Unbiased Analysis of Today's Healthcare Issues

Measuring hospital quality requires understanding what a hospital is

Many programs–such as Medicare’s Hospital Value-Based Purchasing (HVBP) program–aim to reward hospitals with high quality through higher reimbursement and penalize hospitals with low quality through lower reimbursement.  Will this approach be successful? A commentary by McMahon and Howell (2017) says that hospitals are not really unified entities but rather a collection of workshops. Thus, the […]

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Health care market concentration

One question is whether more physician concentration is a good thing.  On the one hand, larger practices could lead to more efficient care. On the other hand, larger practices could give providers more market power and could drive up prices. A separate question is whether federal authorities could do anything about increased physician market concentration. […]

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Identifying high quality providers in the presence of heterogeneous preferences

Why is it so difficult for health care payers to identify a “best” provider?  A paper by Gutacker and Street (2017) explains: There are two key elements that complicate assessment of how well public sector organisations are doing their job (Besley & Ghatak, 2003; Dixit, 2002). First, they lack a single overarching objective against which […]

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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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Providers move into digital health

Marketplace reports: On a recent visit to the hospital, Riley, who is five years old, swallowed a tiny white pill with an embedded sensor – roughly the size of a grain of sand. When it reached her stomach, it sent a signal to a patch she’s wearing on her skin and alerted her parents and […]

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Is value-based purchasing working for hospitals?

The Incidental Economist is one of my favorite blogs to read.  This week’s post on a recent BMJ article on the failure of P4P did not disappoint.  The article (Figueroa et al. 2016) looks at 4267 acute care hospitals in the United States that participated in Medicare’s Hospital Value Based Purchasing (HVBP) system.  During my time […]

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2016 ASSA: How does competitions among insurers affect premiums

Typically, most economists believe that increased competition decreases prices.  However, is that the case for competition among health insurers? On the one hand, competition among health insurers could decrease prices if consumers choose plans based on premiums.  Competition may increase insurer’s incentive to negotiate with providers and may force insurers to make lower margins or lower […]

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Hospitals moving to the ‘burbs

The ACA offers States the option to expand Medicaid eligibility to millions of Americans.  The goal of the expansion was to increase poor and middle class Americans’s access to affordable health care.  However, access to acute care may be getting more difficult for poor individuals. A recent article looking at Milwaukee’s hospital market describes how hospitals are […]

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Will a VA scandal happen in England?

The VA scandal of long wait times is now well-known. Part of the reason why patients were left off official wait lists–ironically–was because VA senior staffers wanted to reduce wait times. Senior VA staff monitored wait times closely to check for any upticks. Some of the VA management at the Phoenix hospital believed the only […]

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The uselessness of volume-based hospital analysis

Do hospitals with higher volumes have better outcomes? If hospitals specialize or providers learn-by-doing, hospitals with more admissions or more procedures may have higher quality. A paper by Hentschker and Mennicke (2014) examine just this question and find: We define hypothetical minimum volume standards in both conditions and assess consequences for access to hospital services […]

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