The Issue in Brief
On April 15th, 2011, the O’Neill Institute for National and Global Health Law hosted the annual Empirical Health Law Conference. O’Neill Faculty Director Lawrence Gostin and Professor Kathy Zeiler welcomed the attendees, stressing the importance of empirical work in guiding policy decisions. The attendees represented diverse backgrounds—economics, law, medicine, and public policy. Each presenter was followed by a commentator. The first three presentations addressed the effects of payment methods. Ashish Jha (Harvard School of Public Health) discussed the impact of hospital financial incentives on low-income patients, and Laura Peterson (Baylor College of Medicine) addressed the impact of physician financial incentives on minority hypertension patients. Both sets of data indicated that pay-for-performance did not adversely affect these groups. In their comments, Wally Mullin (George Washington University Department of Economics) and Carole Roan Gresenz (RAND Corporation) discussed study design issues (for example whether providers knew the study focused on minority patients) and alternate explanations for these findings (for example if the hospitals that opted into the voluntary program are representative of hospitals generally). The third presenter, Peter Hussey (RAND Corporation), described an episode-based payment pilot project. In her comments, Professor Kathy Zeiler (Georgetown University Law Center) emphasized the importance of using theory to predict behavior in empirical studies.
The fourth presenter, Frank Sloan (Duke University Department of Economics), analyzed low conviction rates and high recidivism in domestic violence cases. Nora Gordon’s (Georgetown University Public Policy Institute) comments focused on overcoming data limitations—for example addressing underreporting of domestic violence through hospital admissions data. The fifth presenter, Jill Horwitz, (University of Michigan Law School) presented evidence that the uptake of cardiac technology is more closely linked to geography (whether nearby competitors have the technology) than medical need. In his comments, Ron Borzekowski (Federal Reserve Board) discussed a similar phenomenon in the context of social credit unions, and raised variables affecting technology uptake other than those controlled for in Horwitz’ study. In the final session, Max Schanzenbach (Northwestern University Law School) presented evidence that tort reforms reduce premiums in self-insured health insurance plans, while they do not impact fully-insured plans. In his comments, Billy Jack (Georgetown University Department of Economics) highlighted areas for future research, such as the relationship between tort reform and firm profits (as impacted by market concentration).