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New postings and analysis from Health Affairs, the leading journal of health policy. Health Affairs publishes new research each week online at For more information, contact Chris Fleming at 301-347-3944.

Consumer-Directed Plans Can Save Money; Quality Effects Still Uncertain

Early returns suggest that "consumer-directed" health plans can restrain health care costs and utilization, but whether these high-deductible plans can accomplish this without deterring consumers from seeking needed care is still up for debate. So report economist Melinda Beeuwkes Buntin and colleagues at RAND in a lead paper of a seven-article Health Affairs Web-Exclusive package on consumer-directed health care, published October 24 on the journal's Web site with the support of the California HealthCare Foundation.

In a second paper, Jill Yegian, the CHCF health insurance director, presents concrete steps that could prevent the increased cost sharing in consumer-directed plans from harming the chronically ill.

In Oregon, Enforcement Pullback Hinders Translation Of Evidence Into Practice

Oregon has been a leader in studying the comparative effectiveness of prescription drugs, but the state's efforts to translate this research into clinical practice changes in its Medicaid program have been hampered by an enforcement retreat. So report Oregon State's Daniel Hartung and coauthors in the Sep/Oct Health Affairs. When Oregon required physicians prescribing drugs not on the state's preferred drug list to specify "dispense as written," the result was a 28 percent shift in market share toward preferred drugs in affected classes. A later requirement that physicians prescribing non-preferred drugs listen to an educational message about comparative effectiveness evidence produced another 43 percent market-share shift to preferred agents. But when both requirements were revoked in October 2003, the shifts in market share were largely reversed, Hartung and coauthors say.

Print editions of Health Affairs may be ordered for $35 each from Health Affairs' Customer Service at 301-347-3900 or online at

Biotech Pricing Debated on Health Affairs Blog:

James Robinson, professor of economics, University of California, Berkeley, writes: "The biotechnology industry has grounds for complaint. The research pipeline is disgorging breathtaking new treatments for cancer, rheumatoid arthritis, multiple sclerosis, and other once-intractable diseases. But instead of praise, or in addition to praise, the industry finds itself subjected to ever-louder criticism of prices and earnings."

Ian Spatz, Merck Vice President for Public Policy, writes: "Some have suggested that government intervention is necessary" in pricing biotech therapies with no close substitutes. The better alternative, Spatz argues, is "purchaser- and patient-driven cost-effectiveness evaluation. ...Where such evaluations are not available, comparisons to interventions that provide similar benefits and that have themselves developed cost-effectiveness data may be appropriate to establish pricing."

Leighton Read, partner at Alloy Ventures, writes: "Let's introduce a better framework for purchasing medical innovation that is set to begin enough years in the future that investors in the long-lead-time technologies can adjust to the new signals (and will not need to expend their political capital to derail these changes). This system will pave the way for wider and faster adoption of medical innovation demonstrating objective value for money that exceeds some pay-line on a cost-per-QALY yardstick that is reasonably consistent with trade-offs we make elsewhere in our economy.

Coming Monday on the Blog: Drew Altman, president and CEO of the Henry J. Kaiser Family Foundation, and Robert Blendon, Harvard Professor of Health Policy and Management, say it's "Time for a Wake-Up Call on Health Reform."


Health Affairs, published by Project HOPE, is the leading journal of health policy. The nonpartisan, peer-reviewed journal appears bimonthly in print, with additional online-only papers published weekly as Health Affairs Web Exclusives at The full text of each Health Affairs Web Exclusive is available free of charge to all Web site visitors for a two-week period following posting, after which it switches to pay-per-view for nonsubscribers. The abstracts of all articles are free. The Sep/Oct 2006 issue was supported principally by the Blue Shield of California Foundation with additional support from Amgen and Genentech. Web Exclusives are supported in part by a grant from the Commonwealth Fund.


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