Does private health insurance reduce public hospital procedure wait times?

In countries that have universal health insurance, but limited patient out-of-pocket costs for public hospital services, non-urgent hospital treatment often has a waiting list in public hospitals. To address this issue, some countries (e.g., UK, Canada) use strategies such as setting maximum wait targets, monitoring provider performance, or adding public funding; other countries (e.g., Australia,…

Are hospital quality metrics causal?

That is the question asked by a recent NBER working paper by Chandra et al. (2023). This question is important for a variety of reasons. First, quality measure data collection is expensive. Saraswathula et al. 2023 found that Johns Hopkins Hospital had to report 162 unique quality metrics, and the cost for collecting these data…

Who are 340B third-party administrators?

That is the question asked by a recent paper by Nikpay et al. (2023). The authors begin by describing the magnitude of the 340B program: The 340B drug discount program is designed to lower drug costs and increase drug profits for safety-net providers, called “covered entities,” by entitling them to discounts on drugs for all…

Patients love Medicare Advantage, but do providers?

Just this year a majority of Medicare beneficiaries enrolled in a Medicare Advantage plan. While these plans are popular with patients, I recently wrote that some rural providers are refusing to accept Medicare Advantage due to low reimbursement. A recent article from Kaiser Health News finds that provider frustration with Medicare Advantage is spreading to…

Impact of 340B on the use of biosimilars

Biosimilar drugs for biologic treatments are analogous to generic drugs for branded small molecules. Switching to biosimilars after biologic patent expiry can save payers and patients money. Why doesn’t it happen more often? There are a variety of reasons but a paper by Bond et al. (2023) argues that the 340B program incentivizes hospitals to…

The Corporatization of Independent Hospitals

That is the title from an interesting paper by Andreyeva et al. (2023). The abstract is below: Between 2000 and 2020, the share of US hospital bed capacity under multi-unit firms (systems) increased from 58% to 81% – a rapid corporatization of a sector with $1.3 trillion in annual spend. However, little is known about…

Does the 340B program improve quality of care?

According to a paper by Smith et al. 2023, the answer is ‘no’. The authors use data from AHRQ’s Healthcare Cost and Utilization Project (HCUP) State Inpatient Data, Hospital Cost Reporting Information System Data, Office of Pharmacy Affairs Information System Data, and American Hospital Association Annual Survey for 15 states between 2008 to 2014. The…

Impact of the public option in Minnesota

A Minnesota bill would expand the MinnesotaCare Medicaid system to incorproate a public option. The public option would reduce uninsurance rates, but would also have some negative impacts on providers. An FTI report (“Evaluating the Potential Impact of a Public Option on Minnesota’s Hospitals and Patients“) reviews the implications of the public option in Minnesota.…