Accomplishments in the past
36 months:
Economist Dewar’s research on end-of-life care and healthcare costs contributes to CSDA’s signature theme on health and health disparities. Her emphasis is not only on the economic costs of different types of healthcare, but also on the health outcomes associated with them, making her research highly relevant to the goals of Healthy People 2010. An important strand of Dewar’s work has focused on evaluating the Health Care Reform Act of 1996 in New York State. One conclusion is that managed care and the competitive reimbursement system did indeed result in cost savings as a result of decreased use of hospital resources, but they also led to poorer long-term health outcomes and greater numbers of discharges to skilled nursing facilities. For patients who remained in the hospital, however, increased use of social workers and case-management interventions improved hospital survival rates. Overall, then, managed care did not have a simple effect on health outcomes. As the U.S. population continues to age, studies of how to best reconcile health care costs with first-rate care will be crucial.
In other work, Dewar analyzes gender differentials in health-care costs, including the costs associated with living with an abusive partner, and in critical-care utilization. She has also studied the benefits of using high-cost life-saving technology among the aged. Dewar has recently published work on the impact on managed care and competitive hospital reimbursements on survival for patients (Critical Care Medicine, 2003) and on end-of-life care (Quarterly Journal of Cost and Quality, 2004).
She is recognized as an expert in the field of health economics, as reflected by her service on scientific review panels for the Agency for Healthcare Research and Quality and for the American Society for Health Economics, as well as her activities in the American Public Health Association
.
Externally funded work
Dr. Dewar is currently serving as a Co-Investigator on the Prevention Center grant to the School of Public Health. In addition, she is the Director of economic evaluation for a Kaiser Foundation grant studying coordinated care for the elderly, as well as a Co-Investigator on a current project focusing on cost effectiveness of primary care for the elderly funded through Langeloth Foundation. She has recently has begun work on a project funded by NIJ to evaluate an intervention concerning violence and children entitled “A randomized trial of Health Families New York.”
Work in progress and
pending/planned research projects
Dewar has an article forthcoming in Review of Social Economy on the feasibility of a single-payer health-care system in the U.S., two chapters forthcoming in the Encyclopedia of Epidemiology (one dealing with health economics and the other dealing with economic evaluations), and a forthcoming book (and workbook) tentatively entitled Essentials of Public Health Economics. Her pending grant (Robert Wood Johnson) will examine palliative care use and costs.
Contribution to the
population research program
Dewar’s training in health economics and her research on the end of life represent a significant contribution relating to the CSDA theme of health and health disparities. She helps to bridge the public-health and social-science worlds in Albany by her activities at CSDA. During 2004-05 she was the co-coordinator of the Center’s colloquium series. She is leading a CSDA-funded working group on end-of-life issues that brings together faculty from the Schools of Public Health and Social Work and from the Department of Sociology, along with professionals from local agencies.
Dewar uses the computing infrastructure, statistical consultation, and administrative resources provided by the Center in the preparation of grant applications and for grant administration. During a recent year, she was allocated a research office at CSDA to increase her contacts with the core population researchers.