A large part of the ACA/Obamacare was to expand Medicaid; many (though not all) states elected to do so. New data out this week in JAMA Internal Medicine suggests that patients are benefiting. Compared to states that did not expand Medicaid, previously uninsured patients who have now gained access to Medicaid coverage do better on many metrics, including better access to outpatient care, increased diabetes screening, and reduced non-compliance due to cost.
The Oregon Medicaid experiment from a few years ago left Medicaid skeptics with some reason to be agnostic as to whether Medicaid actually improves people’s health. These data lessen the foundation for such skepticism, and should thus should help move the conversation forward. Continue reading Health Policy Updates: August 14 2016
Why don’t market forces seem to apply to health care? In the rest of the world, competition drives prices down. Imatinib (Gleevec) was the first of the now-numerous tyrosine kinase inhibitors, a class of drugs that brought chronic myloid leukemia to its knees and have proven very effective for other cancers as well. However, despite increasing competition from other drugs that are just as effective, as well as (presumably) increased efficiency over the past 2 decades in manufacturing the drug, the price of imatinib is now higher than ever.
“In 2010, Gleevec gained more direct competition from both drugs, which were approved for newly diagnosed leukemia patients. At this point, Gleevec’s price increases veered quickly into larger hikes that brought it closer to its competitors. An era of price increases of 10 percent or higher began.” Continue reading Health Policy Updates: March 19 2016
I’ve written before, in my health care spending map here, about the problems with fee-for-service reimbursement in medicine. When our financial interest is to provide patients with more medical care, then we doctors tend to do so – often, more than the patient actually needs. There is a new study out this week further demonstrating that doctors do, in fact, respond to the reimbursement incentive. Blog commentary here. Continue reading Health Policy Updates: February 28 2016
From Health Affairs, thoughts on how to move away from fee-for-service reimbursement and towards value-based payment in cancer care:
“The Center for Medicare and Medicaid Innovation (CMMI) has announced the Oncology Care Model (OCM) for physician practices that administer chemotherapy to Medicare patients. Its key features are a monthly care management payment for each patient throughout the six-month episode as well as performance-based payments.” Continue reading Health Policy Updates: November 15 2015
A very fair question: why is anyone going to be in favor of health care reimbursement reform, when all the incentives are to maintain the status quo? That is, doctors and hospitals make out just fine under the fee-for-service system we have right now – why would they want to scrap that and move to a capitation model or bundled payment system? A US New article asks that question this week.
“Attempts at changing payment models in the past, however, have yielded only modest savings at best. Also, what remains unclear is why hospitals would buy into a payment system voluntarily that likely would reduce their bottom lines.” Continue reading Health Policy Updates: July 26 2015