Unbiased Analysis of Today's Healthcare Issues
A paper by Hanson et al. (2023) summarizes the Congressional Budget Office’s projections around US health insurance coverage between 2023-2033. They find that low rates of uninsurance due to provisions enacted to combat COVID-19 will not be sustained as these provisions expire: Temporary policies enacted in response to the COVID-19 pandemic have increased Medicaid and…
A Minnesota bill would expand the MinnesotaCare Medicaid system to incorproate a public option. The public option would reduce uninsurance rates, but would also have some negative impacts on providers. An FTI report (“Evaluating the Potential Impact of a Public Option on Minnesota’s Hospitals and Patients“) reviews the implications of the public option in Minnesota.…
A paper by Westrich et al. (2023) examines payer perceptions of five different value frameworks. Value frameworks of interest included: American Society of Clinical Oncology (ASCO) Value Framework, Drug Pricing Lab’s Drug Abacus (formerly Memorial Sloan Kettering Cancer Center’s Drug Abacus), Institute for Clinical and Economic Review (ICER) value assessment framework and evidence reports The…
In 2020, spending on specialty drugs was $265 billion; this constituted 49.6% of total prescription drug expenditure. To combat rising costs, payers have turned to white, brown and clear bagging as well as approaches to restrict the site of care where patients receive specialty drugs. What are these “bagging” policies, what are the pros and…
According to a 2022 CBO report, healthcare spending per person is much higher for commercially insured individuals than those insured by Medicare and this difference is largely drive by price differentials. Why are the outstanding research questions related to the prices commercial insurers pay providers? That is the topic of a recent Health Affairs article…
How well did payers provide “fair” access policies? Based on an recent ICER report titled “Assessment of Barriers to Fair Access“, the headline figures seem pretty good: Overall rates of concordance with ICER’s criteria were 70% for cost sharing of fairly-priced drugs, 96% for clinical eligibility criteria, 98% for step therapy, and 100% for provider…
According to a recent paper by Wallace (2023), the answer is ‘yes’, but it does so in a highly inefficient manner. Using 2008-2012 Medicaid data from the New York State Department of Health, the author find that: Leveraging the random assignment of over 50,000 Medicaid enrollees in New York, I present causal evidence that narrower…
Based on a study by Frankovic and Kuhn (2022), the answer is both. However, the value of increased innovation–as measured through longevity gains–more than offset inefficiencies from overspending. Specifically, the authors use an overlapping generations model where individuals can purchase health insurance and medical progress depends on health care sector return on investment. The authors…
Part of the Affordable Care Act mandated a medical loss ratio (MLR) for health plans in the individual and small group markets. What this means is that if the MLR is 80% and insurers charge $100 in premiums, plan enrollees must receive $80 in services on average. If they do not (say they only receive…
This is the paraphrased title of a paper by Fusco et al. (2023). The authors conduct a systematic literature review of studies published between 2010 and 2020 and find that among the 79 articles screened: The majority of publications found that, regardless of disease area, increased cost-sharing was associated with worse adherence, persistence, or discontinuation.…