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"Robinson, James C."
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An Introduction to Ordinary Differential Equations
This refreshing, introductory textbook covers both standard techniques for solving ordinary differential equations, as well as introducing students to qualitative methods such as phase-plane analysis. The presentation is concise, informal yet rigorous; it can be used either for 1-term or 1-semester courses. Topics such as Euler's method, difference equations, the dynamics of the logistic map, and the Lorenz equations, demonstrate the vitality of the subject, and provide pointers to further study. The author also encourages a graphical approach to the equations and their solutions, and to that end the book is profusely illustrated. The files to produce the figures using MATLAB are all provided in an accompanying website. Numerous worked examples provide motivation for and illustration of key ideas and show how to make the transition from theory to practice. Exercises are also provided to test and extend understanding: solutions for these are available for teachers.
eBook
Increases In Consumer Cost Sharing Redirect Patient Volumes And Reduce Hospital Prices For Orthopedic Surgery
Some employers are implementing reference-pricing benefit designs, which establish limits on the amount they will pay for some procedures covered by employer-sponsored insurance. Employees are required to pay the difference between the employer's contribution limit and the actual price received by the hospital. These initiatives encourage patients to select low-price facilities and indirectly encourage facilities to reduce prices to increase patient volume. We evaluated the impact of reference pricing on the use of and prices paid for knee and hip replacement surgery by members of the California Public Employees' Retirement System (CalPERS) from 2008 to 2012, using enrollees in Anthem Blue Cross as a comparison group. In the first year after implementation, surgical volumes for CalPERS members increased by 21.2 percent at low-price facilities and decreased by 34.3 percent at high- price facilities. Prices charged to CalPERS members declined by 5.6 percent at low-price facilities and by 34.3 percent at high-price facilities. Our analysis indicates that in 2011 reference pricing accounted for$2.8 million in savings for CalPERS and $ 0.3 million in lower cost sharing for CalPERS members. [PUBLICATION ABSTRACT]
Journal Article
Why Is Aducanumab Priced at $56,000 per Patient? Lessons for Drug-Pricing Reform
Aducanumab’s price can inform the drug-pricing policy debate because it responds to key features of the market environment for physician-administered drugs: Medicare’s reimbursement formula, payment to physicians for infused drugs, and cost-sharing requirements.
Journal Article
How Industrial Policy Could Accelerate Innovation In The Life Sciences
The US is expanding public investment in the technology-based industries, including the life sciences, in a move driven by anger, fear, and hope. Anger at high drug prices is leading to downward pressures and eroding traditional private-sector funding for research and development, fear of China's technological and political ambitions is creating bipartisan support for intervention, and the successful development of COVID-19 vaccines has spurred hope for analogous publicly funded breakthroughs in other therapeutic domains. The instruments of industrial policy used by other nations include grants for scientific research, equity investments in start-ups, tax incentives for corporate research and development, credit guarantees for asset-intensive sectors, governmental procurement, and product pricing. In the face of ever-stronger competition, if the US is to retain its leading position in the life sciences, public policy must consider competition among nations as well as among firms. This article analyzes emerging innovation and industrial policy in the three principal sectors in the life sciences: research universities and laboratories; entrepreneurial startups and \"scale-ups,\" and large pharmaceutical and medical device corporations.
Journal Article
Lower Prices and Greater Patient Access — Lessons from Germany’s Drug-Purchasing Structure
The German system for determining drug prices features collective negotiations on the part of competing health plans. It also creates incentives for agreement, limits price increases not justified by new evidence, and avoids heavy burdens on physicians and patients.
Journal Article
Germany's Use Of Reference Pricing For Biologics: Lessons For The US
A redesign of consumer cost sharing in the United States is important to accelerate the adoption of biosimilars and price reductions for biologics. This article analyzes therapeutic reference pricing for antiinflammatory biosimilars in Germany and its implications for the United States. The German experience demonstrates that a redesign of consumer cost sharing can achieve savings for payers without creating onerous financial barriers for patients. In contrast, the dominant coinsurance structure of cost sharing in the US creates strong incentives for patients to abandon treatment, especially for serious illnesses treated by complex biologics, and only weak incentives to compare prices among therapeutically equivalent products. The Medicare Payment Advisory Commission (MedPAC) has advocated that the Centers for Medicare and Medicaid Services adopt a variant of reference prices for biologics, their related biosimilars, and therapeutically similar branded alternatives by assigning them the same billing code or by paying a similar rate for all the products. The German experience demonstrates that the proposed MedPAC approach is technically feasible and would generate savings for payers without imposing access obstacles on patients.
Journal Article
The Navier–Stokes regularity problem
There is currently no proof guaranteeing that, given a smooth initial condition, the three-dimensional Navier–Stokes equations have a unique solution that exists for all positive times. This paper reviews the key rigorous results concerning the existence and uniqueness of solutions for this model. In particular, the link between the regularity of solutions and their uniqueness is highlighted. This article is part of the theme issue ‘Stokes at 200 (Part 1)’.
Journal Article
Hospital Prices for Physician-Administered Drugs for Patients with Private Insurance
Hospitals can leverage their position between the ultimate buyers and sellers of drugs to retain a substantial share of insurer pharmaceutical expenditures.
In this study, we used 2020-2021 national Blue Cross Blue Shield claims data regarding patients in the United States who had drug-infusion visits for oncologic conditions, inflammatory conditions, or blood-cell deficiency disorders. Markups of the reimbursement prices were measured in terms of amounts paid by Blue Cross Blue Shield plans to hospitals and physician practices relative to the amounts paid by these providers to drug manufacturers. Acquisition-price reductions in hospital payments to drug manufacturers were measured in terms of discounts under the federal 340B Drug Pricing Program. We estimated the percentage of Blue Cross Blue Shield drug spending that was received by drug manufacturers and the percentage retained by provider organizations.
The study included 404,443 patients in the United States who had 4,727,189 drug-infusion visits. The median price markup (defined as the ratio of the reimbursement price to the acquisition price) for hospitals eligible for 340B discounts was 3.08 (interquartile range, 1.87 to 6.38). After adjustment for drug, patient, and geographic factors, price markups at hospitals eligible for 340B discounts were 6.59 times (95% confidence interval [CI], 6.02 to 7.16) as high as those in independent physician practices, and price markups at noneligible hospitals were 4.34 times (95% CI, 3.77 to 4.90) as high as those in physician practices. Hospitals eligible for 340B discounts retained 64.3% of insurer drug expenditures, whereas hospitals not eligible for 340B discounts retained 44.8% and independent physician practices retained 19.1%.
This study showed that hospitals imposed large price markups and retained a substantial share of total insurer spending on physician-administered drugs for patients with private insurance. The effects were especially large for hospitals eligible for discounts under the federal 340B Drug Pricing Program on acquisition costs paid to manufacturers. (Funded by Arnold Ventures and the National Institute for Health Care Management.).
Journal Article
Competition From Biosimilars Drives Price Reductions For Biologics In The French Single-Payer Health System
France has a single-payer health insurance system that has the authority to impose pharmaceutical price reductions but relies on decentralized market negotiations between hospitals and manufacturers to establish prices for injected and infused biologics. Hospitals rely on biosimilars-less expensive but therapeutically equivalent variants of biologic medications-to stimulate competition. Price reductions negotiated by hospitals subsequently are adopted by the health insurance system, driving hospitals to negotiate a new round of discounts. This article measures 2004-20 trends in prices, price reductions, utilization, and market shares for three prominent biologics-Remicade, Enbrel, and Humira-and their eleven competing biosimilars. Biosimilar launches are associated with a sequence of price reductions for the reference biologic, for other biologics that treat similar conditions, and for all related biosimilars. The French experience provides lessons for the US in its efforts to use competition from biosimilars to drive price reductions and savings from biologics.
Journal Article