Overview of physician-hospital ventures

An ongoing environment of reimbursement lagging behind escalating expenses has led physicians to explore new sources of revenue. The goal of physician-hospital ventures is to create a valuable entity that benefits patients, physicians, and the hospital. Physicians may choose to invest in healthcare facilities to improve patient care and obtain increased control over daily operations. If so, they should seek counsel to avoid violating Stark laws and anti-kickback laws. Modalities for investing in physician-hospital ventures are joint equity (stock) ventures, participating bond transactions (PBTs), and contractual integration, a new method to align the goals of specialists and hospital management without using joint equity ventures. Physicians and management should invest time in developing a shared vision of the future before beginning contract negotiations. Successful partnering requires transparency and stepwise building of trust. The greatest gain in joint ventures arises when both sides become active owners, rather than passive investors.

Tobacco control policies and youth smoking: evidence from a new era

This chapter examines the impact of cigarette prices, taxes, and tobacco control policies on youth and young adult smoking propensity and intensity, in the U.S. during the years 1997-2001, a period characterized by significant changes in cigarette prices and tobacco control policies. Employing a fixed effects technique, we find a strong negative impact of cigarette prices and taxes on youth and young adult smoking prevalence and conditional demand. Moreover, we find purchase, use, and possession laws to be inversely related to youth and young adult smoking prevalence.

Taxing for stormwater drainage systems

This article evaluates the possibility of creating a tax for urban drainage in order to make the system self-financing. Average costs of implementation and maintenance of the services were used to individualize the charges and definition of the tax. The conventional drainage system was evaluated along with a source control alternative, water detention in tanks on the lot. The magnitude of the values being charged varies in function of the impermeable surface and the density of the urban area. Preserving creeks in natural conditions and using source control approach, are all options with the advantages of lower investment and smaller burden for the users.

Americans' views of the uninsured: an era for hybrid proposals

Data drawn from ten recent public opinion polls show that the issue of the uninsured is likely to become more visible on the U.S. agenda, although not as prominent as it was in the early 1990s. Although there is no public consensus on any single approach, a hybrid plan--which leaves workplace insurance in place and includes elements of several proposals now being discussed to cover more of the uninsured--offers the possibility of public support. The critical issue is whether or not there will be public support in the future for raising revenues to pay for major expansions in coverage.

Tobacco initiation, cessation, and change: evidence from Vietnam

Studies of the impact of tobacco prices on decisions to initiate and quit smoking have, to date, largely been restricted to developed countries. Such analyses, when set in developing countries, are complicated by the availability of a wide range of tobacco products that are nicotine substitutes for cigarettes. This study, which uses data from two rounds of the Vietnam Living Standards Survey in 1992-1993 and 1997-1998, finds evidence of substitution among tobacco products in response to changes in relative prices and points to the need for comprehensive tobacco-control strategies that are not restricted to cigarettes alone. We find that higher cigarette prices may not necessarily encourage quitting and may only divert cigarette smokers to rustic tobacco, which is potentially as harmful to human health as cigarettes.

Valuation of social and health effects of transport-related air pollution in Madrid (Spain)

Social impacts of pollutants from mobile sources are a key element in urban design and traffic planning. One of the most relevant impacts is health effects associated with high pollution periods. Madrid is a city that suffers chronic congestion levels and some periods of very stable atmospheric conditions; as a result, pollution levels exceed air quality standards for certain pollutants. This paper focuses on the social evaluation of transport-related emissions. A new methodology to evaluate those impacts in monetary terms has been designed and applied to Madrid. The method takes into account costs associated with losses in working time, mortality and human suffering; calculated using an impact pathway approach linked to CORINAIR emissions. This also allows the calculation of social costs associated with greenhouse gas impacts. As costs have been calculated individually by effect and mode of transport, they can be used to design pricing policies based on real social costs. This paper concludes that the health and social costs of transport-related air pollution in Madrid is 357 Meuro. In these circumstances, the recent public health tax applied in Madrid is clearly correct and sensible with a fair pricing policy on car use.

The role of public and private transfers in the cost-benefit analysis of mental health programs

This paper revisits the issue of whether to include maintenance costs in an economic evaluation in mental health. The source of these maintenance costs may be public or private transfers. The issue is discussed in terms of a formal cost-benefit criterion. It is shown that, when transfers have productivity effects, income distribution is important, and one recognizes that public transfers have tax implications, transfers can have real resource effects and cannot be ignored. The criterion is then applied to an evaluation of three case management programs in California that sought to reduce the intensive hospitalization of the severely mentally ill.

State tobacco excise taxes and adolescent smoking behaviors in the United States

The objective of the study described in this article was to examine the association between state cigarette excise taxes and smoking behaviors among youth in the United States. A survey was nationally mailed to adolescents in the Growing Up Today Study, an ongoing cohort of offspring of participants in the Nurses' Health Study II. A volunteer sample of 10,981 adolescent boy and girl participated in the Growing Up Today Study, who were 12 to 18 years old in 1999. Logistic regression was used to examine the relationship between state cigarette excise taxes (in quartiles) and experimentation (ever smoked) and established smoking (smoked at least 100 cigarettes in a lifetime). State tax levels in 1999 ranged from 2.5 to 100 cents. In a model that adjusted for age, gender, peer smoking, parental smoking, state clustering, state poverty level, and possession of tobacco promotional items, higher tax rates were associated with decreased odds of experimentation (test for trend p < 0.01). The highest quartile of tax (60-100 cents) was significantly associated with lower odds of experimentation (OR = 0.79; 95% CI, 0.64-0.98) and appeared protective against established smoking (OR = 0.80; 95% CI, 0.49-1.29). This study provides recent evidence that higher state cigarette excise taxes are associated with decreased experimental smoking among adolescent boys and girls. Higher state cigarette taxes may also be associated with lower odds of established smoking in this age group, although the association appears to be attenuated by peer and parental smoking. These results support the inclusion of tobacco taxes in state tobacco control programs.

Is incremental change working? Or is it time to reconsider universal coverage?

This Issue Brief was prepared for The Commonwealth Fund/John F. Kennedy School of Government Bipartisan Congressional Health Policy Conference, January 15-17, 2004.

How much downside? Quantifying the relative harm from tobacco taxation

OBJECTIVE

To estimate the loss of life expectancy attributable to tobacco taxation (via financial hardship and flow-on health effect) in New Zealand.

DESIGN

Data were used on the gradients in life expectancy and smoking by neighbourhood socioeconomic deprivation and survey data on tobacco expenditure. Three estimates were modelled of the percentage of the crude association of neighbourhood deprivation with life expectancy that might be mediated via financial hardship: 100%, 50%, and 25% (best estimate). From this information the impact of tobacco taxation on life expectancy was estimated.

MAIN RESULTS

For the total population, the estimated loss of life expectancy due to tobacco tax ranged from 0.005 years to 0.027 years. For people living in the most deprived 30% of neighbourhoods, the range was 0.009 to 0.044 years (that is, 3 to 16 days of lost life expectancy). For the total population the loss of life expectancy attributable to tobacco tax ranged from 119 to 460 times less than that attributable to deprivation. The loss of life expectancy attributable to tobacco tax was 42 to 257 times less than that attributable to smoking.

CONCLUSIONS

The estimated harm to life expectancy from tobacco taxation (via financial hardship) is orders of magnitude smaller than the harm from smoking. Although the analyses involve a number of simplistic assumptions, this conclusion is likely to be robust. Policy makers should be reassured that tobacco taxation is likely to be achieving far more benefit than harm in the general population and in socioeconomically deprived populations.

Health care fraud and abuse data collection program: technical revisions to Healthcare Integrity and Protection Data Bank data collection activities. Final rule

The rule finalizes technical changes to the Healthcare Integrity and Protection Data Bank (HIPDB) data collection reporting requirements by clarifying the types of personal numeric identifiers that may be reported to the data bank in connection with adverse actions. The rule clarifies that in lieu of a Social Security Number (SSN), an individual taxpayer identification number (ITIN) may be reported to the data bank when, in those limited situations, an individual does not have an SSN.

Alcohol and marijuana use among college students: economic complements or substitutes?

Previous research has shown that the recent tightening of college alcohol policies has been effective at reducing college students' drinking. Over the period in which these stricter alcohol policies have been put in place, marijuana use among college students has increased. This raises the question of whether current policies aimed at reducing alcohol consumption are inadvertently encouraging marijuana use. This paper begins to address this question by investigating the relationship between the demands for alcohol and marijuana for college students using data from the 1993, 1997 and 1999 waves of the Harvard School of Public Health's College Alcohol Study (CAS). We find that alcohol and marijuana are economic complements and that policies that increase the full price of alcohol decrease participation in marijuana use.