Unbiased Analysis of Today's Healthcare Issues
That is the topic from a recent study by Hayes et al. (2024): Payments for some diagnostic scans undertaken in outpatient settings were unbundled from Diagnosis Related Group based payments in England in April 2013 to address under-provision. Unbundled scans attracted additional payments of between £45 and £748 directly following the reform. We examined the…
A paper by Kogut (2024) has a nice overview of the organizations that develop pharmacy plan quality metrics. Pharmacy plan quality is vital since approximately 85% of the US population has prescription drug coverage through public (e.g., Medicare , Medicaid) or commercial (e.g., employer-provided) pharmacy plans. A helpful summary table is below. Quality measures are…
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…
A great paper by Gruber et al. 2023 looks at the evolution of long-term care for ten countries: Canada, Denmark, England, Germany, Italy, Japan, the Netherlands, Singapore, Spain and the United States. Long-term care is divided into three categories: institutional care, formal home care, and informal care. For the 10 countries examined, the paper finds…
In countries that have universal health insurance, but limited patient out-of-pocket costs for public hospital services, non-urgent hospital treatment often has a waiting list in public hospitals. To address this issue, some countries (e.g., UK, Canada) use strategies such as setting maximum wait targets, monitoring provider performance, or adding public funding; other countries (e.g., Australia,…
That is according to an article in JAMA based on a report from the Center for Healthcare Quality and Payment Reform. The report states: More than half (55%) of the rural hospitals in the U.S. do not offer labor and delivery services, and in 10 states, more than two-thirds do not. Over the past decade,…
That is the title of a paper by Bodnar et al. 2023. A summary of this interesting paper is below. Overview of general practitioners in the UK Under the English National Health Service (NHS) program, …patients register with a single general practice that acts as the gatekeeper to most other NHS services, including non-emergency hospital…
That is the question asked by a recent NBER working paper by Chandra et al. (2023). This question is important for a variety of reasons. First, quality measure data collection is expensive. Saraswathula et al. 2023 found that Johns Hopkins Hospital had to report 162 unique quality metrics, and the cost for collecting these data…
That is the question asked by a recent paper by Nikpay et al. (2023). The authors begin by describing the magnitude of the 340B program: The 340B drug discount program is designed to lower drug costs and increase drug profits for safety-net providers, called “covered entities,” by entitling them to discounts on drugs for all…
Just this year a majority of Medicare beneficiaries enrolled in a Medicare Advantage plan. While these plans are popular with patients, I recently wrote that some rural providers are refusing to accept Medicare Advantage due to low reimbursement. A recent article from Kaiser Health News finds that provider frustration with Medicare Advantage is spreading to…