Unbiased Analysis of Today's Healthcare Issues
Quality of care is difficult to measure. Even if you had a perfect measure of quality in terms of health outcomes, risk adjustment is imperfect. For instance, academic medical centers are often assumed to have high quality, but actual outcomes observed in the data may not be that good if they also receive the sickest,…
There are a few sub-questions we need to break down to answer before answering this one larger question. These sub-questions include: Is nursing staff turnover at nursing homes a big problem? Is nursing staff turnover correlated with quality of care? Does using nursing staff turnover as a quality metric provide the right incentives? A paper…
Urgent care centers are on the rise. Back in 2013, there were only 6,100, but this number increased to 9,616 by late 2019 a 7.9% average annual increase. The rise of urgent care could have positive or negative impacts on overall health care spending. On the one hand, increased supply could lead to higher cost…
Health systems have been touted by some to be a cure to many of our health care systems ills by providing integrated, high quality care. Others claim that health systems are just a way for providers to big up prices through more bargaining power. Either way, it is not entirely clear to what extent health…
Haven was a high-profile effort whereby three industry titans–Amazon, Berkshire Hathaway and JP Morgan–created a joint venture with the hope of lower costs and improving quality. Today, Haven announced it is shutting down in February. What happened? I don’t know the answer, but below are a few possibilities. Scale. Although these are three large companies,…
What is better: public or private health care systems? This is a difficult question to answer. If we compare the British against the US health care systems, they differ for a large number of reasons beyond just public vs. private. Additionally, one must specify what one means by public vs. private. Is this public vs.…
How much are hospital CEOs getting paid? A paper by Mulligan et al. (2020) provides the answer: Between 2010 and 2015, mean hospital CEO compensation (in 2015 US$…) increased 7.8%, from approximately $639,000 to $689,000 (p = .05), and median compensation increased from $431,000 to $464,000. Not surprisingly, CEOs of larger hospitals systems get paid…
Last week I reviewed an article on some of the potential positives and negatives of large, integrated health systems. A recent 60 Minutes episode talks about some of the perils by examining how Sutter health system has become a near monopoly provider in Northern California. Consider the following interaction between Leslie Stahl of 60 minutes…
Integrated delivery networks. IDNs. Accountable Care Organizations. ACOs. Systems of care. Health systems. Whatever you call them, many health policy experts claim that they are the best way for the U.S. health care system to deliver high quality care in a cost-effective manner. But is that really the case? A commentary by UCSD professor and…
Interesting findings from an NBER working paper by Cronin and Evans (2020): Higher-quality nursing homes, as measured by inspection ratings, have substantially lower COVID-19 mortality. Quality does not predict the ability to prevent any COVID-19 resident or staff cases, but higher-quality establishments prevent the spread of resident infections conditional on having one. Preventing COVID-19 cases…