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A Couple of Health Care Related Items

By December 17, 2023Commentary

I keep sprinkling these in because that is what I do in the main part of my life.  The first study comes from the American Medical Association and is highly ironic, to the point of being humorous.  The AMA has long complained about the level of market concentration among health insurance plans, which upsets them because it means the plans have some leverage in negotiations with providers.  The AMA analysis says 73% of metro markets are highly concentrated and I suspect that is accurate.  The AMA study is ironic because the provider markets, whether for hospitals or physicians, are equally or more concentrated and providers have used that concentration and resulting market power to extract high prices from the plans.  The plans in response consolidated and the end result has been that both groups are highly concentrated and happy with higher prices–the providers get paid more and the plans charge higher premiums because they are paying the providers more.  And as usual, consumers get screwed.  (AMA Analysis)

The second study examines the relative performance of Medicare Advantage plans to traditional Medicare in regard to a variety of quality measures.  The differences are often slight, but any concerns people have about lower quality in MA should be alleviated.  This difference in quality has existed for many, many years.  73% of women get recommended breast cancer screenings in MA plans, versus 70% in traditional Medicare; for colon cancer the numbers are 39% versus 31%.  MA members also received slightly better care for cardiovascular conditions and diabetes.  For osteoporosis management after a bone break, the difference was quite stark, 42% to 21%.  It is also likely that since many doctors treat both MA patients and fee-for-service ones, there is some spillover effect from the more intensive efforts made by MA plans to adhere to quality recommendations.  (AHIP Study) 

Join the discussion 2 Comments

  • John Oh says:

    I have often wondered what would happen health insurance was a personal choice like auto insurance. No more group plans. It’s obvious that the centralization (of almost everything, not just in health) makes it so much easier for interested parties to sway government action one way or the other at the expense of consumers.

  • Sue Beer says:

    I have a MA plan that has served me well. I have seen articles that say the hospitals are dumping MAs Left and right.

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