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
A very detailed, and very good, piece in Politico about the ongoing cost problem facing the ACA/Obamacare. Fewer young and healthy people have signed up than anticipated, leaving the average costs higher for everyone else. As a result, insurance companies are losing money, and are raising their prices to try to catch up. Trends like this are concerning that we may be seeing the early stages of a “death spiral,” in which prices continue to rise higher than more and more people are able to afford.
I found this article to cover both the successes and the problems of the ACA in a fair and comprehensive way, and recommend it highly.
“A close look at what’s really keeping the exchanges underwater suggests that some of the problems are self-inflicted wounds by Obama and his administration; others are the handiwork of Republican saboteurs, who undercut the safeguards intended to help companies weather the uncertainty of the new law…None of the problems are insurmountable, but if they aren’t fixed, the law could find itself in a mounting crisis—what observers call a “death spiral”—in which competition vanishes, costs skyrocket, and a dwindling pool of insurers offer policies so expensive that health insurance is as out of reach as it ever was.” Continue reading Health Policy Updates: July 24 2016
After this study made the news several years ago, it became common knowledge that “doctors die differently” from the rest of us. Having been behind the scenes in providing care to dying patients, the story went, doctors know how ineffective and truly painful such care can be. As a result, they are more interested in Hospice care, and they forgo such interventions such a CPR when they finally reach the end. If only everyone knew what doctors know, then they could be spared the agony and indignity of dying in a hospital!
In contrast, a more recent study finds that doctors really don’t differ from everyone else. It seems like they spend just as much time in the hospital, and in the ICU. I was surprised by this finding; if true, it makes me more pessimistic about the ability of more information or education to help people to avoid painful, costly, low-value care at the end of life.
“They found that the majority of physicians and non-physicians were hospitalized in the last six months of life and that the small difference between the two groups was not statistically significant after adjusting for other variables. The groups also had the same likelihood of having at least one stay in the ICU during that period”
Continue reading Health Policy Updates: June 11 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
This piece isn’t health care policy per se, but it does have a lot to say about the ongoing conversation on high drug prices. This New Yorker story uses the bona-fide villain of the pharmaceutical industry, Martin Shkreli, as a jumping-off point to discuss larger problems with our current system.
“A truly greedy executive would keep a much lower profile than Shkreli: there would be no headline-grabbing exponential price hikes, just boring but reliable ticks upward; no interviews, no tweeting, and absolutely no hip-hop feuds. A truly greedy executive would stay more or less anonymous. (How many other pharmaceutical C.E.O.s can you name?) But Shkreli seems intent on proving a point about money and medicine, and you don’t have to agree with his assessment in order to appreciate the service he has done us all. By showing what is legal, he has helped us to think about what we might want to change, and what we might need to learn to live with.” Continue reading Health Policy Updates: February 13 2016