The August issue of Health Affairs, a variety issue, includes a number of papers focusing on the role of consumers and competition in achieving a more efficient and higher quality health care system. Other issue studies address global health, Medicare savings, and the health gains of an FDA expedited review.
Life expectancy and infant mortality in Appalachia versus the rest of the country: disparities widen
Appalachia has long been recognized as a socially and economically disadvantaged part of the United States. Gopal Singh from the Health Resources and Services Administration (HRSA) and coauthors compared disparities in infant mortality and life expectancy between Appalachia and the rest of the United States in the period 1990–2013. According to the study, infant mortality in Appalachia, while not significantly different from the rest of the United States in the early 1990s, was 16 percent higher in the region by the end of the study period, compared to the rest of the country. The life expectancy trends were equally dramatic: While Appalachians had a life expectancy of 75.2 years in the early 1990s—seven months less than Americans elsewhere—that deficit had increased to 2.4 years by the end of the study period (76.9 years versus 79.3 years). Further stratification by sociodemographic groups showed even wider disparities in life expectancy, including a thirteen-year gap between black men in high-poverty areas of Appalachia and white women in low-poverty areas elsewhere. The authors noted that overcoming these disparities would require both specific health policy interventions (such as efforts to reduce smoking and obesity in the region) and efforts to reduce the underlying causes of these growing health disparities.
Medical equipment competitive bidding saved Medicare money
The idea of using competitive bidding, rather than an administered fee schedule, to set Medicare prices, has long been considered. A pilot program was initiated in 2011 by the Centers for Medicare & Medicaid Services (CMS) in nine Metropolitan Statistical Areas and will become nationwide later this year. David Newman and coauthors of the Health Care Cost Institute analyzed the effects of the 2011 program—which has focused on durable medical equipment—comparing prices paid under this program with those paid by national commercial insurers for the same types of items in 2011–14. While prices in the Round 1 Rebid were, on average, 34.7 percent lower than the prices in the 2010 CMS fee schedule, the authors also found that CMS was able to obtain prices comparable to those obtained by other sophisticated purchasers that were able to negotiate with suppliers.
Americans say price shopping for health care is a good thing—but few do it
Policy makers have assumed that the increase in the number of Americans holding high-deductible insurance plans would be accompanied with a rise in patients seeking to identify lower-cost providers. Ateev Mehrotra of Harvard Medical School and coauthors conducted a nationally representative online survey of approximately 3,000 nonelderly US adults in early 2015 who reported having received medical care in the past twelve months. The authors found that a large majority (72 percent) of respondents said that their out-of-pocket spending played an important role in determining a choice of provider (see the exhibit below). However, only 13 percent of those surveyed reported seeking information about their expected spending before receiving care, and just 3 percent had compared costs across providers before their medical visit. The most frequently cited reason (77 percent) for avoiding price shopping was not wanting to switch their doctor. Also, 75 percent of respondents said that they did not know of a price-comparing resource, and 53 percent said that they would use a website to price-shop if one were made available to them. The authors conclude that price transparency laws and online tools have had a limited impact on health care price shopping—and new efforts might need to be targeted to selected clinical contexts that are suitable for shopping.
Offering a price transparency tool did not reduce spending
Price transparency tools, usually in the form of apps and websites, allow patients to compare health care service prices and expected out-of-pocket spending across local providers. Sunita Desai of Harvard Medical School and coauthors evaluated the impact of offering Castlight, a commercial price transparency product, to members of the California Public Employees’ Retirement System (CalPERS). The authors examined members’ insurance claims data for the first fifteen months of Castlight’s availability. They found that only 12.3 percent of those offered the tool had used it—and use of the tool was not associated with lower spending on a set of services suitable to price shopping on the tool, including lab tests and office visits. Their findings support the emerging evidence that introducing price transparency tools has not made it easier for patients to price-shop for their health care.
Also of interest:
- DATAWATCH: Medicaid Expansion And State Trends In Supplemental Security Income Program Participation; Aparna Soni of Indiana University and coauthors
- THE PRACTICE OF MEDICINE: Federally Qualified Health Center Clinicians And Staff Increasingly Dissatisfied With Workplace Conditions; Mark Friedberg and coauthors from the RAND Corporation
In China, health insurance coverage rates rebound
The years between 1991 and 2011 were a time of significant economic change in China. Yanping Li and coauthors from the Harvard T. H. Chan School of Public Health analyzed different types of health insurance coverage in China between 1991 and 2011 through data from the China Health and Nutritional Survey, an ongoing survey with cohorts across nine provinces. According to the authors, the health insurance coverage rate, 32.3 percent in 1991, fell to 21.9 percent in 2000 before increasing to 49.7 percent in 2006, 90.1 percent in 2009, and 94.7 percent in 2011. The authors also examined trends over time for different types of health insurance; they found declines in public insurance and recent sharp increases in basic insurance for urban residents as well as collective insurance for rural residents. Finally, they identified patients with diabetes or hypertension and observed that those with insurance were more likely to seek treatment for those conditions, compared to those who lacked coverage.
Also of interest:
- In Madagascar, Use Of Health Care Services Increased When Fees Were Removed: Lessons For Universal Health Coverage; Andres Garchitorena of Harvard Medical School and coauthors.
- ANALYSIS & COMMENTARY: A Voucher System To Speed Review Could Promote A New Generation Of Insecticides To Fight Vector-Borne Diseases; David Ridley of Duke University and coauthors.
Drugs approved through the FDA expedited review process offer greater gains
The Food and Drug Administration (FDA) has developed a number of programs to expedite the review of drugs that are considered to meet a particular unmet clinical need. James Chambers and coauthors of the Center for the Evaluation of Value and Risk in Health at Tufts Medical Center, compared the health gains associated with drugs approved on an expedited basis with those of drugs approved on a routine basis in the period 1999–2012. They found that drugs that were included in at least one expedited review program were associated with larger health gains, on average, than those that were not. Their analysis, they conclude, suggests that the FDA has prioritized drugs that offer the largest health gains.
Health Affairs’ August Issue: Consumerism, Competition, Drug Approval, And More posted first on http://ift.tt/2lsdBiI
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