Economic Principles for Medicare Reform

Amitabh  Chandra; Craig  Garthwaite

Article | Annals of the American Academy of Political and Social Science

Economic Principles for Medicare Reform

by Amitabh Chandra and Craig Garthwaite

Abstract

In this article, we develop an economic framework for Medicare reform that highlights trade-offs that reform proposals should grapple with but often ignore. Central to our argument is a tension in administratively set prices, which may improve short-term efficiency but do so at the expense of dynamic efficiency (slowing innovations in new treatments). The smaller the Medicare program is relative to the commercial market, the less important this is; but in a world where there are no market prices or the private sector is very small, the task of setting prices that are dynamically correct becomes more complex. Reforming Medicare should focus on greater incentives to increase competition between Medicare Advantage plans, which necessitates a role for government in ensuring competition; premium support; less use of regulated prices; and less appetite for countless “pay for performance” schemes. We apply this framework to evaluate Medicare for All proposals.

Keywords: Medicare; value-based care; health care reform; markets in health care; Health Care and Treatment; Value; Governing Rules, Regulations, and Reforms;

Format: Print

Read Now

Citation:

Chandra, Amitabh, and Craig Garthwaite. "Economic Principles for Medicare Reform." Annals of the American Academy of Political and Social Science 686, no. 1 (November 2019): 63 – 92.

This Technical Note provides an introduction to Bayes’ Rule and the statistical intuition that stems from it. In this note, we review the concepts that underlie Bayesian statistics, and we offer several simple mathematical examples to illustrate applications of Bayes’ Rule. Instructors can assign this note either as a standalone reading to familiarize students with Bayesian statistics or as a supplement to accompany “Adaptive Platform Trials: The Clinical Trial of the Future?” (HBS Case No. 618-025). This case introduces the concept of an adaptive platform clinical trial, in which Bayesian statistical methods are used to expedite the investigation and regulatory approval of promising new therapies, such as cancer treatments.

For more than two decades, scientific advances have been driving profound changes in drug discovery and the drug industry itself. This case provides an overview and description of these technical and scientific advances. Written for the nonscientific reader, it may be used as companion reading for other case materials that require basic knowledge of the tools, techniques, and approaches used in the pharmaceutical and biotechnology industries.

Chapter | Economic Dimensions of Personalized and Precision Medicine | 2019

Characterizing the Drug Development Pipeline for Precision Medicines

Amitabh Chandra, Craig Garthwaite and Ariel Dora Stern

BOOK ABSTRACT: Personalized and precision medicine (PPM)—the targeting of therapies according to an individual’s genetic, environmental, or lifestyle characteristics—is becoming an increasingly important approach in health care treatment and prevention. The advancement of PPM is a challenge in traditional clinical, reimbursement, and regulatory landscapes because it is costly to develop and introduces a wide range of scientific, clinical, ethical, and socioeconomic issues. PPM raises a multitude of economic issues, including how information on accurate diagnosis and treatment success will be disseminated and who will bear the cost; changes to physician training to incorporate genetics, probability and statistics, and economic considerations; questions about whether the benefits of PPM will be confined to developed countries or will diffuse to emerging economies with less developed health care systems; the effects of patient heterogeneity on cost-effectiveness analysis; and opportunities for PPM’s growth beyond treatment of acute illness, such as prevention and reversal of chronic conditions. This volume explores the intersection of the scientific, clinical, and economic factors affecting the development of PPM, including its effects on the drug pipeline, on reimbursement of PPM diagnostics and treatments, and on funding the requisite underlying research. The research also examines recent empirical applications of PPM.

Keywords: healthcare; precision medicine;

Citation:

Chandra, Amitabh, Craig Garthwaite, and Ariel Dora Stern. "Characterizing the Drug Development Pipeline for Precision Medicines." Chap. 5 in Economic Dimensions of Personalized and Precision Medicine, edited by Ernest R. Berndt, Dana P. Goldman, and John W. Rowe, 115–158. University of Chicago Press, 2019. View Details

Cite View Details

Faculty & Research

Economic Principles for Medicare Reform

Abstract

Citation:

About the Author

More from the Author