Unbiased Analysis of Today's Healthcare Issues
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…
According to a recent paper by Doshi et al. (2023), the answer is ‘yes‘! Why do people think otherwise? Many people are concerned that there may not be a sustainable way for the private group insurance market, particularly in small self-insured firms, to cover gene therapies? If a firm—particularly a smaller, self-insured firm—gets one or…
Copay cards are somewhat controversial. These cards or coupons are used to help patients afford copayments and deductible payments patients owe when using pharmaceuticals. On the one hand, these programs are highly beneficial for patients. Patient out-of-pocket costs have risen dramatically in recent years, even among the insured. For instance, whereas only 7% of workers…
Adverse selection is a classic problem in health insurance. If you offer insurance to individuals, you may want to set the premiums based on the average price of the population you plan to cover. At this price, however, the sickest patients are the ones most likely to take up insurance and the health insurer’s expenses…
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…
In many markets, however, we observe that lower income individuals do not purchase the most generous forms of health insurance. For instance, despite the passage of the Affordable Care Act–which provided subsidies to lower income individuals to purchase relatively generous insurance–some individuals preferred the less generous Association Health Plans (AHPs) also known as “skinny” health…
Many countries allow private plans to administer health insurance benefits but with restrictions on premiums and with the potential for risk adjusted government payments based on the health of a health plan pool For instance, Belgium , Germany, Israel, the Netherlands and Switzerland all have mandatory health insurance schemes; Ireland and Australia have voluntary health…
From a recent article in NBER by Dunn et al. (2021): Observing the back-and-forth sequences of claims’ denials and resubmissions for past visits, we can estimate physicians’ costs of haggling with insurers to collect payments. Combining these costs with the revenue never collected, we estimate that physicians lose 17% of Medicaid revenue to billing problems,…
Last week I reviewed a paper the sought to understand why people don’t buy health insurance. A key finding was that there health insurance purchase was correlated with income, but not perfectly. One reason was that the cost of other goods–especially housing–affected individuals ability to purchase insurance. The paper was getting at whether health insurance…
In 2010, Premera Blue Cross (Premera), a large nonprofit health plan in the Pacific Northwest implemented a value-based formulary design for its beneficiaries. In essence, enrollees could purchase high-value treatments for low copayments and low-value treatments for higher copayments. Can we use this change from more standard to value-base formulary designs to estimate the price elasticity…