Reference Pricing

What percentage of your prescription drug costs should your insurance company cover?  You may say “100%, of course!”  However, if health insurance cover all pharmaceutical costs this will drive up premiums.   One solution to this problem is reference pricing.  If generics are available for $10 and name brand drugs are available for $100, the…

Should low quality hopsitals be given more or less money?

Recently, the San Diego Union Tribune reported that the Sharp Grossmont Hospital in eastern San Diego county was cited for a number of preventable deaths. Reporter Cherl Clark found numerous problems, which included: “staff members restraining a highly medicated, 25-year-old man with schizophrenia in such a way that he was allowed to suffocate. In addition,…

Pay first, evidence later.

Merrill Goozer reports (“CMS okays heart scan…“) on how Center for Medicare and Medicaid Services (CMS) has reversed a policy to stop paying for heart scans.  There has been no clinical evidence to show that these expensive heart scans identify heart disease any better than less expensive procedures (i.e.: stress tests). Physician revenue, however, would…