Tag Archives: preventive care

Health Policy Updates: March 13 2016

The big news in the world of prescription drug costs – and the economics behind oncology practice – was the White House’s announcement of its exploration into new payment models. The current system has incentives which “may encourage the use of higher-price drugs when lower-cost drugs of equivalent effectiveness are available,” and so the hope is that changing the system may hold down costs and unnecessary treatments. What the new system would look like is not yet clear, as there are many proposals on the table, but the fact that they are moving towards change is significant in and of itself.

“Dr. Patrick H. Conway, a deputy administrator of the Centers for Medicare and Medicaid Services, said the government would test a half-dozen alternative ways of paying for drugs under Part B of Medicare.” Continue reading Health Policy Updates: March 13 2016

Health Policy Updates: August 15 2015

You may have heard of the “21th Century Cures Act,” which is winding its way through Congress. If you want a summary of the act, with some opinion on its merits and drawbacks from the physician’s perspective, check out this summary on the Science Based Medicine blog.

“The central question regarding my supporting the 21st Century Cures Act is whether the decent—but not spectacularly so—provisions in the bill outweigh the bad and the ugly. To answer this question, let’s take a closer look. In examining this bill, it is important to note the central assumptions behind the bill.”

Continue reading Health Policy Updates: August 15 2015

Health Policy Updates: April 11 2015

The Freakonomics podcast just did a piece on how to improve health care. One of the discussion points is how to cut down on “super users” – the frequent flyers who present to the ED and get admitted multiple times per year. A lot of it sounds a lot like what has been working here at the DOC!

On reason commonly blamed for driving up health care costs (for better or worse) is the “moral hazard” problem created by health insurance. If someone else (your insurance company) is paying your bills, then you have no incentive to be a smart shopping a pick out low-cost, high-quality care. This is especially apparent by looking at the other side of the coin – cosmetic surgery, where people DO pay out of pocket, and costs have NOT gone up! Fascinating article!
If cosmetic procedures were covered by insurance, Medicare and Medicaid, what would have happened to their prices over time? Basic economics tell us that those prices would have most likely risen at about the same 88.5% increase in the prices of medical services between 1998 and 2014.”
Hat tip to Kevin Shah

I was not familiar with the health care system in China. This NEJM article provides a basic overview, highlighting a few places where government policy and economic/market forces have intersected:
The government kept its hand in one major aspect of health care: pricing. Presumably to ensure access to basic care, it limited the prices charged for certain services, such as physicians’ and nurses’ time. However, it allowed much more generous prices for drugs and technical services, such as advanced imaging. The predictable result: hospitals and health care professionals greatly increased their use of drugs and high-end technical services, driving up costs of care, compromising quality, and reducing access for an uninsured citizenry.”

Screening can save lives, but it is also very expensive; the idea that we will save money over the long term through investing in preventive care is a popular myth. As an example, a new report on the staggering costs of mammography and the false-positives it generates:
This translates to a national cost of $4 billion each year. The costs associated with false-positive mammograms and breast cancer overdiagnoses appear to be much higher than previously documented.”

One popular idea to reform the fee-for-service payment model, and also hopefully increase health care quality and lower costs over the long term, is “pay for performance.” The idea there is to link doctors’ attention to certain quality measures to a significant portion of their salary, to incentivize them to take good care of patients. The problem, as new research shows, is that this might not actually go very far in making us increase the quality of our care:
The research, published in the latest issue of Health Affairs, found doctors at Fairview Health Services in Minneapolis did no better on quality than doctors elsewhere in the state even after Fairview said 40% of its paychecks would be tied to quality performance.”

 

Health Policy Updates: October 26 2013

If you read one thing this week, read this.
It’s a four-part series in the NYT on why health care prices are so high in the USA, focusing on a different treatment (colonoscopies, prescription drugs, etc) in each part. The length is substantial, but well worth it.
http://www.nytimes.com/2013/06/02/health/colonoscopies-explain-why-us-leads-the-world-in-health-expenditures.html
“...payments are often determined in countless negotiations between a doctor, hospital or pharmacy, and an insurer, with the result often depending on their relative negotiating power. Insurers have limited incentive to bargain forcefully, since they can raise premiums to cover costs.”

Economist Tyler Cowen proposes some ideas on the (realistic) potential future of health care reform. One particular idea I hadn’t heard before, but seems to make quite a bit of sense: why not slowly move people from Medicaid onto the exchanges, and eliminate Medicaid entirely?
http://www.nytimes.com/2013/10/20/business/driving-a-new-bargain-on-obamacare.html?_r=1&
One way forward would look like this: Federalize Medicaid, remove its obligations from state budgets altogether and gradually shift people from Medicaid into the health care exchanges and the network of federal insurance subsidies. One benefit would be that private insurance coverage brings better care access than Medicaid, which many doctors are reluctant to accept.”

National Review columnist Reihan Salam responds to the above proposal:
http://www.nationalreview.com/agenda/361810/thinking-about-tyler-cowens-medicaid-proposal-reihan-salam
All that said, Cowen’s bargain is a good starting point for liberals and conservatives, and it’s definitely preferable to the ACA as it stands.”

Wouldn’t this be a good trend to continue? Some insurance companies are starting to target certain preventive treatments and making them low-cost for their customers to try to encourage their usage.
http://www.advisory.com/Daily-Briefing/2013/10/16/Why-three-insurers-are-eliminating-co-pays-deductibles
Aetna now has a list of drugs for which copays have been waived or reduced based on medical literature and the U.S. Preventive Services Task Force (USPSTF) data

Health Policy Updates: August 10 2013

I stumbled across an awesome new blog called Project Millennial, a youth-driven perspective on health care reform. Everyone take a look!
This week, they’re reported on the failure of a California law that would expand the roles of nurse practitioners. Turns out not everyone (specifically, not the AMA) is a fan of this concept.
http://projectmillennial.org/2013/08/07/californias-scope-of-practice-bill-was-shot-down-last-night-heres-why-that-matters/

The ACA requires that evidence-based preventive services be covered by insurance (including Medicare and Medicaid) without cost sharing (ie, no copays). However, it seems that there is a loophole in this, so that current Medicaid beneficiaries will be left out.
http://content.healthaffairs.org/content/32/7/1188.abstract

On the ACA’s “Cadillac tax” and the response of public employee labor unions:
http://www.nytimes.com/2013/08/05/nyregion/health-care-law-raises-pressure-on-public-employees-unions.html?hp&pagewanted=all&_r=0