Adjusting the Measurement of the Output of the Medical Sector for Quality: A Review of the Literature

Abstract

The Bureau of Economic Analysis recently created new price indexes for health care in its health care satellite account and now faces the problem of how to adjust them for quality. I review the literature on this topic and divide the articles that created quality-adjusted price indexes for individual medical conditions into those that use primarily outcomes-based adjustments and those that use only process-based adjustments. Outcomes-based adjustments adjust the indexes based on observed aggregate health outcomes, usually mortality. Process-based adjustments adjust the indexes based on the treatments provided and medical knowledge of their effectiveness. Outcomes-based adjustments are easier to implement, while process-based adjustments are more demanding in terms of data and medical knowledge. In general, the research literature shows adjusting for quality in the measurement of output in the medical sector to be quantitatively important.

Keywords

health economics economic measurement health care quality measurement

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References

Atkinson

(2005). Atkinson review: Final report. Measurement of government output and productivity for the national accounts. Basingstoke, England: Palgrave Macmillan.

Berndt

E. R.

Bir

Busch

S. H.

Frank

R. G.

Normand

S. T.

(2002). The medical treatment of depression, 1991-1996: Productivity inefficiency, expected outcome variations, and price indexes. Journal of Health Economics, 21, 373-396.

Berndt

E. R.

Bui

Reiley

D. R.

Urban

G. L.

(1995). Information, marketing, and pricing in the U.S. antiulcer drug market. American Economic Review, 85, 100-105.

Berndt

E. R.

Busch

S. H.

Frank

R. G.

(2001). Treatment price indexes for acute phase major depression. In Cutler

D. M.

Berndt

E. R.

(Eds.), Medical care output and productivity (National Bureau of Economic Research Studies in Income and Wealth Series, Vol. 62, pp. 463-505). Chicago, IL: University of Chicago Press.

Berndt

E. R.

Cutler

D. M.

Frank

R. G.

Griliches

Newhouse

J. P.

Triplett

J. R.

(2001). Price indexes for medical care goods and services: An overview of measurement issues. In Cutler

D. M.

Berndt

E. R.

(Eds.), National Bureau of Economic Research Studies in Income and Wealth Series: Vol. 62. Medical care output and productivity (pp. 141-198). Chicago, IL: University of Chicago Press.

Bhandari

Busse

J. W.

Jackowski

Montori

Schünemann

Sprague

. . . Devereaux

(2004). Association between industry funding and statistically significant pro-industry findings in medical and surgical randomized trials. Canadian Medical Association Journal, 170, 477-480.

Bresnahan

T. F.

Gordon

R. J.

(1996). Introduction to “The Economics of New Goods.” In Bresnahan

T. F.

Gordon

R. J.

(Eds.), National Bureau of Economic Research Studies in Income and Wealth Series: Vol. 58. The economics of new goods (pp. 1-26). Chicago, IL: University of Chicago Press.

Bureau of Economic Analysis. (2015). NIPA handbook: Concepts and methods of the U.S. national income and product accounts. Retrieved from http://www.bea.gov/national/pdf/all-chapters.pdf

Bureau of Labor Statistics. (2015). The consumer price index. In Handbook of methods. Washington, DC: Author. Retrieved from http://www.bls.gov/opub/hom/pdf/homch17.pdf

10.

Cockburn

I. M.

Anis

A. H.

(2001). Hedonic analysis of arthritis drugs. In Cutler

D. M.

Berndt

E. R.

(Eds.), National Bureau of Economic Research Studies in Income and Wealth Series: Vol. 62. Medical care output and productivity (pp. 439-458). Chicago, IL: University of Chicago Press.

11.

Colla

C. H.

Morden

N. E.

Sequist

T. D.

Schpero

W. L.

Rosenthal

M. B.

(2015). Choosing wisely: Prevalence and correlates of low-value health care services in the United States. Journal of General Internal Medicine, 30, 221-228.

12.

Congressional Budget Office. (2016). The budget and economic outloook: 2016 to 2026. Retrieved from https://www.cbo.gov/publication/51129

13.

Cram

(2015). Assessing hospital productivity. Health Affairs, 34, 1069. doi:10.1377/hlthaff.2015.0454

14.

Cutler

D. M.

(2004). Your money or your life: Strong medicine for America’s health care system. New York, NY: Oxford University Press.

15.

Cutler

D. M.

McClellan

(2001). Productivity change in health care. American Economic Review, 91, 281-286.

16.

Cutler

D. M.

McClellan

Newhouse

J. P.

Remler

(1998). Are medical prices declining? Evidence for heart attack treatments. Quarterly Journal of Economics, 113, 991-1024.

17.

Cutler

D. M.

McClellan

Newhouse

J. P.

Remler

(2001). Pricing heart attack treatments. In Cutler

D. M.

Berndt

E. R.

(Eds.), National Bureau of Economic Research Studies in Income and Wealth Series: Vol. 62. Medical care output and productivity (pp. 305-362). Chicago, IL: University of Chicago Press.

18.

Cutler

D. M.

Meara

(2000). The technology of birth: Is it worth it? In Garber

A. M.

(Ed.), Frontiers in health policy research, Volume 3 (National Bureau of Economic Research, pp. 33-68). Cambridge: MIT Press.

19.

Cutler

D. M.

Richardson

(1997). Measuring the health of the U.S. population. Brookings Papers on Economic Activity: Microeconomics, 1997, 217-282.

20.

Cutler

D. M.

Rosen

A. B.

Vijan

(2006). The value of medical spending in the United States, 1960-2000. New England Journal of Medicine, 355, 920-927.

21.

Dawson

Gravelle

O’Mahony

Street

Weale

Castelli

. . . Stokes

(2005). Developing new approaches to measuring NHS outputs and productivity (CHE Research Paper 6). Retrieved from http://www.york.ac.uk/media/che/documents/papers/researchpapers/rp6_Measuring_NHS_outputs_and_productivity.pdf

22.

Dolan

(2000). The measurement of health-related quality of life. In Culyer

A. J.

Newhouse

J. P.

(Eds.), Handbook of health economics (Vol. 1B, pp. 1723-1760). New York, NY: Elsevier/North-Holland.

23.

Duggan

M. G.

Evans

W. N.

(2008). Estimating the impact of medical innovation: A case study of HIV antiretroviral treatments. Forum for Health Economics & Policy, 11(2), 1102.

24.

Dunn

(2012). Drug innovations and welfare measures computed from market demand: The case of anti-cholesterol drugs. American Economic Journal: Applied Economics, 4, 167-189.

25.

Dunn

Liebman

Rittmueller

Shapiro

(2014, April). Defining disease episodes and the effects on the components of expenditure growth (BEA Working Paper 2014-4). Retrieved from http://www.bea.gov/papers/pdf/definingdisease.pdf

26.

Dunn

Rittmueller

Whitmire

(2015). Introducing the new BEA health care satellite account. Survey of Current Business, 95(1). Retrieved from http://www.bea.gov/scb/pdf/2015/01%20January/0115_bea_health_care_satellite_account.pdf

27.

Eggleston

K. N.

Shah

N. D.

Smith

S. A.

Berndt

E. R.

Newhouse

J. P.

(2011). Quality adjustment for health care spending on chronic disease: Evidence from diabetes treatment, 1999-2009. American Economic Review, 101, 206-211.

28.

Eggleston

K. N.

Shah

N. D.

Smith

S. A.

Wagie

A. E.

Williams

A. R.

Grossman

J. H.

. . . Newhouse

J. P.

(2009). The net value of health care for patients with type 2 diabetes, 1997 to 2005. Annals of Internal Medicine, 151, 386-393.

29.

Eurostat. (2001). Handbook on price and volume measures in national accounts. Luxembourg: European Communities.

30.

Fisher

E. S.

Wennberg

D. E.

Stukel

T. A.

Gottlieb

D. A.

Lucas

F. L.

Pinder

E. L.

(2003). The implications of regional variations in Medicare spending: Health outcomes and satisfaction with care. Annals of Internal Medicine, 138, 288-298.

31.

Frank

R. G.

Berndt

E. R.

Busch

A. B.

Lehman

A. F.

(2004). Quality-constant “prices” for the ongoing treatment of schizophrenia: An exploratory study. Quarterly Review of Economics and Finance, 44, 390-409.

32.

Garber

A. M.

Skinner

(2008). Is American health care uniquely inefficient? Journal of Economic Perspectives, 22(4), 27-50. doi:10.1257/jep.22.4.27

33.

Goldacre

(2013). Bad pharma: How drug companies mislead doctors and harm patients. New York, NY: Faber & Faber.

34.

Goldman

D. P.

Jena

Lakdawalla

D. N.

Malin

J. L.

Malkin

J. D.

Sun

(2010). The value of specialty oncology drugs. Health Services Research, 45, 115-132.

35.

Government Accountability Office. (2015). State and local governments’ fiscal outlook: 2015 Update. Retrieved from http://www.gao.gov/assets/680/674205.pdf

36.

Hall

R. E.

Jones

C. I.

(2007). The value of life and the rise in health spending. Quarterly Journal of Economics, 122, 39-72.

37.

Henderson

(2015, December). Industry employment and output projections to 2024. Monthly Labor Review. Retrieved from http://www.bls.gov/opub/mlr/2015/article/industry-employment-and-output-projections-to-2024.htm

38.

Highfill

Bernstein

(2014). Using disability-adjusted life years to value the treatment of thirty chronic conditions in the U.S. from 1987-2010 (BEA Working Paper 2014-9). Retrieved from http://www.bea.gov/papers/pdf/Highfill_Bernstein%202015%20DALYS%20update.pdf

39.

Howard

D. H.

Bach

P. B.

Berndt

E. R.

Conti

R. M.

(2015). Pricing in the market for anticancer drugs. Journal of Economic Perspectives, 29, 139-162.

40.

Kornfeld

Hartman

Catlin

(2010, September). Health care expenditures in the national health expenditures accounts and in gross domestic product: A reconciliation (BEA Working Paper 2010-12). Retrieved from http://www.bea.gov/papers/pdf/healthrecon_workingpaper_Sep2010.pdf

41.

Lakdawalla

Shafrin

Lucarelli

Nicholson

Khan

Philipson

(2015). Quality-adjusted cost of care: A meaningful way to measure growth in innovation cost versus the value of health gains. Health Affairs, 34, 555-561.

42.

Landefeld

J. S.

Seskin

E. P.

Fraumeni

B. M.

(2008). Taking the pulse of the economy: Measuring GDP. Journal of Economic Perspectives, 22, 193-216.

43.

Lucarelli

Nicholson

(2009, July). A quality-adjusted price index for colorectal cancer drugs (NBER Working Paper 15174). Retrieved from http://www.nber.org/papers/w15174

44.

Martin

A. B.

Hartman

Benson

Catlin

the National Health Expenditure Accounts Team. (2016). National health spending in 2014: Faster growth driven by coverage expansion and prescription drug spending. Health Affairs, 35, 150-160. doi:10.1377/hlthaff.2015.1194

45.

National Research Council. (2002). At what price? Conceptualizing and measuring cost-of-living and price indexes (Panel on conceptual, measurement, and other statistical issues in developing cost-of-living indexes; Schultze

C. L.

Mackie

[Eds.], Committee on National Statistics, Division of Behavioral and Social Sciences and Education). Washington, DC: National Academies Press.

46.

National Research Council. (2009). Strategies for a BEA Satellite Health Care Account: Summary of a Workshop. Mackie

, rapporteur. Steering Committee for the Workshop to Provide Guidance for Development of a Satellite Health Account at the Bureau of Economic Analysis. Committee on National Statistics, Division of Behavioral and Social Sciences and Education. Washington, DC: National Academies Press.

47.

National Research Council. (2010). Accounting for health and health care: Approaches to measuring the sources and costs of their improvement (Panel to Advance a Research Program on the Design of National Health Accounts, Committee on National Statistics, Division of Behavioral and Social Sciences and Education). Washington, DC: National Academies Press.

48.

Newhouse

J. P.

(1989). Measuring medical prices and understanding their effects. Journal of Health Administration Education, 7, 19-26.

49.

Newhouse

J. P.

(1992). Medical care costs: How much welfare lost? Journal of Economic Perspectives, 6(3), 3-21.

50.

Organization for Economic Cooperation and Development, Eurostat, & World Health Organization (2011). A system of health accounts. Paris, France: Author.

51.

Romley

J. A.

Goldman

D. P.

Sood

(2015). US hospitals experienced substantial productivity growth during 2002-11. Health Affairs, 34, 511-558.

52.

Rosen

A. B.

Cutler

D. M.

Norton

D. M.

H. M.

Vijan

(2007). The value of coronary heart disease care for the elderly: 1987-2002. Health Affairs, 26, 111-123.

53.

Rosen

A. B.

Liebman

Aizcorbe

Cutler

D. M.

(2012). Comparing commercial systems for characterizing episodes of care (BEA Working Paper 2012-7). Retrieved from http://www.bea.gov/papers/pdf/meg_vs_etg_paper.pdf

54.

Salomon

J. A.

Vos

Hogan

Gagnon

Naghavi

Mokdad

. . . Jonas

(2012). Common values in assessing health outcomes from disease and injury: Disability weights measurement study for the Global Burden of Disease Study 2010. Lancet, 380, 2129-2143.

55.

Skinner

Fisher

Wennberg

J. E.

(2005). The efficiency of Medicare. In Wise

D. A.

(Ed.), Analyses in the economics of aging (pp. 129-163). Chicago, IL: University of Chicago Press and NBER.

56.

Suslow

V. Y.

(1996). Measuring quality change in pharmaceutical markets: Hedonic price indexes for anti-ulcer drugs. In Helms

R. B.

(Ed.), Competitive strategies in the pharmaceutical industry (pp. 49-72). Washington, DC: American Enterprise Institute.

57.

Trajtenberg

(1990). Economic analysis of product innovation. Cambridge, MA: Harvard University Press.

58.

U.S. Burden of Disease Collaborative. (2013). The state of US health, 1990-2010: Burden of disease, injuries, and risk factors. JAMA Journal of the American Medical Association, 310, 591-606.

59.

Zuvekas

S. H.

Olin

G. L.

(2009). Accuracy of Medicare expenditures in the medical expenditure panel survey. Inquiry, 46(Spring), 92-108.