Harkness Project: A Tiger with Teeth: Evaluating and Monitoring the Ethical Implications of Health Care Payment Reform
Placement: New England Journal of Medicine
Mentors: Thomas H. Lee, M.D., professor and network president, Partners Health Care System; and Gregory D. Curfman, M.D., executive editor, New England Journal of Medicine
Biography at time of Harkness Fellowship: Nikola Biller-Andorno, M.D., Ph.D., a 2012-13 Swiss Harkness Fellow in Health Care Policy and Practice, is professor and chair of biomedical ethics at University of Zurich, where she also founded and directs the Institute of Biomedical Ethics. Currently she is leading a grant on the impact of diagnostic-related groups (DRGs) on patient care and professional practice in Switzerland. Biller-Andorno is also immediate past-president of the International Association of Bioethics, and an adviser to a national pilot project on evidence-based, transparent health care priority-setting. Previously, she worked on issues around organ transplantation, regulation of biobanks, and use of human subjects in health research in the then-new department of Ethics, Trade, Human Rights and Health Law at the World Health Organization. Prior to this, she was a visiting scholar at Yale in the Humanities in Medicine Program, and a post-doctoral research fellow in anesthesia and pain management at Harvard Medical School. Biller-Andorno has many peer-reviewed publications including in Lancet, Bioethics, and British Journal of General Practice. Biller-Andorno holds an M.D. from the University of Erlangen Medical School and a Ph.D. in philosophy from the University of Hagen.
Current Project Abstract: Biller-Andorno will investigate aspects of the Affordable Care Act that raise ethical concerns, particularly related to how accountable care organizations (ACOs) will balance the tension between containing costs, ensuring high quality care, and improving population health. She will explore three primary research questions: 1) whether incentives to foster cost-efficiency (e.g. ACOs) can compromise the goals of patient-centered care and fair access; 2) whether performance indicators address ethical concerns about the quality and fairness of health care delivery; and 3) how ethical concerns can be integrated in performance measurements. A significant part of this study will be analytical, and will rely mainly on literature analysis, complemented by interviews with health policy experts, health economists, health care managers, and ethicists. A selection of ACOs will be studied in more detail to explore the spectrum of different incentive and measurement schemes.
Career Activity Since Fellowship:
Current Position:
- Professor and Chair, Biomedical Ethics and Founding Director, Institute of Biomedical Ethics, University of Zurich
Email: [email protected]
Harkness-Related Publications
Biller-Andorno N, Zeltner T. “Individual Responsibility and Community Solidarity — The Swiss Health Care System,” New England Journal of Medicine, 2015.
Biller-Andorno N, Lee T. “Ethical Physician Incentives — From Carrots and Sticks to Shared Purpose” New England Journal of Medicine, 2013.
Boudreau JD, Somerville MA, Biller-Andorno N, “Clinical Decisions: Physician-Assisted Suicide,” New England Journal of Medicine, 2013.