I loved this perspective piece in JAMA on pricing inefficiencies in US health care. Authors Austin Frakt and Michael Chernew point out several areas in which the US health care system pays different prices for the same care – including 340b drug pricing, and differential Medicare reimbursement between office-based and hospital care – and how these price distortions harm care delivery. Highly recommended, in understanding some of the structural problems in our health care system.
“…Implementing site-neutral payments, and reforming how the physician fee schedule is updated are examples of potentially simple, although admittedly politically difficult, policy changes…Nevertheless, changing fee schedules is difficult because politically powerful stakeholders, such as hospitals, that succeed under the current system (many of whom built business models based on the existing prices) vigorously oppose it. These groups often maintain they need the revenue resulting from overpriced services to accomplish a valued mission.”
Continue reading Health Policy Updates: January 7 2018
New data from the Kaiser Family Foundation on prescription drug spending in Medicare. I found the out-of-pocket cost burden to be particularly notable – over $3,000 on average for patients hitting the catastrophic threshold, which will include most cancer patients.
A couple of pieces this week analyzing what the White House could do (if it truly wanted) to lower drug prices. This comes in the wake of the nomination of Azar, a former pharmaceutical executive, for HHS secretary.
The first, from three separate, feasible policy strategies that could lower prices:
“Finally, Trump and Azar could bring the pharmaceutical industry to the negotiating table for excessively priced essential drugs covered by government payers such as Medicare and Medicaid. Current law allows federal programs to seek competitive bids for patented medicines, even if they come from companies other than the patent holder.”
The second describes and analyzes the actions that White House has already taken to start to address drug prices:
“Several health policy experts noted that although the new policies spare pharmaceutical companies any direct intervention, they are aimed at fixing real market distortions and are grounded in evidence. They may also reflect the levers the government can easily pull without legislative action.”
The newly-reported results of the ORBITA clinical trial caught my eye this week. Patients with chronic, stable angina with severe coronary blockages were randomized to angioplasty+stenting vs. ongoing medical therapy alone. Interestingly, the medical therapy patients also received a “sham” cardiac procedure, so the patients were blinded to whether or not they had actually received PCI. There was no significant improvement in angina symptoms with PCI, as measured by exercise duration. Does this mean that the huge number of stents placed annually in the US for angina symptoms is not money well-spent?
Continue reading Health Policy Updates: November 4 2017
This week, a bipartisan bill emerged to stabilize the ACA insurance market. It remains unclear whether this compromise proposal will enjoy enough support to pass.
“Alexander said the deal he struck with Murray would extend CSR payments for two years and provide states ‘meaningful flexibility’ under the ACA, allowing them to make changes to insurance offerings as long as the plans had ‘comparable affordability,’ which is a slightly looser definition than the existing one…The framework would also allow insurers to offer catastrophic insurance plans to consumers aged 30 and older on ACA exchanges, while maintaining a single risk pool…”
Sarah Kliff at Vox.com gave the shortest, quickest rundown of the different ACA insurance subsidies, and exactly how the recent Trump executive order would change things:
“The Trump administration is not ending insurance subsidies. Instead, they have created a policy where they spend more money to insure fewer people — something you probably won’t see on the president’s Twitter feed.”
Continue reading Health Policy Updates: October 22 2017
Vox.com runs down the recent Trump executive order on health care:
“The ultimate impact will depend on any new regulations written as a result of the order, but overall, the Trump administration could make cheaper plans with skimpier benefits more available — and experts worry that will damage the ACA’s marketplaces.”
More on the White House’s efforts to undermine Obamacare in absence of a Congressional repeal bill:
“But Trump administration officials say that with insurance premiums soaring in many states, consumers should be able to buy less comprehensive, less expensive coverage as an alternative to conventional plans…That has some insurance experts worried. The influx of a set of plans exempt from the Affordable Care Act rules will essentially divide the market and make it increasingly unstable, said Rebecca Owen, a health research actuary with the Society of Actuaries.”
The NYTimes is keeping track of all the ways the White House has been sabotaging the health care law.
Continue reading Health Policy Updates: October 15 2017