Peter Hussey - Academia.edu (original) (raw)
Papers by Peter Hussey
This collaborative project aims to provide guidance as to how researchers many design, conduct an... more This collaborative project aims to provide guidance as to how researchers many design, conduct and report upon healthcare studies which utilise the Delphi technique
Israel Journal of Health Policy Research, 2018
International comparisons of health systems are frequently used to inform national health policy ... more International comparisons of health systems are frequently used to inform national health policy debates. These comparisons can be used to gauge areas of strength and weakness in a health system, and to find potential solutions from abroad that can be applied locally. But such comparisons are methodologically fraught and, if not carefully performed and used, can be misleading. In a recent IJHPR article, Baruch Levi has raised concerns about the use of international comparisons of self-reported health data in health policy debates in Israel. Self-reported health is one of the most robust and frequently used measures of health, and the OECD uses a commonly accepted measure specification, which has five response categories. Israel's survey question, unlike the OECD measure specification, includes only four response categories. While this may be a valid method when applied over time as a scale within Israel, it creates problems for international comparison. To improve comparability, Israel's Central Bureau of Statistics could revise the survey question. However, revising the question would introduce a "break" in the data series that interrupts comparisons within Israel over time. Israeli policymakers therefore face a decision about priorities: is it more important to them to be able to track health status within Israel over time, or to be able to make meaningful comparisons to other countries? If the priority were international comparisons and the Israel survey was revised, a small study could be conducted among a sample of Israeli respondents to enable crosswalking of self-reported health responses from the four-point scale to the five-point scale. If the Central Bureau of Statistics does not revise its survey, the OECD should examine whether a stronger caveat is possible for its comparisons.
128 had strong affiliations with the Longshoremen's Union dating back to the 1916 San Pedro Bay s... more 128 had strong affiliations with the Longshoremen's Union dating back to the 1916 San Pedro Bay strike. The unionism of this region was broad and encompassed the radicalism of the I.W.W. and the idea of cross-industry solidarity.
This document and trademark(s) contained herein are protected by law as indicated in a notice app... more This document and trademark(s) contained herein are protected by law as indicated in a notice appearing later in this work. This electronic representation of RAND intellectual property is provided for non-commercial use only. Unauthorized posting of RAND PDFs to a non-RAND Web site is prohibited. RAND PDFs are protected under copyright law. Permission is required from RAND to reproduce, or reuse in another form, any of our research documents for commercial use. For information on reprint and linking permissions, please see RAND Permissions.
NAM Perspectives, 2012
Rising health care costs continue to stress budgets at all levels-family, employer, state, and na... more Rising health care costs continue to stress budgets at all levels-family, employer, state, and national. At the same time, the results from health care are not commensurate with this level of investment. But there is cause for optimism that results can improve: the large number of individuals and organizations around the country who are involved in substantive efforts to improve care by piloting new care practices, care delivery models, payment methods, and other initiatives, thereby building an evidence base about what works and spreading that knowledge more broadly. To take best advantage of these activities, practical strategies are needed to accelerate and improve the planning, evaluation, scale-up, and spread of these initiatives. By improving the process for pilot projects, the potential becomes greater for large-scale improvements to the health care system-and the achievement of better care at lower cost. THE IMPORTANCE OF PILOTS In recent years, there has been increasing concern about the rising cost of the health care system. In 2012, health care constituted 18 percent of the American economy, with expenditures of $2.8 trillion (Martin et al., 2012). However, there are outstanding questions about the quality of care and patient health outcomes achieved from that substantial investment of resources. Medical errors remain too common, evidence is too rarely applied to health care, and quality remains uneven among different areas and populations (
he recently enacted federal health care reform law (the Affordable Care Act, or ACA) is designed ... more he recently enacted federal health care reform law (the Affordable Care Act, or ACA) is designed to increase the number of Americans covered by health insurance. One way it does this is by creating health insurance exchanges, which are new markets for purchasing insurance. It also imposes fines on certain employers that do not offer coverage and on individuals who do not have public or private insurance (known as the individual mandate). Employers with 50 or fewer workers are exempt from fines. By 2016, firms with 100 or fewer employees will be allowed to purchase coverage for employees through the insurance exchanges. However, there is considerable debate about the likely effect of these provisions in the law. A recent RAND Health study assessed the likely impact of the ACA on, among other outcomes, employee health insurance coverage. The analysis used RAND's COMPARE microsimulation model, which was updated and refined to analyze how people and firms will respond to the health insurance exchanges created under the ACA. RAND found that the ACA will increase employer offer rates (that is, the probability that businesses will offer coverage) to workers. After the new policies have taken full effect, employer offer rates will increase from ■ 57 percent under the status quo to 80 percent for firms with 50 or fewer workers ■ 90 percent to 98 percent for firms with 51 to 100 workers ■ 93 percent to 98 percent for firms with more than 100 workers.
Limited Print and Electronic Distribution Rights This document and trademark(s) contained herein ... more Limited Print and Electronic Distribution Rights This document and trademark(s) contained herein are protected by law. This representation of RAND intellectual property is provided for noncommercial use only. Unauthorized posting of this publication online is prohibited. Permission is given to duplicate this document for personal use only, as long as it is unaltered and complete. Permission is required from RAND to reproduce, or reuse in another form, any of its research documents for commercial use. For information on reprint and linking permissions, please visit www.rand.org/pubs/permissions. The RAND Corporation is a research organization that develops solutions to public policy challenges to help make communities throughout the world safer and more secure, healthier and more prosperous. RAND is nonprofit, nonpartisan, and committed to the public interest. RAND's publications do not necessarily reflect the opinions of its research clients and sponsors.
Limited Print and Electronic Distribution Rights This document and trademark(s) contained herein ... more Limited Print and Electronic Distribution Rights This document and trademark(s) contained herein are protected by law. This representation of RAND intellectual property is provided for noncommercial use only. Unauthorized posting of this publication online is prohibited. Permission is given to duplicate this document for personal use only, as long as it is unaltered and complete. Permission is required from RAND to reproduce, or reuse in another form, any of its research documents for commercial use. For information on reprint and linking permissions, please visit www.rand.org/pubs/permissions. The RAND Corporation is a research organization that develops solutions to public policy challenges to help make communities throughout the world safer and more secure, healthier and more prosperous. RAND is nonprofit, nonpartisan, and committed to the public interest. RAND's publications do not necessarily reflect the opinions of its research clients and sponsors.
Health Affairs, 2019
A 2003 article titled "It's the Prices, Stupid," and coauthored by the three of us ... more A 2003 article titled "It's the Prices, Stupid," and coauthored by the three of us and the recently deceased Uwe Reinhardt found that the sizable differences in health spending between the US and other countries were explained mainly by health care prices. As a tribute to him, we used Organization for Economic Cooperation and Development (OECD) Health Statistics to update these analyses and review critiques of the original article. The conclusion that prices are the primary reason why the US spends more on health care than any other country remains valid, despite health policy reforms and health systems restructuring that have occurred in the US and other industrialized countries since the 2003 article's publication. On key measures of health care resources per capita (hospital beds, physicians, and nurses), the US still provides significantly fewer resources compared to the OECD median country. Since the US is not consuming greater resources than other countries, the most logical factor is the higher prices paid in the US. Because the differential between what the public and private sectors pay for medical services has grown significantly in the past fifteen years, US policy makers should focus on prices in the private sector.
The Joint Commission Journal on Quality and Patient Safety, 2013
* DRG, diagnosis-related group. † Missings IQIs 3 and 10 reflect changes to the list of indicator... more * DRG, diagnosis-related group. † Missings IQIs 3 and 10 reflect changes to the list of indicators. ‡ Missing PSIs 1 and 17 reflect changes to the list of indicators.
Rand health quarterly, 2011
Under Medicare, many health care services can be provided in a range of ambulatory settings, and ... more Under Medicare, many health care services can be provided in a range of ambulatory settings, and improvements in technology and delivery mean that many services no longer require an inpatient hospital stay. Medicare's payment for physician work and malpractice liability expenses is the same regardless of where a service is provided. However, payment differentials exist between settings for the facility-related components of care, such as nursing and other staff salaries, equipment, buildings, and supplies. A three-phase RAND study examined the available data on various procedure costs and payment differentials and the bundling or packaging of services offered to Medicare beneficiaries in physician offices, ambulatory surgical centers, and hospital outpatient departments. Building on exploratory analyses conducted in the first two phases of the study, this article documents findings from the third phase, which sought to identify options for modifying Medicare payment policies to ...
Rand health quarterly, Jan 30, 2015
Innovative health care delivery organizations are developing programs that aim to improve quality... more Innovative health care delivery organizations are developing programs that aim to improve quality and demonstrate reductions in unnecessary use of acute care and costs. RAND researchers sought to identify paths to sustainability for these innovative care delivery programs. Using a sample of health plans and ACOs in Massachusetts, researchers sought to identify the methods in use to reimburse new care delivery models, criteria that health plans use to determine eligibility for these models, and criteria that accountable care organizations apply for their investments in delivery innovations. Researchers identified a highly uncertain environment for the sustainability of care delivery innovations despite a high degree of interest in these programs. Dynamics in the current environment suggest that innovation will likely be concentrated in health care delivery systems that are able to manage financial risk and that have experience and capacity in delivery innovation. For providers seekin...
Rand health quarterly, 2011
The RAND Corporation's Comprehensive Assessment of Reform Efforts microsimulation model was u... more The RAND Corporation's Comprehensive Assessment of Reform Efforts microsimulation model was used to analyze the effects of the Patient Protection and Affordable Care Act (PPACA) on employers and enrollees in employer-sponsored health insurance, with a focus on small businesses and businesses offering coverage through health insurance exchanges. Outcomes assessed include the proportion of nonelderly Americans with insurance coverage, the number of employers offering health insurance, premium prices, total employer spending, and total government spending relative to what would have been observed without the policy change. The microsimulation predicts that PPACA will increase insurance offer rates among small businesses from 53 to 77 percent for firms with ten or fewer workers, from 71 to 90 percent for firms with 11 to 25 workers, and from 90 percent to nearly 100 percent for firms with 26 to 100 workers. Simultaneously, the uninsurance rate in the United States would fall from 19...
This collaborative project aims to provide guidance as to how researchers many design, conduct an... more This collaborative project aims to provide guidance as to how researchers many design, conduct and report upon healthcare studies which utilise the Delphi technique
Israel Journal of Health Policy Research, 2018
International comparisons of health systems are frequently used to inform national health policy ... more International comparisons of health systems are frequently used to inform national health policy debates. These comparisons can be used to gauge areas of strength and weakness in a health system, and to find potential solutions from abroad that can be applied locally. But such comparisons are methodologically fraught and, if not carefully performed and used, can be misleading. In a recent IJHPR article, Baruch Levi has raised concerns about the use of international comparisons of self-reported health data in health policy debates in Israel. Self-reported health is one of the most robust and frequently used measures of health, and the OECD uses a commonly accepted measure specification, which has five response categories. Israel's survey question, unlike the OECD measure specification, includes only four response categories. While this may be a valid method when applied over time as a scale within Israel, it creates problems for international comparison. To improve comparability, Israel's Central Bureau of Statistics could revise the survey question. However, revising the question would introduce a "break" in the data series that interrupts comparisons within Israel over time. Israeli policymakers therefore face a decision about priorities: is it more important to them to be able to track health status within Israel over time, or to be able to make meaningful comparisons to other countries? If the priority were international comparisons and the Israel survey was revised, a small study could be conducted among a sample of Israeli respondents to enable crosswalking of self-reported health responses from the four-point scale to the five-point scale. If the Central Bureau of Statistics does not revise its survey, the OECD should examine whether a stronger caveat is possible for its comparisons.
128 had strong affiliations with the Longshoremen's Union dating back to the 1916 San Pedro Bay s... more 128 had strong affiliations with the Longshoremen's Union dating back to the 1916 San Pedro Bay strike. The unionism of this region was broad and encompassed the radicalism of the I.W.W. and the idea of cross-industry solidarity.
This document and trademark(s) contained herein are protected by law as indicated in a notice app... more This document and trademark(s) contained herein are protected by law as indicated in a notice appearing later in this work. This electronic representation of RAND intellectual property is provided for non-commercial use only. Unauthorized posting of RAND PDFs to a non-RAND Web site is prohibited. RAND PDFs are protected under copyright law. Permission is required from RAND to reproduce, or reuse in another form, any of our research documents for commercial use. For information on reprint and linking permissions, please see RAND Permissions.
NAM Perspectives, 2012
Rising health care costs continue to stress budgets at all levels-family, employer, state, and na... more Rising health care costs continue to stress budgets at all levels-family, employer, state, and national. At the same time, the results from health care are not commensurate with this level of investment. But there is cause for optimism that results can improve: the large number of individuals and organizations around the country who are involved in substantive efforts to improve care by piloting new care practices, care delivery models, payment methods, and other initiatives, thereby building an evidence base about what works and spreading that knowledge more broadly. To take best advantage of these activities, practical strategies are needed to accelerate and improve the planning, evaluation, scale-up, and spread of these initiatives. By improving the process for pilot projects, the potential becomes greater for large-scale improvements to the health care system-and the achievement of better care at lower cost. THE IMPORTANCE OF PILOTS In recent years, there has been increasing concern about the rising cost of the health care system. In 2012, health care constituted 18 percent of the American economy, with expenditures of $2.8 trillion (Martin et al., 2012). However, there are outstanding questions about the quality of care and patient health outcomes achieved from that substantial investment of resources. Medical errors remain too common, evidence is too rarely applied to health care, and quality remains uneven among different areas and populations (
he recently enacted federal health care reform law (the Affordable Care Act, or ACA) is designed ... more he recently enacted federal health care reform law (the Affordable Care Act, or ACA) is designed to increase the number of Americans covered by health insurance. One way it does this is by creating health insurance exchanges, which are new markets for purchasing insurance. It also imposes fines on certain employers that do not offer coverage and on individuals who do not have public or private insurance (known as the individual mandate). Employers with 50 or fewer workers are exempt from fines. By 2016, firms with 100 or fewer employees will be allowed to purchase coverage for employees through the insurance exchanges. However, there is considerable debate about the likely effect of these provisions in the law. A recent RAND Health study assessed the likely impact of the ACA on, among other outcomes, employee health insurance coverage. The analysis used RAND's COMPARE microsimulation model, which was updated and refined to analyze how people and firms will respond to the health insurance exchanges created under the ACA. RAND found that the ACA will increase employer offer rates (that is, the probability that businesses will offer coverage) to workers. After the new policies have taken full effect, employer offer rates will increase from ■ 57 percent under the status quo to 80 percent for firms with 50 or fewer workers ■ 90 percent to 98 percent for firms with 51 to 100 workers ■ 93 percent to 98 percent for firms with more than 100 workers.
Limited Print and Electronic Distribution Rights This document and trademark(s) contained herein ... more Limited Print and Electronic Distribution Rights This document and trademark(s) contained herein are protected by law. This representation of RAND intellectual property is provided for noncommercial use only. Unauthorized posting of this publication online is prohibited. Permission is given to duplicate this document for personal use only, as long as it is unaltered and complete. Permission is required from RAND to reproduce, or reuse in another form, any of its research documents for commercial use. For information on reprint and linking permissions, please visit www.rand.org/pubs/permissions. The RAND Corporation is a research organization that develops solutions to public policy challenges to help make communities throughout the world safer and more secure, healthier and more prosperous. RAND is nonprofit, nonpartisan, and committed to the public interest. RAND's publications do not necessarily reflect the opinions of its research clients and sponsors.
Limited Print and Electronic Distribution Rights This document and trademark(s) contained herein ... more Limited Print and Electronic Distribution Rights This document and trademark(s) contained herein are protected by law. This representation of RAND intellectual property is provided for noncommercial use only. Unauthorized posting of this publication online is prohibited. Permission is given to duplicate this document for personal use only, as long as it is unaltered and complete. Permission is required from RAND to reproduce, or reuse in another form, any of its research documents for commercial use. For information on reprint and linking permissions, please visit www.rand.org/pubs/permissions. The RAND Corporation is a research organization that develops solutions to public policy challenges to help make communities throughout the world safer and more secure, healthier and more prosperous. RAND is nonprofit, nonpartisan, and committed to the public interest. RAND's publications do not necessarily reflect the opinions of its research clients and sponsors.
Health Affairs, 2019
A 2003 article titled "It's the Prices, Stupid," and coauthored by the three of us ... more A 2003 article titled "It's the Prices, Stupid," and coauthored by the three of us and the recently deceased Uwe Reinhardt found that the sizable differences in health spending between the US and other countries were explained mainly by health care prices. As a tribute to him, we used Organization for Economic Cooperation and Development (OECD) Health Statistics to update these analyses and review critiques of the original article. The conclusion that prices are the primary reason why the US spends more on health care than any other country remains valid, despite health policy reforms and health systems restructuring that have occurred in the US and other industrialized countries since the 2003 article's publication. On key measures of health care resources per capita (hospital beds, physicians, and nurses), the US still provides significantly fewer resources compared to the OECD median country. Since the US is not consuming greater resources than other countries, the most logical factor is the higher prices paid in the US. Because the differential between what the public and private sectors pay for medical services has grown significantly in the past fifteen years, US policy makers should focus on prices in the private sector.
The Joint Commission Journal on Quality and Patient Safety, 2013
* DRG, diagnosis-related group. † Missings IQIs 3 and 10 reflect changes to the list of indicator... more * DRG, diagnosis-related group. † Missings IQIs 3 and 10 reflect changes to the list of indicators. ‡ Missing PSIs 1 and 17 reflect changes to the list of indicators.
Rand health quarterly, 2011
Under Medicare, many health care services can be provided in a range of ambulatory settings, and ... more Under Medicare, many health care services can be provided in a range of ambulatory settings, and improvements in technology and delivery mean that many services no longer require an inpatient hospital stay. Medicare's payment for physician work and malpractice liability expenses is the same regardless of where a service is provided. However, payment differentials exist between settings for the facility-related components of care, such as nursing and other staff salaries, equipment, buildings, and supplies. A three-phase RAND study examined the available data on various procedure costs and payment differentials and the bundling or packaging of services offered to Medicare beneficiaries in physician offices, ambulatory surgical centers, and hospital outpatient departments. Building on exploratory analyses conducted in the first two phases of the study, this article documents findings from the third phase, which sought to identify options for modifying Medicare payment policies to ...
Rand health quarterly, Jan 30, 2015
Innovative health care delivery organizations are developing programs that aim to improve quality... more Innovative health care delivery organizations are developing programs that aim to improve quality and demonstrate reductions in unnecessary use of acute care and costs. RAND researchers sought to identify paths to sustainability for these innovative care delivery programs. Using a sample of health plans and ACOs in Massachusetts, researchers sought to identify the methods in use to reimburse new care delivery models, criteria that health plans use to determine eligibility for these models, and criteria that accountable care organizations apply for their investments in delivery innovations. Researchers identified a highly uncertain environment for the sustainability of care delivery innovations despite a high degree of interest in these programs. Dynamics in the current environment suggest that innovation will likely be concentrated in health care delivery systems that are able to manage financial risk and that have experience and capacity in delivery innovation. For providers seekin...
Rand health quarterly, 2011
The RAND Corporation's Comprehensive Assessment of Reform Efforts microsimulation model was u... more The RAND Corporation's Comprehensive Assessment of Reform Efforts microsimulation model was used to analyze the effects of the Patient Protection and Affordable Care Act (PPACA) on employers and enrollees in employer-sponsored health insurance, with a focus on small businesses and businesses offering coverage through health insurance exchanges. Outcomes assessed include the proportion of nonelderly Americans with insurance coverage, the number of employers offering health insurance, premium prices, total employer spending, and total government spending relative to what would have been observed without the policy change. The microsimulation predicts that PPACA will increase insurance offer rates among small businesses from 53 to 77 percent for firms with ten or fewer workers, from 71 to 90 percent for firms with 11 to 25 workers, and from 90 percent to nearly 100 percent for firms with 26 to 100 workers. Simultaneously, the uninsurance rate in the United States would fall from 19...