Past Articles

The Puzzling Popularity of Back Surgery in Certain Regions

You might think that once drugs, devices and medical procedures are shown to be effective, they quickly become available. You might also think that those shown not to work as well as alternatives are immediately discarded.

Reasonable assumptions both, but you’d be wrong.

Instead, innovations in health care diffuse unevenly across geographic regions — not unlike the spread of a contagious disease. And even when studies show a new technology is overused, retrenchment is very slow and seemingly haphazard.

Managing new health technologies

Countries around the world are struggling with rising healthcare bills. Every introduction of pricey new biologics, surgical procedures, and exotic “precision” treatments causes ever-increasing fiscal stress, leading to deficit spending, cutbacks in other government services, and insurance costs shouldered by firms and employees alike. Yet, freezing budgetary allocations is clearly not an option, as citizens in our ageing societies are likely to demand more and better access to new health innovations, and essential healthcare services. What can be done?

Life expectancy is down for a second year. Drug overdoses are a big reason why.

The difference between the U.S. and most of the rest of the world “is very stark,” said Jonathan Skinner, a professor of economics at Dartmouth College.

Newborns in 29 countries, including Japan, Australia and Spain, had life expectancies above 80 years in 2015, according to the World Health Organization. The average global life expectancy was 71.4 and rising, according to that agency’s most recent report.  

Study finds more spending doesn’t improve heart attack patients’ outcomes

More Medicare dollars spent on treatment of a heart attack patient doesn't lead to better health outcomes, according to a new study.

A JAMA study published Wednesday found that mortality rates stayed constant for heart attack patients up to 180 days after discharge even as spending on cardiac procedures and post-acute care rose. But the study did find mortality dropped among patients who received early percutaneous coronary intervention, also known as angioplasty with a stent.

These Maps Show How Americans Are Dying Younger. It’s Not Just the Opioid Epidemic.

"Every once in a while, you get these spikes and mortality jumps up — but there’s usually something you can point to to explain why it happened," said one of the authors of that commentary, Dartmouth health economist Jonathan Skinner. "You can point to the fact that millions of Russian men lost their secure jobs in the Soviet Union."

The same isn’t true for the mortality trends in the US today, he added. "The attribution here is just much more difficult because we think we have some idea — we are pointing to opioids — but we don’t really know yet."

Dying Younger: U.S. Life Expectancy ‘a Real Problem’

If only the good die young, Americans are unfortunately getting better.

U.S. life expectancy dipped by a little more than a month last year from 2014, to 78.8 years, according to a report from the National Center for Health Statistics. It's the first decline in more than two decades. And after years of gains, U.S. life expectancy has been essentially flat for a few years, which means an inauspicious trend could be in the works.

The decline "could be a blip, but even if it’s flat, we have a real problem," said Jonathan Skinner, a professor at the Dartmouth Institute for Health Policy & Clinical Practice.

We Need a Moore’s Law for Medicine

Much of the spending has been worth it. While the U.S. spends the most of any country by far, health care is becoming a larger part of nearly every economy. That makes sense. Better medicine is buying longer lives. Yet medical spending is so high in the U.S. that the White House now projects that if it keeps growing, it could, in 25 years, reach a third of the economy and devour 30 percent of the federal budget. That will mean higher taxes. If we can’t accept that, says Gruber, we’re going to need different technology. “Essentially, it’s how do we move from cost-increasing to cost-reducing technology? That is the challenge of the 21st century,” he says.

That is the big question in this month’s MIT Technology Review Business Report. What technologies can save money in health care? As we headed off to find them, Jonathan Skinner, a health economist at Dartmouth College, warned us that they are “as rare as hen’s teeth.”

Are Hospital's Saving Money for Medicare?

Aug. 26 (Bloomberg) -- Medicare continues to exhibit remarkably slow growth: a modest 3 percent over the past year. That’s great news, but a debate is raging about whether this is caused by a weak economy (and therefore will reverse as the economy recovers) or other factors (and therefore may persist, drastically improving the budget outlook).

Stay Loose on Social Security

With the first Baby Boomers headed for retirement within a bare decade, worries are growing about the huge burden this group will place on the federal budget in the 21st century--and politicians are busy unveiling plans to keep Social Security and Medicare afloat.

How realistic are such fears? In a study in the Journal of Economic Perspectives, Ronald Lee of the University of California at Berkeley and Jonathan S. Skinner of Dartmouth College underscore the high degree of uncertainty attached to current demographic and economic projections.

How to Cure Medicare's Ills

Only a few years ago, it looked as if the U.S. had finally managed to put a leash on surging health-care expenditures, which consume some 14% of gross domestic product. Now, with costs picking up steam again, the search is on for ways to control spending--not only to ease the pain for current employers, workers, and taxpayers, but also to lighten the massive burden that lies ahead when the baby boom generation enters its retirement years.

One potentially useful tack is suggested by a new study by economist Jonathan Skinner of Dartmouth College and physician John E. Wennberg of Dartmouth Medical School that focuses on geographic disparities in Medicare spending. Specifically, the study looks at differences in outlays and care for patients in the last six months of their lives, a period that accounts for some 30% of total Medicare expenditures.