Long term care spending around the world

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…

Does private health insurance reduce public hospital procedure wait times?

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,…

Are hospital quality metrics causal?

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…

Who are 340B third-party administrators?

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…

Patients love Medicare Advantage, but do providers?

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…

How do PBMs make money?

A helpful article from Mattingly et al. (2023) describes history, business practices, economics, and policy for pharmacy benefit managers (PBMs). Part of this article explains how PBMs make money. They claim there are three primary avenues. Rebate retention. Plan sponsors pays the list price of the drug net of rebates and discounts received.  PBMs are…

Impact of 340B on the use of biosimilars

Biosimilar drugs for biologic treatments are analogous to generic drugs for branded small molecules. Switching to biosimilars after biologic patent expiry can save payers and patients money. Why doesn’t it happen more often? There are a variety of reasons but a paper by Bond et al. (2023) argues that the 340B program incentivizes hospitals to…

What is better: public or private provision of health care?

This is a question that can be answered empirically but doing so is challenging. While cross-country comparisons are feasible for comparing public and private health care provisions, often there are many other differences between health care systems across country. Within any given country, there is significant selection bias in terms of who receives public vs.…