Unbiased Analysis of Today's Healthcare Issues
If you go to the doctor or dentist in the US, you often can get a discount if you pay out of pocket as compared to paying through insurance. Why is that the case? Wouldn’t the physician like to get a big insurance company to pay them as compared to potentially incurring credit card fees…
Patients hate narrow networks. Anything that limits their choice of physicians or hospitals is disliked. Americans love more choice. Payers, on the other hand, like narrow networks because they save cost–through the ability to negotiate lower rates–and potentially increase quality–if the contracted network has higher quality physicians. In fact, according to the KFF Employer Health…
The Congressional Budget Office (CBO) recently released projections of US health insurance levels between 2024 and 2034. In the Hale et al. (2024) study, CBO estimates that: …92.3 percent of the US population, or 316 million people, have coverage in 2024, and 7.7 percent, or 26 million, are uninsured. The uninsured share of the population…
How does Medicare Advantage market share impact skilled nursing facility (SNF) profitability? That is the question asked by Marr and Shen (2024). Using data from Medicare SNF cost reports, LTCFocus.org data, and county MA penetration rates, the authors use an ordinary least squares regression with SNF and year fixed effects examining how MA penetration impacts…
Medical debt in the U.S. is a major problem. While over 90% of individuals have health insurance, many people are uninsured and even those with insurance may be liable to high deductibles and copayments. A Kaiser Family Foundation (KFF) analysis uses data from Survey of Income and Program Participation (SIPP) and finds that: …20 million…
Medicare Advantage (MA) plans have a number of advantages and drawbacks over traditional Medicare (TM) (i.e., fee-for-service). One advantage of MA plans is that cost sharing is often lower. Another benefit is that enrollees may receive additional coverage benefits. One drawback is that enrollee provider choice may be restricted. Fewer provider options may be bad…
One reason is that reimbursement rates for Medicaid are lower than for Medicare or commercial insurance. Another (often overlooked) factor, however, is physician’s risk of payment denials and the administrative hassle they face trying to get reimbursed by Medicaid. A paper by Dunn et al. (2024)–cleverly named “A Denial a Day Keeps the Doctor Away“–shows…
Many researchers are interested in how cost sharing impacts health care utilization, cost and patient outcomes. This is especially true as high-deductible health plans (HDHP) have become more common in the US. In 2023, 29% of covered workers in the US had a HDHP. One helpful type of data for analyzing HDHPs is claims data.…
Medicaid policies vary from state-to-state. With the advent of new, GLP-1 medications (and others) to treat obesity and overweight, there are potentially significant health benefits to be gained. However, are State Medicaid Agencies actually covering these medications? This is the question asked by Liu et al. (2024). They use data from public state Medicaid formulary…
Perhaps so according to the health policy editor at the Guardian. He writes that as NHS has grown weaker, private medical insurance is becoming a more attractive option. The long delays for NHS care that are now endemic – and cause so much worry, risk and harm to those left waiting – are not going…