Douglas Barthold, Ph.D., joined the Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute faculty in 2018, after completing a postdoctoral fellowship at the Schaeffer Center for Health Policy and Economics at the University of Southern California. He received his Ph.D. in Economics from McGill University in 2015, with a specialization in empirical health economics.
Doug is broadly interested in the relationships between health policies, healthcare utilization, and health outcomes and inequalities. His current research examines the intersection between health policies, chronic disease management, and cognition, from mid-life to end-of-life. This includes the role of health policies in the management of mid-life risk factors for Alzheimer’s disease and related dementias (ADRD), as well as the value of care for conditions that influence healthy aging.
It is plausible that mild cognitive impairment (MCI) and Alzheimer’s disease and related dementias (ADRD) may predispose certain older adults to differential receipt of both high and low value healthcare, which would have important consequences for patient health, health system waste, and societal welfare. While the Centers for Medicare and Medicaid Services (CMS) have called for programs and policies to promote value, a lack of evidence on the relationship between cognitive impairment and utilization of high and low value services remains a critical obstacle to targeting and implementing these policies for older adults, where MCI and ADRD are prevalent. This study examines these relationships in over two decades of data from the Health and Retirement Study (HRS) linked to Medicare claims, and finds that cognitive impairment is associated with a reduction in the use of both high and low value services. The unnuanced reduction in the use of services of both high and low and low value suggests that not enough attention is given to evidence-based recommendations.