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The Cost Of Health Care

Published: March 20, 2017

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A new face in Health Care Administration knows that the U.S spends more than 17.5 percent of its gross domestic product on health care. However, with what results?

Yang Lu, who joined the university in the fall of 2016, points out that level of expenditure is more than what other developed countries spend but with less benefit.

“We’re spending a lot more money for less care,” she said. “Now, health care is starting to pay more attention to self-management and prevention.”

Lu focuses on reducing health disparities in patient safety and improving health outcomes in vulnerable patient populations with chronic conditions such as children with type 1 diabetes.

“Diabetes and heart disease are my research interests,” she said. “For one of the projects, we work with diabetes patients from low-resource areas in Los Angeles County to try to make them more adherent to preventive services.”

The weight of numbers pointed Lu to studying chronic conditions. “Many Americans are burdened with chronic conditions. For example, 12-14 percent of the U.S. adults have diabetes. Another 36 percent have pre-diabetes,” she explained. “The American health care system is usually about treating a disease once it has happened. Can we instead encourage proactive preventions for chronic conditions and their accompanying complications?

“If you manage diabetes, you can live a pretty normal life,” she added. “But if your blood glucose is way out of whack, any body part might be permanently damaged. People could lose their vision or legs due to ill-managed diabetes. Low-income, less-educated patients such as those treated at county hospitals tend to suffer more from such diabetes-related complications. Their constraints include limited access to care and the pressure of making a living. When can they afford the time to see a doctor or go to for a recommended screening procedure? It is key to convincing people to do more preventive care then waiting before it all gets too bad and ending up in urgent care. That is why chronic condition management with a real understanding of patients’ constraints is so important.”

Lu joins CSULB after working at the RAND Bing Center for Health Economics before moving to USC’s Children Hospital in Los Angeles as an assistant professor of research from 2010-13 then as an assistant professor in residence at the Harbor-UCLA Medical Center from 2013-16.

“I was trained in health policy and health economics, where I gained experience to perform analyses with large data such as Medicare claims to evaluate health behaviors and health outcomes,” she said. “Does the level of cost sharing affect patients’ level of adherence to medication use?”

Lu also has an on-going study that looks at such chronic condition management as congenital heart disease in emerging young adults.

“When I worked at the USC Children’s Hospital Los Angeles, I started studying young patients as they grew into adulthood after surviving severe congenital problems,” she recalled. “Sometimes you have gaps in insurance. What if these kids could be insured continually? Would that help them do better?”

As part of that project, Lu looked at how young people can learn to self-manage such chronic conditions as type 1 diabetes. “We focus on vulnerable populations such as teens, young adults and ethnic minorities,” she said. Another extension of her work is with low-income individuals in Los Angeles County in collaboration with clinicians and researchers from the Los Angeles County Department of Health Services and Harbor-UCLA Medical Center.

“There are diabetes-related complications such as retinopathy which carries the possibility of permanent eye damage,” she said. “We want to know more about the shortage in the supply of eye care specialists such as ophthalmologists. It is challenging to get many patients to come in for screening every year. We look at innovative ways to get that done in a primary care office. What if staff could be trained to screen the patients and have the photos read remotely by ophthalmologists? Who needs to be screened first? They could be called in ahead of schedule.”

Lu earned her Ph.D. in Policy Analysis from Pardee RAND Graduate School in Santa Monica in 2009; an MPP from University of Maryland-College Park; and a Bachelor of Law degree from the University of International Business and Economics in Beijing.

What is next on her research horizon is a study of how patients respond differently to “black box warnings” on drug labels that warn about a drug’s most severe, sometimes life-threatening, potential side effects.

“What interests me especially is whether there are any racial/ethnic disparities in learning about important bad news,” she said, “and how socio-economic status or level of health literacy might contribute to those potential disparities.”