With an election coming up (as well as the first debate, next week!), to the extent that health care gets discussed at all, we are likely to hear the idea of “high deductible” health care plans getting touted as a solution to our health care cost problem. The idea is that by putting more of the cost burden on patients (aka, “cost sharing”), these types of insurance plans will force patients to become smarter consumers of health care and shop for high-value, low-cost providers. The evidence, however, is that people don’t use lower-cost care, then just use less care in general. Which has concerning implications for long-term health outcomes.
“In one sense, then, the high-deductible plan did accomplish a key goal: lower health spending. But when the researchers looked at why spending dropped, they found it had nothing to do with smarter shopping. The average price of a doctor visit wasn’t dropping. Instead, under the high-deductible plan, workers just went to the doctor way less.” Continue reading Health Policy Updates: September 24 2016
The NYTimes reports on reimbursement practices that leave many seniors and chronic ill people unable to qualify for rehabilitative and home care service, on the premise that they do not have a “rehabable” condition. This leaves many people with long-term and chronic illnesses unable to get coverage for the care they need, and either pay out of pocket or go without. Importantly, this situation continues despite recent policy changes that “improvement” is no longer an appropriate requirement; “maintenance” of current function should theoretically be sufficient to qualify.
“Medicare beneficiaries often hear such rationales for denying coverage of skilled nursing, home health care or outpatient therapy: They’re not improving. They’ve “reached a plateau.” They’re “stable and chronic,” or have achieved “maximum functional capacity.”[…] What matters, as the 2013 settlement of a class-action lawsuit specified, is maintenance. Medicare must cover skilled care and therapy when they are “necessary to maintain the patient’s current condition or prevent or slow further deterioration.”
Continue reading Health Policy Updates: September 17 2016
This chart, published by the Wall Street Journal, gets my vote for the best of the week. Especially in a time of modest wage growth, the rapidly rising burden of health care costs on consumers can make people feel “underwater” – like their standard of living lower than it had been in the past. Even as other goods and services get cheaper, health care costs are greedily taking up more of families’ monthly budgets.
“The Kaiser Family Foundation, a health-care research nonprofit, found deductibles for individual workers have soared in the past five years, rising 67% since 2010 without adjusting for inflation, roughly seven times earnings growth over the same period. ” Continue reading Health Policy Updates: September 10 2016
Given the problems that the ACA/Obamacare has faced, were there any realistic alternatives at the time the law was passed, that would have done any better? Megan McArdle, writing at Bloomberg, thinks yes. Specifically, focus on the simple expansion of Medicaid to support low-income Americans rather than trying to set up the complex Exchange infrastructure.
“Here’s my radical plan: If the Obamacare exchanges are going to result in, at best, people being able to buy Medicaid-style plans with limited choices and benefits, then why not just eliminate the middleman and give them … Medicaid?”
Continue reading Health Policy Updates: September 3 2016
There was a new study out this week in JAMA Internal Medicine assessing the impact of Accountable Care Organization on health care spending. The ACO model of reimbursement, with the ACA/Obamacare has supported the growth of, is a form of capitation. The idea is that if health systems get paid for the overall care of each patient but not for each additional test it performs, then the financial incentive to order more tests will decrease, as will overall spending.
That is indeed what this study found, though the effect was modest – about $136 per patient per year. Continue reading Health Policy Updates: August 27 2016