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1.  Coordination versus Competition in Health Care Reform 
The New England journal of medicine  2013;369(9):789-791.
PMCID: PMC4083619  PMID: 23944255
2.  The Oregon Experiment — Effects of Medicaid on Clinical Outcomes 
The New England journal of medicine  2013;368(18):1713-1722.
Despite the imminent expansion of Medicaid coverage for low-income adults, the effects of expanding coverage are unclear. The 2008 Medicaid expansion in Oregon based on lottery drawings from a waiting list provided an opportunity to evaluate these effects.
Approximately 2 years after the lottery, we obtained data from 6387 adults who were randomly selected to be able to apply for Medicaid coverage and 5842 adults who were not selected. Measures included blood-pressure, cholesterol, and glycated hemoglobin levels; screening for depression; medication inventories; and self-reported diagnoses, health status, health care utilization, and out-of-pocket spending for such services. We used the random assignment in the lottery to calculate the effect of Medicaid coverage.
We found no significant effect of Medicaid coverage on the prevalence or diagnosis of hypertension or high cholesterol levels or on the use of medication for these conditions. Medicaid coverage significantly increased the probability of a diagnosis of diabetes and the use of diabetes medication, but we observed no significant effect on average glycated hemoglobin levels or on the percentage of participants with levels of 6.5% or higher. Medicaid coverage decreased the probability of a positive screening for depression (−9.15 percentage points; 95% confidence interval, −16.70 to −1.60; P = 0.02), increased the use of many preventive services, and nearly eliminated catastrophic out-of-pocket medical expenditures.
This randomized, controlled study showed that Medicaid coverage generated no significant improvements in measured physical health outcomes in the first 2 years, but it did increase use of health care services, raise rates of diabetes detection and management, lower rates of depression, and reduce financial strain.
PMCID: PMC3701298  PMID: 23635051
3.  The Insurance Value of Medicare 
The New England journal of medicine  2012;367(19):1773-1775.
PMCID: PMC3726035  PMID: 23113834
4.  Comparing Local and Regional Variation in Healthcare Spending 
The New England journal of medicine  2012;367(18):1724-1731.
Wide geographic variation in healthcare spending has generated concern about inefficiency and policy debate about geographic-based payment reform. Evidence on variation has focused on hospital referral regions (HRRs), which incorporate numerous local hospital service areas (HSAs). If there is substantial variation across local areas within HRRs, then policies focusing on HRRs may be poorly-targeted.
Using pharmacy and medical claims data from a 5% random sample of Medicare beneficiaries in 2006–2009, we compared variation in health care spending and utilization in 306 HRRs and 3436 HSAs. We adjusted for beneficiary-level demographics, insurance status, and clinical characteristics to calculate adjusted use and spending.
There is substantial local variation in drug and non-drug utilization and spending, and substantial dispersion of local areas within HRRs; many low-spending HSAs are located within the borders of high-spending HRRs and vice versa. Only about half of the HSAs located within the borders of the highest spending quintile of HRRs are in the highest spending quintile of HSAs; conversely, only about half of the highest spending HSAs are located within the borders of the highest-spending HRRs.
The effectiveness of payment reforms in reducing overutilization while maintaining access to high-quality care depends crucially on the effectiveness of targeting. Our analysis suggests that HRR-based policies may be too crudely targeted to promote the best use of healthcare resources.
PMCID: PMC3490218  PMID: 23113483
5.  Geographic Variation in Medicare Drug Spending 
The New England Journal of Medicine  2010;363(5):405-409.
PMCID: PMC3364516  PMID: 20538621
7.  Geographic Variation in the Quality of Prescribing 
The New England journal of medicine  2010;363(21):1985-1988.
PMCID: PMC3047447  PMID: 21047217

Results 1-7 (7)