Telemedicine and Diabetes

“Second Interim Report on the Informatics for Diabetes Education and Telemedicine (IDEATel) Demonstration: Final Report on Phase I.” Lorenzo Moreno, Arnold Chen, Leslie Foster, and Nancy D. Archibald, June 2005. Telemedicine may hold promise for reducing access barriers for chronically ill Medicare beneficiaries. To evaluate the effectiveness of home telemedicine, Congress mandated a two-phase demonstration to improve primary care for Medicare beneficiaries with diabetes living in medically underserved areas, designed and implemented by a consortium led by Columbia University, and an independent evaluation, being conducted by Mathematica. This report addresses implementation; participants' use of the technology; and impacts on access to care, behavioral and physiologic outcomes, health services use, Medicare costs, quality of life, and satisfaction with care during Phase I. Findings show that the demonstration responded to the congressional mandate and addressed design and implementation challenges, with positive impacts on several key clinical outcomes. However, it had no impact on Medicare service use or expenditures, and costs of designing and implementing the demonstration were high. After Phase II ends in February 2008, a final report to Congress will present findings from both phases.

Prescription Drug Costs

"Prescription Drug Demand for Therapeutic Substitutes: The Influence of Copayments and Insurer Non-Price Rationing." Domenico Esposito, Journal of Pharmaceutical Finance, Economics & Policy, volume 14, 2005. This study uses a retrospective medical claims data set to examine the influence of copayments and insurance type on the demand for therapeutically equivalent, cholesterol-lowering drugs in the statins class for a population of insured individuals. Multivariate regression results from a multinomial logit specification suggest that differences in copayments influence choice, shifting market share across drugs. Insurers also appear to affect patient drug choice through non-price rationing methods, as evidenced by differences in utilization across insurance type. These results imply that both health insurers and Medicare prescription drug plans could use differential copayments as a negotiating tool to obtain price discounts for higher volume from drug manufacturers, while manufacturers could use them to capture additional market share from competitors.

The Critical Early Years

"Children Born in 2001: First Results From the Base Year of the Early Childhood Longitudinal Study, Birth Cohort (ECLS-B)." Kristin Denton Flanagan and Jerry West, Education Statistics Quarterly, volume 6, number 4, 2005. Presents information on children born in the United States in 2001, collected when they were about nine months of age. Includes information on the characteristics of children and their families, the early mental and physical skills of the children, their first experiences in child care, and their fathers.

Food Stamp Effectiveness

“Empirical Bayes Shrinkage Estimates of State Food Stamp Participation Rates in 2000-2002 for All Eligible People and the Working Poor.” Laura A. Castner and Allen L. Schirm, October 2005. This report documents the methodology used to derive the previously published estimates of food stamp participation rates for all eligible people and the working poor. Read the related brief.

Incentives and Children's Health Care

"Evaluation of the Local Initiative Rewarding Results Collaborative Demonstrations: Interim Report." Suzanne Felt-Lisk and Fabrice Smieliauskas, August 2005. This report assesses the first known collaboration formed to establish financial incentives for multiple health plans in Medicaid to improve the timeliness of care for low-income children in California. The authors note that most plans found it feasible, but not easy, to implement the incentives. Interviews with providers found that some were responding by improving their outreach and followup with members. Although nearly all supported incentives in concept, many highlighted difficulties in improving care for the Medicaid population because of population factors, such as issues associated with poverty, and office characteristics, such as limited computer capability or use.

Arbitration and the Global Economy

“Recent Practice/Future Possibilities: A Survey of Practitioners in International Commercial Arbitration.” Grace Farrell Roemer, Melissa Miller, and Martha Kovac, May 2005. International commercial arbitration has the potential to improve the expansion of world trade by decreasing some of the costs, and risks, of conducting business in the global economy. This report highlights interviews with a handpicked sample of 53 advocates and arbitrators from around the world who provided information on their past experience as well as their projections for the future. By comparing recent experience to future projections, the study identified possible areas of continuity and change to inform discussion, future research, and strategy development.