Unbiased Analysis of Today's Healthcare Issues

Archive for the 'Health Insurance' Category

Are quality bonus payments based on hospital readmissions reliable?

Maybe not.  That is the answer from a study by Thompson et al. (2016).  Using data from the Healthcare Cost and Utilization Project (HCUP) State Inpatient Databases (SID) for six states (AR, FL, IA, MA, NY,WA)  from 2011 to 2013, the authors measure hospital performance reliability for the Hospital Readmission Reduction Program (HRRP).  The define reliability as follows: […]

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The Healthcare Economist on NPR

Check out my interview on NPR with Here & Now’s Jeremy Hobson about what recent changes in health insurance premiums changes mean for the future of the Affordable Care Act.  

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Obamacare Death Spiral?

Health insurance premiums are projected to increase an astronomical 25% for plans in the health insurance exchanges. Some pundits claim that these increases represent that Obamacare is crumbling or in a death spiral. As premiums rise, healthy people flee the market. This leaves insurers with only more sick individuals which leads to premium increases. More […]

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Bad news for Obamacare?

Premiums are rising.  HHS Secretary Sylvia Burwell stated: Building a new market is never easy,” she told the group at HHS headquarters. “We expect this to be a transition period for the marketplace. Issuers are adjusting their prices, bringing them in line with actual data on costs.” Burwell’s comments foreshadow the higher premiums expected when […]

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The problem with managed care is…

Managed care, as the names suggests, aims to manage health care.  The goal is to identify high quality, low cost treatments in order to insure that patients get the best care while keeping premiums low.  While good in theory, managed care critics often contend that some of the stricter managed care policies reduce patient access […]

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Do narrow networks reduce cost?

Many health plans in the Obamacare health insurance exchanges aim to keep premiums down by limiting patients to a select group of providers (e.g., hospitals, physicians). The thought is, by limiting patients to a “narrow network” of providers, patients are in essence restricted to see the most efficient providers.  Some may claim that “efficient” means high quality […]

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Health reform and health insurance churn

The Affordable Care Act provides a lifeline for individuals previously “too rich” for Medicaid, but who did not have access to employer-provided insurance.  First, making Medicaid eligibility rules more generous lead to more people just above the poverty line getting access to health insurance.  Second, the “Obamacare” health insurance exchanges offered community-rated, income-subsidized health insurance coverage for people […]

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Should patients pay high-cost sharing for treatments for the Hepatitis C Virus?

Treatments for the hepatitis C virus (HCV) are expensive.  At one point they cost over $80,000 per year, although costs have decreased since then.  To prevent moral hazard, should insurance companies rely on cost sharing to decrease utilization?  An article by Lakdawalla, Linthicum, and Vanderpuye-Orgle (2016) argues that they shouldn’t. Cost sharing appears even less efficient when […]

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The problem with step therapy

Step therapy is good in theory, but often not in practice.  In step therapy, patients are required to try one drug first–typically a low cost and/or high-value treatment–before moving on to more expensive alternatives.  In theory, this is a great idea.  The first drug patients should try should be the highest value one. In practice, however, […]

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Will payers pay for new healthcare technologies

Wearables, digital medicine and ‘beyond-the-pill’ are the latest healthcare craze.  New technologies–particular those combined with patients mobile phones–offer the promise of improving patient health.  One question is will insurance companies, the government and other payers actually reimburse for these technologies.  According to a recent FiercePharma article, the answer is yes…if there is evidence. Payers say they’re willing […]

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