Health Policy Updates: September 9 2017

The September issue of Health Affairs was a special edition, focusing on the topic of health care market concentration in the US. I’ve pointed to the closely related issue of hospital consolidation as one of the biggest drivers of increasing health care costs.

As one of the featured studies in this special issue found, the health care market in the US continues to concentrate, with more and more health systems merging into larger and larger networks. The end result of this is not more efficient care for the patient, but simply higher prices, as these large networks exert their monopoly power:

“Although provider concentration could produce efficiencies that benefit purchasers of health care services, the evidence does not point in that direction. For example, reviews of studies of hospital markets have found that concentrated markets are associated with higher hospital prices, with price increases often exceeding 20 percent when mergers occur in such markets. Of even greater concern, the reviews found that these price increases did not appear to improve quality: In some cases, higher hospital concentration was associated with higher mortality rates.” 
Continue reading Health Policy Updates: September 9 2017

Health Policy Updates: September 2 2017

The Atlantic on the ongoing efforts in the Senate to pass a bipartisan “improvement bill” to stabilize Obamacare insurance exchanges:

“The hearings are the brainchild of Senator Lamar Alexander of Tennessee, the Republican chairman of the Health, Education, Labor, and Pensions Committee, who has been talking for months about the need to stabilize Obamacare’s individual insurance market…Alexander, aides said, has an ambitious goal of moving quickly from hearings to drafting legislation that would, at minimum, guarantee the continued payment of cost-sharing reduction subsidies to insurance companies and allow states more flexibility to adjust insurance rules…”

Continue reading Health Policy Updates: September 2 2017

Health Policy Updates: August 27 2017

I reported last week on the Trump Administration’s CMS rollback of Medicare cost-saving bundled payment programs. Two Obama-era health policy advisors penned a Wall Street Journal op-ed to further describe why these changes are a bad move.

“This fee-for-service model, which has dominated American health care for decades, is hardly efficient. Paying for inputs—tests, procedures, hospital stays and the like—creates incentives for overtreatment, with little regard for coordinating care or improving patient outcomes…Now the Trump administration is re-embracing the old fee-for-service model. In six months, the Department of Health and Human Services has gone from driving innovation to dragging health care backward.”

  Continue reading Health Policy Updates: August 27 2017

Health Policy Updates: August 19 2017

What would it take to make the US health care system the best in the world? We already spend more money (by far) on health care than any other country, but our results are middling (see the figure below). Recent thoughts on what the US might do in order to translate our huge financial investment in health into better results, in the NEJM.

“The first challenge the U.S. health care system must confront is lack of access to health care…Affordable and comprehensive insurance coverage is fundamental. If people are uninsured, some delay seeking care, some of those end up with serious health problems, and some of them die.

The second challenge is the relative underinvestment in primary care in the United States as compared with other countries…In contrast to the United States, a higher percentage of these countries’ professional workforce is dedicated to primary care than to specialty care, and they enable delivery of a wider range of services at first contact…”  Continue reading Health Policy Updates: August 19 2017

Health Policy Updates: August 6 2017

The Vox.com policy podcast The Weeds gives a great recap on last week’s demise of GOP efforts to repeal the ACA. Link on Player.FM.

With GOP efforts to repeal the ACA currently stalled, a bipartisan group has begun meeting in order to improve on the ACA framework and stabilize its insurance markets.

“The roll out of their stabilization agenda follows months of private meetings between various members involved in the House’s centrist caucuses about ways to stabilize Obamacare if the GOP’s repeal effort sputtered.”

These efforts put lawmakers at odds with the President, who continued to suggest allowing (and causing) the ACA markets’ collapse.

“These problems have been exacerbated by a president who has publicly predicted that the Affordable Care Act will ‘implode’ and appears determined to help fulfill that prophecy. Mr. Trump has repeatedly threatened to cut off the subsidies, known as cost-sharing reduction payments, which reimburse insurers for cutting deductibles and other out-of-pocket costs for millions of low-income people. Without them, insurers would almost certainly raise premiums…”

 
Continue reading Health Policy Updates: August 6 2017