Unbiased Analysis of Today's Healthcare Issues
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…
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…
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…
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.…
That is the title from an interesting paper by Andreyeva et al. (2023). The abstract is below: Between 2000 and 2020, the share of US hospital bed capacity under multi-unit firms (systems) increased from 58% to 81% – a rapid corporatization of a sector with $1.3 trillion in annual spend. However, little is known about…
There has been much research showing that fee-for-service (FFS) leads to increased provision of medical services and capitation leads to decreased provision of medical services. My own research shows that there are system-wide effects and that the impact of capitation for primary care physicians on services may depend on whether specialists are also reimbursed via…
According to a paper by Smith et al. 2023, the answer is ‘no’. The authors use data from AHRQ’s Healthcare Cost and Utilization Project (HCUP) State Inpatient Data, Hospital Cost Reporting Information System Data, Office of Pharmacy Affairs Information System Data, and American Hospital Association Annual Survey for 15 states between 2008 to 2014. The…
How did the number of pediatrician and family medicine physician (FMP) change between 2010 and 2020, particularly for rural areas? A paper by Ramesh and Yu (2023) use data from the Health Resources and Services Administration (HRSA) Area Health Resources Files and and county characteristics from the American Community Survey and find that: From 2010…
That may be the case. Modern Healthcare reports: Last month, St. Charles Health System threatened to cut ties with all Medicare Advantage plans next year, a move that would leave an estimated 26,000 local beneficiaries without access to a hospital less than 100 miles away.“The reality of Medicare Advantage in central Oregon is that it…
From Brownie et al. (2017): Healthcare access impacts almost every human indicator including maternal/child mortality rates, rates of preventable infectious and noncommunicable disease, employability, gender equality, workforce productivity, trends in mortality rates and more… Several hospital-based studies can be cited to illustrate nursing impacts; for example, increasing the ratio and educational level of nursing staff…