Seattle University Collaborative Projects - International Academy of ...

As diabetes continues to affect the population of the United States in epidemic proportions,public health officials from the various states have launched initiatives designed to curtail thestaggering toll in resulting diabetes complications, disability and mortality. In 2005 the NewYork City Board of Health approved the implementation of a diabetes registry, mandatinglaboratories to report all A1C levels of diabetic patients to the city’s Department of Health andMental Hygiene. The department would then contact those patients, whose A1C valuesexceeded the 8% marker (indicative of poor diabetes control) and their physicians to suggestmodifications to their course of treatment. Under established registry procedures, information iscollected without the patient’s explicit consent, using opt-out procedures. Although this initiativewas designed to cover the entire population in the city of New York, it was piloted first in alargely African- American and Hispanic- American community with high rates of diabetes.While disease registries are well recognized and accepted surveillance tools used in publichealth, the mandatory nature of this diabetes surveillance system raises issues of privacy, socialjustice and governmental authority to intervene in the clinical management of non-infectiousdiseases. This presentation will address the possible psychological impact of this chronic diseasemanagement measure on those affected by it: patients of ethnic and racial diversity, physiciansand the health care system in general, seeking to guide public health policy makers in the furtheruse of such registries in other states.Therapeutic Implications of Value-Based Insurance Design and Attaching“Value” to Health-Related BehaviorsAmy T. Campbell, SUNY Upstate Medical School (campbela@upstate.edu)“Value-based” behavior is increasingly sought when making health insurance coveragedecisions, including through use of financial (dis)-incentives. A longstanding approach, forexample, is to offer lower co-pays for generic (or “lower tier”) medications. However, thedemand for “value” in health insurance is growing given recent trends, including: a rise in theevidence base on which to base treatment decisions; the influence of behavioral economics inhealth care; and economic pressures across nations where health care systems face agingpopulations, a growth in expensive technology, and greater awareness of the role of preventiveand public health measures to address many health woes.In the US, “value based” purchasing has begun to take hold across the states (e.g., Oregon andConnecticut) and at the federal level. This presentation will discuss these trends and situate themwithin a global context. The emphasis, however, will not be on the merits per se of theseapproaches; rather, the goal will be to highlight how the term “value” may embed within it biasesor judgments masked behind the language of cost-effectiveness and data-driven (i.e., seemingly“objective” terms). Using obesity as a case study, this presentation will discuss the therapeuticimplications of adopting “value based” approaches (and terminology) in coverage decisions, andpotential disparate impact or unintended costs of adopting these approaches (e.g., costs to whom,as perceived by whom). Therapeutic jurisprudence will be offered as a potential means to486