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 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
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
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