this study and others is that we take into account differences in utilization, practice expense costs, education costs, and lost earnings. That’s important, because the usual explanations for that difference might be related to those differences. The paper shows these differences don't account for higher earnings, and that is a new interpretation. Another difference is that we tease out the public-private differences in payment rates that are typically not compared.

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