While 2017 promises to be an eventful year in health policy, it’s worth reflecting back on what we learned in 2016. As Health Affairs Editor-in-Chief, I have the pleasure of reading hundreds of articles each year — more, I’m sure, than most of our readers have time to read. I have selected my own “top ten” for 2016. The papers I chose go beyond our “most-read” and “most-shared” articles, which, this year, were disproportionately on topics related to health care costs.
My list of articles covers a broad range of topics. Many of these articles analyze the effects of a specific policy; others raise the profile of issues that deserve more attention. Some articles had unexpected findings. Their shared attribute is that the authors chose to focus on interesting and important questions. These are my favorites for the year — whether they are yours or not, I hope you find them interesting, enjoy reading them, and learn something from them.
1. Workers Without Paid Sick Leave Less Likely To Take Time Off For Illness Or Injury Compared To Those With Paid Sick Leave
LeaAnne DeRigne, et al., March 2016
Paid sick leave is an important employer-provided benefit, but it is not universally available to US workers. Using data from the National Health Interview Survey (NHIS), the authors find that those without paid sick leave were 3.0 times more likely to forgo medical care for themselves and 1.6 times more likely to forgo medical care for their family compared to working adults with paid sick leave benefits, with lower income workers at higher risk.
2. Study Of Physician And Patient Communication Identifies Missed Opportunities To Help Reduce Patients’ Out-Of-Pocket Spending
Peter A. Ubel, et al., April 2016
Many decisions about the course of a patient’s treatment are made during a physician office visit, with potentially significant implications for what patients will ultimately have to pay. The authors analyze physician-patient interactions and find myriad examples of missed opportunities for physicians to engage with patients regarding the cost of services.
3. Yelp Reviews Of Hospital Care Can Supplement And Inform Traditional Surveys Of The Patient Experience Of Care
Benjamin Ranard, et al., April 2016
When experts think about patient satisfaction with hospital care, they think of HCAHPS, the Hospital Consumer Assessment of Healthcare Providers and Systems. When the public thinks about their experience, they go to Yelp. The authors find that Yelp ratings and HCAHPS ratings are correlated — hospitals with higher Yelp ratings also have higher HCAHPS ratings. Their findings suggest that policy makers could better measure patient experience by learning from online consumer rating platforms.
4. Evidence Suggests That The ACA’s Tobacco Surcharges Reduced Insurance Take-Up And Did Not Increase Smoking Cessation
Abigail Friedman, et al., July 2016
The ACA eliminated health insurers’ ability to charge differential premiums on the basis of an enrollee’s health status. Tobacco use, along with age and geography, are now the only permissible bases for different rates. The authors find striking effects of the tobacco use premium surcharge, permitted in 43 states. High tobacco surcharges led to a 20-percentage-point reduction in insurance coverage among adults under age 40 and made no difference in smoking cessation.
5. Private Sector An Important But Not Dominant Provider Of Key Health Services In Low- And Middle-Income Countries
Karen A. Grépin, July 2016
In recent years, international donors and governments have made efforts to strengthen public systems in low- and middle-income countries. The private sector also provides health services in these countries, but the extent of private sector use has not been well understood. Karen A. Grépin analyzes data from 70 countries, finding that the private sector plays a significant role in providing certain types of maternal and child health services but that there is large variation between countries.
6. Physicians’ Participation In ACOs Is Lower In Places With Vulnerable Populations Than In More Affluent Communities
Laura C. Yasaitis, et al., August 2016
Accountable Care Organizations (ACOs), which bear the risk for the cost and health outcomes of a defined population, are expanding throughout the US as one model for delivery system improvement. The authors find that physicians are less likely to participate in an ACO when the population is disadvantaged, raising questions about how the ACO movement might exacerbate rather than diminish disparities.
7. Controlled Substance Lock-In Programs: Examining An Unintended Consequence Of A Prescription Drug Abuse Policy
Andrew Roberts, et al., October 2016
The authors report a troubling finding from their analysis of North Carolina’s lock-in program, designed to limit Medicaid enrollees to obtaining and filling prescriptions for controlled substances from a single provider and pharmacy. As Medicaid-covered prescription fills declined, enrollees increasingly filled prescriptions outside of the Medicaid program, effectively circumventing the program and undermining its goals.
8. Effect Of A Large-Scale Social Franchising And Telemedicine Program On Childhood Diarrhea And Pneumonia Outcomes In India
Manoj Mohanan et al., October 2016
Evaluating the World Health Partners (WHP) Sky program, a large-scale social franchising and telemedicine program in Bihar, India, the authors analyze its impact on treatment for childhood diarrhea and pneumonia and associated health care outcomes. Their findings show that the WHP-Sky program did not improve rates of appropriate treatment or disease prevalence, and offer lessons for the design of future social franchising programs.
9. Mandatory Provider Review And Pain Clinic Laws Reduce The Amounts Of Opioids Prescribed And Overdose Death Rates
Deborah Dowell, et al., October 2016
The authors report on the effects of two state policies adopted in response to the ongoing opioid epidemic. Examining prescribing and death records for the period 2006–13, they find a significant decline in deaths related to opioid overdoses in states adopting laws regulating pain clinics and requiring providers to consult prescription drug monitoring program data before writing a prescription.
10. Expanded Scopes Of Practice For Dental Hygienists Associated With Improved Oral Health Outcomes For Adults
Margaret Langelier, et al., December 2016
One thing dentistry and medicine have in common is disputes over different professionals’ appropriate scope of practice. Rating states according to the degree to which dental hygienists can practice autonomously, the authors find an overall increase in dental hygienists’ scope of practice between 2001 and 2014. They also find a positive correlation between a state’s more autonomous scope of practice and the oral health of that state’s adult population.