Unbiased Analysis of Today's Healthcare Issues
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…
Academic health centers often have a glowing reputation among clinicians and the general public of being the best of the best. In many cases, simple analysis of the numbers does not seem to back this assertion up. Part of the reason is selection bias. Academic and community health centers do not treat the same types…
Health care costs are high in the U.S., making up 17.9% of the U.S. economy. The Economist reports on recent key drivers of US health care cost…and the answer isn’t drugs. Mr Trump has correctly identified a big villain behind health-care cost inflation, and it is not Big Pharma. Hospitals account for over 30% of…
One trend in recent years is how many hospitals are being purchased by large regional or national hospital chains. An April 2019 slide deck from the NIHCM Foundation shows this trend graphically. A paper by Hsieh and Rossi-Hansberg (2019) provide some aggregate data as well as a case study from the Boston area. Four decades…
As the N.Y. Times reports, more transparency is coming to provider prices. The White House released an executive order Monday afternoon intended to require insurance companies, doctors and hospitals to give patients more information about precisely what their care will cost before they get it. More transparency is generally good and surprise billing for out-of-network costs has been a major…
This question is difficult to answer. In many countries with government provided health care, wait times are long. For the Veterans Affairs (VA) beneficiaries, this does not seem to be much of an issue according to a Penn et al. (2019) study covering wait times between 2014 and 2019: Although wait times in the VA…
Perhaps according to Austin Frakt. He writes in JAMA Forum: In every year since 2011, more hospitals have closed than opened…For example, 15 of the 21 hospitals that closed in 2016 were in rural communities, and since 2010, nearly 90 rural hospitals have done so. Hundreds more are at risk of closure.One source of financial challenges to…
While I leave the answer to the first question for another day, the answer to the second question is ‘yes’. Done, Herring and Wu (2019) explain’s Maryland’s approach to global capitation payments for hospitals covering both inpatient and outpatient hospital services. Maryland is the only state that still operates an all‐payer rate‐setting system for hospitals,…
The National Institute for Health Care Management (NIHCM) has some nice slides describing trends in hospital consolidation. First, we see a trend of increased hospitalizations over time. Further, these mergers are not small. In 49% of cases, the acquired (i.e., smaller) hospital has revenue of >$100m and in 19% of cases the acquired hospitals has…
A number of studies (e.g., Wasfy et al. 2017, Desai et al. 2016) have found that the Centers for Medicare and Medicaid Services (CMS) Hospital Readmissions Reduction Program (HRRP) reduce hospital readmissions. However, are these findings valid? A recent paper by Ody et al. (2019) argues maybe not. Because readmission rates are risk-adjusted, changing coding…