Unbiased Analysis of Today's Healthcare Issues
The answer is health plans according to a new paper by Sen, Chang and Hargraves (2023): Using the Health Care Cost Institute’s data set of claims for one-third of the US population with employer-sponsored insurance, we found that unadjusted prices were higher in self-insured plans for most of the services we studied, with the largest…
Hospital admissions are typically paid largely based on DRGs. DRGs account for the type of admission (e.g., heart failure, hip fracture, COPD) and some measure of patient characteristics and disease severity. However, should hospital structural factures be incorporated into reimbursement? On the one hand, if the structural factor is a cause of less efficient care,…
This is the paraphrased title of a paper by Fusco et al. (2023). The authors conduct a systematic literature review of studies published between 2010 and 2020 and find that among the 79 articles screened: The majority of publications found that, regardless of disease area, increased cost-sharing was associated with worse adherence, persistence, or discontinuation.…
Conventional wisdom holds that the prices of pharmaceuticals are higher in the US than in other countries. But is that really the case? And if so, by how much? Which price? The question we need to answer is “which price” do you mean? There is the manufacturer wholesale price (i.e., gross price) which is how…
I have an article up at the Washington Post‘s In Theory blog titled How we should pay for cures, according to economics. Imagine a major medical breakthrough: a cure for Alzheimer’s. Imagine that cure not only would improve the cognitive abilities of the more than 5 million Americans living with Alzheimer’s but also would give these patients…
Medicare aims to move away from fee-for-service reimbursement and towards value-based payment mechanisms based on quality of care. Although the goal is laudable, there are a number of practical challenges. First, most care is still provided via fee for service. In 2013, 95% of all physician office visits were reimbursed using fee-for-service. Second, collecting quality of…
High-cost cancer drugs often get bad press. Cancer treatment certainly is expensive. However, drug costs are not the primary driver of high cost of cancer treatment; hospitalizations are. Using data from SEER-Medicare, Brooks et al. (2014) examine regional variation in the cost of cancer care and find: Acute hospital care was the largest component of…
In most goods and services you buy, the answer is yes. A Tesla is more expensive than a KIA; a large house is more expensive than a big house; a night at the Ritz Carlton is more expensive than a night at the Motel 6. Nevertheless, in healthcare, many policy wonks believe that cost and quality may…
A paper by Geue et al. (2012) attempts to answer this question by examining five different methods of estimating the cost of a continuous hospital stay (CIS). Each method is discussed below in more detail. Costing Methods
Reuters reports on a PwC study evaluating health care premium growth. “The cost of healthcare services is expected to rise 7.5 percent in 2013, more than three times the projected rates for inflation and economic growth, according to an industry research report released on Thursday. But premiums for large employer-sponsored health plans could increase by…