Our Publications

Accountable Care Organizations and Antitrust Conference Briefing Document

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by Liora Bowers, Benjamin Handel, Emilio Varanini, Richard Scheffler | Published November 2011 by the Petris Center | Link to Full Briefing Document

This briefing paper serves as a background for the discussion that took place during the “Accountable Care Organizations and Antitrust Conference” held on November 11, 2011 at UC Berkeley. With the October 20, 2011 release of the final rule creating the Medicare Shared Savings Program (MSSP), the Center for Medicare & Medicaid Services has paved the way for a national move towards coordinated delivery systems known as Accountable Care Organizations (ACOs). This paper provides background on government policy towards an accountable care delivery system, the balance between integration efficiencies and market power, and the goals and methods of antitrust analysis within healthcare delivery. It provides context for the issues of market definition, anticompetitive effects, antitrust evaluations, and contracting practices among healthcare providers. The paper concludes with a brief discussion of the California ban on the corporate practice of medicine.

Mental Health Care Reform in the Czech and Slovak Republics, 1989 to the Present

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Edited by Richard M. Scheffler and Martin Potůcĕk | Published in 2008 by Karolinum Press | Link to Book Website

This book analyzes the needs, processes, and challenges of mental health care reform in the Czech Republics and Slovakia. Comparing these two countries (which used to be one state until the end of 1992), it identifies many obstacles to ongoing reforms: low funding levels distributed in inefficient ways, not always reaching those with greatest needs; the reliance on psychiatrists and reluctance to expand the role of other staff groups; and  the lack of information for appropriate decision making and poor systems of quality control.

Is There a Doctor in the House? Market Signals and Tomorrow’s Supply of Doctors

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By Richard M. Scheffler | Published in 2008 by Stanford University Press | Link to Book Website

This book explores American’s bedrock healthcare concern – “Will there be a doctor―a good doctor―when I need one?” In this concise and readable analysis, Scheffler goes beyond the guessing game to demonstrate that today’s health care system is the product of financial influences in both the policy realm and on the ground in the offices of medical centers, HMOs, insurers, and physicians throughout America. He shows how factors such as physician income, medical training costs, and new technologies affect the specialties and geographic distribution of doctors. As part of his vision of tomorrow’s ideal workforce, he offers a template for enhancing the efficiency and cost-effectiveness of the health care system overall. In the groundbreaking second half of the book, Scheffler tests his ideas in conversations with leading figures in health policy, medical education, health economics, and physician practice. Their unguarded give-and-take offers a window on the best thinking currently available anywhere.

California on the Eve of Mental Health Reform

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By Tracy L. Finlayson and the Nicholas C. Petris Center | Published November 2007 by the Petris Center | Link to Full Report

This report summarizes baseline information derived from a survey of county mental health directors about key organizational and budgetary characteristics in California’s county mental health departments. These findings are intended to provide stakeholders, policymakers, researchers and others with a snapshot of county and system characteristics prior to the implementation of the Mental Health Services Act (MHSA) of 2004, which was created by the passage of Proposition 63. Much of the report’s findings, on topics such as financing, organizational structure, staffing patterns, information technology and mental health boards, cannot be found elsewhere. Key findings indicate that California’s counties, while highly diverse, share some common features and strengths. These include: 1) high participation in innovative demonstration programs, 2) minimal spending on institutional care, 3) low administrative overhead, and 4) provision of care in languages beyond the state requirements. This report can provide information on where counties are beginning their transformation process. While each county is different, the similarities between counties may be useful in providing lessons for improving the system as a whole.

The Global Market For ADHD Medications

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By Richard M. Scheffler, Stephen P. Hinshaw, Sepideh Modrek, and Peter Levine | Published April 2007 in Health Affairs | Link to Full Article

Little is known about the global use and cost of medications for attention deficit hyperactivity disorder (ADHD). Global use of ADHD medications rose threefold from 1993 through 2003, whereas global spending (U.S. $2.4 billion in 2003) rose ninefold, adjusting for inflation. Per capita gross domestic product (GDP) robustly predicted use across countries, but the United States, Canada, and Australia showed significantly higher-than predicted use. This article finds that use and spending grew in both developed and developing countries, but spending growth was concentrated in developed countries, which adopted more costly, long-acting formulations.

Private Health Insurance in Development: Friend not Foe

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Edited by Alexander S. Preker, Richard M. Scheffler, and Mark C. Bassett | Published in 2006 by the World Bank Group | Link to Full Book

This volume presents findings of a World Bank review of the existing and potential role of private voluntary health insurance in low- and middle-income countries and is the third volume in a series of reviews of health care financing. This volume is about managing risk. Not the risk of national or man-made disasters but the risk of illness. The developing world is plagued by many of the historical scourges of poverty: infectious disease, disability, and premature death. As countries pass through demographic and epidemiological transition, they face a new wave of health challenges from chronic diseases and accidents. In this respect, illness has both a predictable and unpredictable dimension. Contributors to this volume emphasize that the public sector has an important role to play in the health sector, but they demonstrate that the private sector also plays a role in a context in which private spending and delivery of health services often compose 80 percent of total health expenditure.  The authors examine frameworks for analyzing health financing and health insurance. They conclude that most studies are hampered by lack of data on the impact of private voluntary health insurance on broad social goals, such as financial protection. They find no overall consensus on the impact of voluntary health insurance on public health activities or on the quality, innovation, and efficiency of personal health services.

Consumer-Driven Health Plans: New Developments and the Long Road Ahead

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By Richard M. Scheffler and Mistique C. Felton | Published July 2006 in Business Economics | Link to Full Article

The continued rise in U.S. healthcare spending, along with growth in the number of uninsured, has spurred the move toward consumer-driven health plans. This article reviews new legislation covering such plans, analyze their penetration in the marketplace, and predict their growth. We also use current information about plans that are compatible with Health Savings Accounts to compare them to traditional Preferred Provider Organization plans. Next, we discuss some concerns about the impact of these plans on vulnerable populations, such as the poor and sick. Finally, we suggest how consumer-driven health plans may help to improve the functioning of the healthcare market, especially by producing more transparent information on cost and quality.

Hospital Service Changes in California: Trends, Community Impacts and Implications for Policy

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By the Staff of the Nicholas C. Petris Center | Published April 2005 by the Petris Center | Link to Full Report

While hospital closures have generated a great deal of media attention and community concern, hospitals have other possible responses to the difficult financial environment. This report focuses on one such response. Are hospitals changing their inpatient service offerings in order to improve their financial health? This study is a systematic look at the changes in services offered by California hospitals from 1995 to the 2002. It shows that over the study period there were several significant shifts in service patterns.  This report documents these changes and provides a systematic exploration of the possible explanations for what has happened in California’s hospital system.

Measuring Mental Health in California’s Counties: What Can We Learn?

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By Daniel Eisenberg, Nicole Bellows, Timmothy T. Brown, Richard M. Scheffler | Published in January 2005 by the Petris Center | Link to Full Report

This report provides the first county-level comparison of a detailed set of mental health-related measures in the general California population utilizing the first California Health Interview Survey (CHIS), which took place in 2001. The main questions are how do counties differ in terms of their population’s mental health status, service utilization, insurance coverage, availability of providers, and government financial resources? This report provides data and information on a series of mental health indicators that enable us to draw a picture of the mental health status throughout Califomia. These mental health indicators include the following: ‘doing less overall due to emotional problems,’ ‘doing one’s work less effectively due to depression or anxiety,’ ‘feeling downhearted and sad,’ ‘not feeling calm and peaceful,’ and ‘lacking energy.’

Is There A Doctor in the House? An Examination of the Physician Workforce in California

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By Janet Coffman, Brian Quinn, Timothy Brown, and Richard Scheffler | Published June 2004 by the Petris Center | Link to Full Report

This report presents important new findings about long-range trends in physician supply in California, as well as a snapshot of the state’s current physician workforce.