Dana Goldman

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Dana P. Goldman
Dana Goldman 2012.png
Dana Goldman 2012
Born (1966-06-03) June 3, 1966 (age 58)
Academic career
Alma materStanford University (Ph.D.)

Dana Paul Goldman is the dean of the USC Price School of Public Policy, Leonard D. Schaeffer Chair and director of the University of Southern California Leonard D. Schaeffer Center for Health Policy and Economics, and Professor of Public Policy, Pharmacy, and Economics at the Price School and USC School of Pharmacy. He is also an adjunct professor of health services and radiology at UCLA, and a managing director and founding partner, along with Darius Lakdawalla and Tomas J. Philipson, at Precision Heath Economics, a health care consulting firm. Previously held positions include the director of the Bing Center for Health Economics, RAND Royal Center for Health Policy Simulation, and UCLA/RAND Health Services Research Postdoctoral Training Program.

Contents

Goldman is also the founding co-editor of the Forum for Health Economics and Policy and has been on the editorial board of Health Affairs, B.E. Journals of Economic Analysis and Policy, and the RAND Journal of Economics, among others. He is a health policy advisor to the Congressional Budget Office and, in 2009, was elected a member of the Institute of Medicine. He is also the 2009 recipient of the Eugene Garfield Economic Impact Prize, in recognition of his outstanding research on how medical research impacts the economy.

In 2022, Goldman was elected as a fellow of the National Academy of Public Administration. [1]

Education

He received his B.A. summa cum laude from Cornell University and a Ph.D. in Economics from Stanford University.

Use of drugs for chronic illness when co-payments are doubled

Data from the Centers for Disease Control and Prevention (CDC) revealed that chronic illness affected 133 million people in the United States and accounted for seven out of ten deaths. [2] In relationship to these numbers, the American Society of Health System Pharmacists say Americans spent $307.5 billion on pharmaceuticals in 2010. [3]

Research by Goldman, Joyce, Escarce, Pace, Soloman, Laouri, Landsman, and Teutsch (2001) studied the purchasing behavior of drugs used to treat eight chronic illnesses: diabetes, high blood pressure, high cholesterol, asthma, depression, allergies, arthritis, and stomach ulcers. This retrospective study presents a strong correlation between co-payment levels and medication use for these chronic illnesses. The study illustrated the change in consumption behaviors based on plan generosity and structure such as coinsurance rates and mandatory generic substitution. [4]

The study by Goldman et al. (2001) predicts there would be a significant decrease in medication utilization in all of the chronic disease categories examined when co-payments were doubled. However, of note, the researchers discovered that patients respond discriminatorily to changes in co-payment and are less likely to reduce consumption of disease specific medications and will reduce pharmacy spending in other medications. [4] Goldman, et al. (2001) exposed the largest decrease in drug spending when co-payments were doubled were in medications to treat arthritis and allergies.

The study revealed that patients with diabetes decreased their purchase of diabetes drugs the most compared to the other chronic illnesses examined when their co-payments doubled. [4]

The research by Goldman et al. (2001) reveals two points that could inform public policy related to pharmaceutical expenditures. One, consumption of over-the-counter drugs to treat allergies and arthritis are highly influenced by out of pocket spending. Two, diabetes patients may choose lifestyle behavior changes when faced with higher drug costs. [5]

Before changing payment structures, more research will be needed to examine adverse health consequences in the chronically ill if pharmaceutical interventions are limited by increasing out of pocket expenses. [6] For instance, emergency department utilization could rise in response to these changes.

The results of the study by Goldman et al. (2001) could inform public policy on ways to decrease excess drug usage when the benefits are less than the cost of the drug. [7]

Related Research Articles

<span class="mw-page-title-main">Medication</span> Substance used to diagnose, cure, treat, or prevent disease

A medication is a drug used to diagnose, cure, treat, or prevent disease. Drug therapy (pharmacotherapy) is an important part of the medical field and relies on the science of pharmacology for continual advancement and on pharmacy for appropriate management.

<span class="mw-page-title-main">Pharmacy</span> Clinical health science

Pharmacy is the science and practice of discovering, producing, preparing, dispensing, reviewing and monitoring medications, aiming to ensure the safe, effective, and affordable use of medicines. It is a miscellaneous science as it links health sciences with pharmaceutical sciences and natural sciences. The professional practice is becoming more clinically oriented as most of the drugs are now manufactured by pharmaceutical industries. Based on the setting, pharmacy practice is either classified as community or institutional pharmacy. Providing direct patient care in the community of institutional pharmacies is considered clinical pharmacy.

Prescription drug list prices in the United States continually are among the highest in the world. The high cost of prescription drugs became a major topic of discussion in the 21st century, leading up to the American health care reform debate of 2009, and received renewed attention in 2015. One major reason for high prescription drug prices in the United States relative to other countries is the inability of government-granted monopolies in the American health care sector to use their bargaining power to negotiate lower prices, and the American payer ends up subsidizing the world's R&D spending on drugs.

A copayment or copay is a fixed amount for a covered service, paid by a patient to the provider of service before receiving the service. It may be defined in an insurance policy and paid by an insured person each time a medical service is accessed. It is technically a form of coinsurance, but is defined differently in health insurance where a coinsurance is a percentage payment after the deductible up to a certain limit. It must be paid before any policy benefit is payable by an insurance company. Copayments do not usually contribute towards any policy out-of-pocket maximum, whereas coinsurance payments do.

In medicine, patient compliance describes the degree to which a patient correctly follows medical advice. Most commonly, it refers to medication or drug compliance, but it can also apply to other situations such as medical device use, self care, self-directed exercises, or therapy sessions. Both patient and health-care provider affect compliance, and a positive physician-patient relationship is the most important factor in improving compliance. Access to care plays a role in patient adherence, whereby greater wait times to access care contributing to greater absenteeism. The cost of prescription medication also plays a major role.

A chronic condition is a health condition or disease that is persistent or otherwise long-lasting in its effects or a disease that comes with time. The term chronic is often applied when the course of the disease lasts for more than three months. Common chronic diseases include diabetes, functional gastrointestinal disorder, eczema, arthritis, asthma, chronic obstructive pulmonary disease, autoimmune diseases, genetic disorders and some viral diseases such as hepatitis C and acquired immunodeficiency syndrome. An illness which is lifelong because it ends in death is a terminal illness. It is possible and not unexpected for an illness to change in definition from terminal to chronic. Diabetes and HIV for example were once terminal yet are now considered chronic due to the availability of insulin for diabetics and daily drug treatment for individuals with HIV which allow these individuals to live while managing symptoms.

<span class="mw-page-title-main">Krka (company)</span>

Krka, d. d., Novo mesto is an international generic pharmaceutical company with headquarters in Novo Mesto, Slovenia. In 2023, Krka Group's total sales amounted to 1.806 billion euros. The net profit of the Krka Group totalled €313.7 million. Krka sells products to more than 70 countries. In Slovenia the company has production sites in Ločna and Bršljin, Krško, Šentjernej and Ljutomer; several departments are spread across various parts of Ljubljana as well. Krka also has production and distribution centers in Russia, Poland, Croatia, and Germany. At the end of 2023, Krka Group had 12,753 employees.

Pharmacoeconomics refers to the scientific discipline that compares the value of one pharmaceutical drug or drug therapy to another. It is a sub-discipline of health economics. A pharmacoeconomic study evaluates the cost and effects of a pharmaceutical product. Pharmacoeconomic studies serve to guide optimal healthcare resource allocation, in a standardized and scientifically grounded manner.

Health is the state of complete physical, mental, and social well-being and a positive concept emphasizing social and personal resources, as well as physical capacities. This article lists major topics related to personal health.

Pharmaceutical policy is a branch of health policy that deals with the development, provision and use of medications within a health care system. It embraces drugs, biologics, vaccines and natural health products.

The healthcare reform in China refers to the previous and ongoing healthcare system transition in modern China. China's government, specifically the National Health and Family Planning Commission, plays a leading role in these reforms. Reforms focus on establishing public medical insurance systems and enhancing public healthcare providers, the main component in China's healthcare system. In urban and rural areas, three government medical insurance systems—Urban Residents Basic Medical Insurance, Urban Employee Basic Medical Insurance, and the New Rural Co-operative Medical Scheme—cover almost everyone. Various public healthcare facilities, including county or city hospitals, community health centers, and township health centers, were founded to serve diverse needs. Current and future reforms are outlined in Healthy China 2030.

The following outline is provided as an overview of and topical guide to medicine:

<span class="mw-page-title-main">Health in the United States</span> Overall health of the population of the United States

Health may refer to "a state of complete physical, mental and social well-being and not merely the absence of disease and infirmity.", according to the World Health Organization (WHO). 78.7 was the average life expectancy for individuals at birth in 2017. The highest cause of death for United States citizens is heart disease. Sexually transmitted infections impact the health of approximately 19 million yearly. The two most commonly reported infections include chlamydia and gonorrhea. All 50 states in the U.S. require immunizations for children in order to enroll in public school, but various exemptions are available by state. Immunizations are often compulsory for military enlistment in the United States.

Trinidad and Tobago operates under a two-tier healthcare system. That is, there is the existence of both private and public facilities.

Rob Horne is Professor of Behavioural Medicine at the School of Pharmacy, University College London (UCL). In September 2006, he founded the Centre for Behavioural Medicine at UCL, which he continues to lead. Horne was designated a Fellow of the Royal College of Physicians Faculty of Pharmaceutical Medicine in 2013 and is a founding fellow of the Royal Pharmaceutical Society of Great Britain. He was appointed as a National Institute for Health Research (NIHR) Senior Investigator in 2011. He is an internationally recognised expert in self-management of chronic illness and adherence to medications.

Specialty drugs or specialty pharmaceuticals are a recent designation of pharmaceuticals classified as high-cost, high complexity and/or high touch. Specialty drugs are often biologics—"drugs derived from living cells" that are injectable or infused. They are used to treat complex or rare chronic conditions such as cancer, rheumatoid arthritis, hemophilia, H.I.V. psoriasis, inflammatory bowel disease and hepatitis C. In 1990 there were 10 specialty drugs on the market, around five years later nearly 30, by 2008 200, and by 2015 300.

Specialty pharmacy refers to distribution channels designed to handle specialty drugs — pharmaceutical therapies that are either high cost, high complexity and/or high touch. High touch refers to higher degree of complexity in terms of distribution, administration, or patient management which drives up the cost of the drugs. In the early years specialty pharmacy providers attached "high-touch services to their overall price tags" arguing that patients who receive specialty pharmaceuticals "need high levels of ancillary and follow-up care to ensure that the drug spend is not wasted on them." An example of a specialty drug that would only be available through specialty pharmacy is interferon beta-1a (Avonex), a treatment for MS that requires a refrigerated chain of distribution and costs $17,000 a year. Some specialty pharmacies deal in pharmaceuticals that treat complex or rare chronic conditions such as cancer, rheumatoid arthritis, hemophilia, H.I.V. psoriasis, inflammatory bowel disease (IBD) or Hepatitis C. "Specialty pharmacies are seen as a reliable distribution channel for expensive drugs, offering patients convenience and lower costs while maximizing insurance reimbursements from those companies that cover the drug. Patients typically pay the same co-payments whether or not their insurers cover the drug." As the market demanded specialization in drug distribution and clinical management of complex therapies, specialized pharma (SP) evolved.„ Specialty pharmacies may handle therapies that are biologics, and are injectable or infused. By 2008 the pharmacy benefit management dominated the specialty pharmacies market having acquired smaller specialty pharmacies. PBMs administer specialty pharmacies in their network and can "negotiate better prices and frequently offer a complete menu of specialty pharmaceuticals and related services to serve as an attractive 'one-stop shop' for health plans and employers."

Value-based insurance design is a demand-side approach to health policy reform. V-BID generally refers to health insurers' efforts to structure enrollee cost-sharing and other health plan design elements to encourage enrollees to consume high-value clinical services – those that have the greatest potential to positively impact enrollee health. V-BID also discourages the use of low-value clinical services – when benefits do not justify the cost. V-BID aims to increase health care quality and decrease costs by using financial incentives to promote cost efficient health care services and consumer choices. V-BID health insurance plans are designed with the tenets of "clinical nuance" in mind. These tenets recognize that medical services differ in the amount of health produced, and the clinical benefit derived from a specific service depends on the consumer using it, as well as when and where the service is provided.

Travel health nursing is a nursing specialty which promotes the health and safety of national and international travelers. Similar to travel medicine, it is an interdisciplinary practice which draws from the knowledge bases of vaccines, epidemiology, tropical medicine, public health, and health education. Travel nursing has experienced an increase in global demand due to the evolution of travel medicine. Travel health nursing was recognized during the 1980s as an emerging occupation to meet the needs of the traveling public, and additional education and training was established. Travel health nurses typically work in "private practice, hospital outpatient units, universities, the government, and the military", and have more opportunities and leadership roles as travel has become more common. However, they also experience organizational and support-related conflicts with general practitioners and patients in healthcare settings.

References

  1. Incorporated, Prime. "National Academy of Public Administration". National Academy of Public Administration. Retrieved 2023-02-13.
  2. Centers for Disease Control and Prevention. Chronic diseases. The power to prevent, the call to control: at a glance 2009. Retrieved from https://www.cdc.gov/chronicdisease/resources
  3. American Society of Health-System Pharmacists. (2012). Retrieved from http://www.ajhp.org/DocLibrary/Advocacy
  4. 1 2 3 Goldman, D.; Joyce, G.; Escarce, J.; Pace, J.; Soloman, M.; Laouri, M.; Landsman, P.; Teutsch, S. (2001). "Pharmacy benefits and the use of drugs by the chronically ill". Journal of the American Medical Association. 291 (19): 2344–2350. doi: 10.1001/jama.291.19.2344 . PMID   15150206.
  5. Folland, S, Goodman, A., and Stano, M. (2010). The economics of health and health care. (6th ed). Boston, MA. Prentice Hall
  6. Soumerai, S. and Ross-Degnan. (1999, March 4). Inadequate prescription-drug coverage for medicare enrollees – a call to action. New England Journal of Medicine. 340. 722–728
  7. Lexchin, J.; Grootendorst, P. (2004). "Effects of prescription drug user fees on drug and health services use and on health status in vulnerable populations: a systematic review of the evidence". International Journal of Health Services. 34 (1): 101–122. doi:10.2190/4m3e-l0yf-w1td-ekg0. PMID   15088676. S2CID   30613140.