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
Last year, the news-worthy story was that “thousands of women with ovarian cancer are not getting a proven, life-saving treatment.” That treatment, intraperitoneal (IP) chemotherapy had some clinical trials showing that it was much more effective than conventional chemotherapy. The kerfuffle was over the fact that IP chemo was not getting incorporated into medical practice, despite the evidence showing it’s benefit, and too many women were still getting traditional chemo. You can find the NYTimes report on this, here.
One year later, we are also one year wiser. Unfortunately, a newer, better study of IP chemo for ovarian cancer failed to show any benefit. It now looks like IP chemo isn’t any better than regular chemotherapy – and is a lot more grueling to endure. Sometimes, medical science is messy like this. While it is certainly bad that many people have probably gotten this treatment unnecessarily, it is science’s dedication to thorough testing and self-questioning that prevented a far worse outcome – that many thousands of future women would go on receiving IP chemo, on the false understanding that it is beneficial. Continue reading Health Policy Updates: April 9 2016
More on the Bernie Sanders health care plan – and it’s financial costs. As the usually left-leaning Vox.com points out, a single-payer plan such as Sanders proposes would required tax increases far larger than what Americans have been able to stomach.
“Vermont’s failed single-payer attempt helps explain the difficulties a Sanders administration would face in building a Medicare-for-all system. Like Vermont, the United States would also need a massive tax increase to build a health care system like Canada’s.”
Continue reading Health Policy Updates: January 30 2016
Should we warn them?
““We’re confident in choosing Epic as our strategic partner as we continue to enhance Mayo Clinic’s excellence in health care and medical innovation,” said John Noseworthy, MD, Mayo Clinic’s president and CEO, in a statement announcing the partnership
The latest from Amitabh Chandra, one of my favorite health economists. He is a big proponent of comparative effectiveness research, and his “big idea” is that the effectiveness of an intervention should be linked reimbursement, to nudge people towards choosing more effective care and reducing waste. Vaccines? Prenatal care? We’ll give those to you for FREE. Want proton beam therapy rather than just-as-effective conventional radiation for your prostate cancer? You might have to pay some of that out-of-pocket.
“The problem of consuming minimal-benefit care is compounded by insurance, which insulates patients and physicians from financial cost so that they don’t weigh it against benefits.”
One common criticism of Medicaid from the conservative side is that it provides inadequate care – too many doctors don’t accept medicaid, so the economically disadvantaged patients on it can’t receive timely care. The liberal response is that the reason so many doctors don’t accept Medicaid is that it is simply underfunded – pay doctors more to accept Medicaid patients, and you would see this access problem go away.
New data in the NEJM (http://www.nejm.org/doi/full/10.1056/NEJMsa1413299?query=featured_home) seem to support that conclusion. When Medicaid reimbursements recently increased, more doctors started seeing Medicaid patients. Discussion/commentary here:
So is the solution for Medicaid just to throw more $$$ at it?
Ongoing developments in Colorado provide a pretty good study in the rubber-hits-the-road of ACA implementation. Prices vary by region, change year to year, and overall make the picture very complex and difficult to sort out. Here is a great NYT piece on this, with a cool infographic showing the price variability for different insurance plans across the state:
“The wild disparity in prices results from many insurers trying to attract more customers by pricing plans as low as they can. But it is not at all clear that the low prices will be sustainable, so prices may well swing sharply upward as time goes on.”