Effects of Policies on the Use of Health Care Services
Health policies have a direct impact on public health through guiding the allocation of scarce resources. This session includes three empirical papers that assess the different policies and guidelines governing the provision of health care services. The first paper examines the effect of the Medicaid pay-for-performance (P4P) programs where providers are reimbursed according to certain performance metrics including the delivery of preventive care, on the use of preventive care services. The authors demonstrate that P4P states were associated with an increase in the prevalence of the receipt of several preventive care services among adults and a small but significant increase in the prevalence of up-to-date vaccinations among children. The second paper examines the effect of a change in Medicare’s reimbursement guidelines that eliminated both copayments and coinsurance for certain preventive screenings, including lipids blood tests which are used to detect cardiovascular disease. The authors did not find a statistically significant increase in the screening rate suggesting that the change did not have the intended outcome. The third paper investigates the medical guidelines related to the treatment of Coronary Artery Disease (CAD). The authors found that among the three types of treatment – medical management, Percutaneous Coronary Intervention (PCI), and Coronary Artery Bypass Graft (CABG) – the most invasive resulted in the most patient behavior change, which has implications for comparative effectiveness and thus medical guidelines. These three papers highlight the importance of evaluating both the intended and unintended consequences of policies governing the use of health care services.