Tag Archives: perverse incentives

Health Policy Updates: August 14 2016

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

Health Policy Updates: August 7 2016

I’m a week behind in sending this link out, but Sarah Kliff at Vox had a great post on “narrow networks,” an effective (if unpopular) strategy used by health care insurance companies to hold down costs and premiums. Insurance companies can lower costs and improve the experience for everyone by restricting their provider networks to the lowest-cost providers in each geographical region…but consumers are often surprised not to see their doctor or favorite big-name hospital on the list.

“So this, then, is Oscar’s coming pitch: less choice of where to get care but a much better, more seamless experience once you’re getting care…Oscar plans to work especially closely with doctors in these systems to eliminate the frequent hassles of obtaining care. Patients with Oscar will be able to see doctors’ schedules, for example, and make appointments on the insurance plan’s website and app.” Continue reading Health Policy Updates: August 7 2016

Health Policy Updates: June 11 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

Health Policy Updates: May 28 2016

An new public health paper in Health Affairs this week compared the effects of social health spending vs. medical spending on outcomes for several common illnesses such as heart attack and diabetes. The results add credence to the view that the social determinants of health may be more important than the medical system in keeping people health.

“We found that states with a higher ratio of social to health spending (calculated as the sum of social service spending and public health spending divided by the sum of Medicare spending and Medicaid spending) had significantly better subsequent health outcomes…”

Continue reading Health Policy Updates: May 28 2016

Health Policy Updates: March 19 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