Unbiased Analysis of Today's Healthcare Issues

Archive for the 'Health Insurance' Category

Are PBM exclusion lists value-based?

Value-based insurance design (VBID) is a simple concept.  In short, interventions that provide high-value should be covered with little cost sharing; treatments with low-value should be covered with higher rates of cost sharing or in some cases perhaps not even covered at all. A paper by Cohen et al. (2017) aims to see how far […]

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Why don’t we rely exclusively on CEA estimates to make drug coverage determinations?

Cost effectiveness analyses (CEA) typically analyses the value of a new treatment relative to its cost.  If the value of the additional health benefits outweigh the additional cost, then they should be covered; if the additional cost outweighs the additional benefit, then it should not be covered, right? There are a few issues with this […]

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Trump tax bill keeps the individual mandate

The Trump tax bill–potentially known as the “the Tax Cuts and Jobs Act“– includes provisions such as increasing the standard deduction and reducing the number of tax brackets from 7 to 4.  Additionally, a number of deductions are removed–such as capping local and state property tax deductions at $10,000 and only allowing mortgage interest deductions for […]

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Do HDHPs save money?

This is the question that Zhang et al. (2017) attempt to answer using data form people who switched to a high-deductible health plan (HDHP) compared to those who stayed in the same plan.  They found: After enrollment in HDHPs, 28 percent of enrollees changed physicians for office visits (compared to 19 percent in the Traditional […]

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Should employers provide health insurance to their workers?

On this Labor Day, I want to address a fundamental question in the U.S. health care system: should employers provide health insurance to their workers?  I won’t take a stand on the issue but I will just list some pros and cons.  Wherever you stand on the issue, I recommend you carefully consider the arguments […]

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What do patients think about price shopping?

Initiatives such as high-deductible health plans (HDHPs) aim to transfer risk form insurers to patients. The rationale behind this risk transfer is that when patients are in control of more funds, there will be less moral hazard and patients will use health care resources more efficiently. That is the theory, but does it bear out […]

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Off-label use of cancer drugs

When each drug is approved by the FDA, the drug is not approved to treat all patients.  Each drug receives an “indication” which basically represents the types of patients the drug can treat.  Giving the treatment to patients with said indication is known as “on label” prescribing. Drugs developed to treat one disease may sometimes […]

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How many people don’t have any health insurance options

Much of the news has claimed that the Affordable Care Act is a failure because individuals in many counties have few or even no health insurance options.  However, how many counties truly will have zero Obamacare exchange insurance options in 2018 ? The Kaiser Family Foundation reports that there are only 17 counties covering 9,595 […]

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Pandemic Bonds

The World Bank is trying to insure against one of the worst crises in the world: a pandemic.  The Economist reports that the World Bank: …has issued $425m in pandemic bonds to support its new Pandemic Emergency Financing Facility (PEF), which is intended to channel funding to countries facing a deadly disease.  The bonds cover […]

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Is VBID gaining a foothold?

The answer is maybe.  Value-based insurance design ties patient cost sharing to the notion of a treatment’s value.  Higher value treatments have lower cost sharing; lower value treatments have higher cost sharing.  The Incidental Economist writes: In his own practice, Dr. Fendrick feels as if standard insurance is working against him and his patients. “They are deeply […]

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