Another issue has arrived, and here are the summaries of the research, with a little commentary.
A couple of articles discuss the most-favored-nations drug pricing policy that the Administration has pursued. The idea is that the US buyers should not be paying more than drug companies charge in other developed countries. For a long time there has been the perception that the US is subsidizing drug development for the rest of the world, which is likely true given that our prices are sometimes multiples of those in other countries. The drug companies could respond by trying to get European countries in particular to pay more, but those countries largely have national insurance systems. Anything that drives drug prices lower is a good thing, and since the pharmaceutical industry is about the most profitable in the country, they will be fine charging less.
Mental health spending is growing at about one percent higher than overall health spending, with about 87% of the growth driven by more people being treated and the rest by unit cost increases. This contrasts with overall health spending, where 66% of the spending rise was due to price increases.
Cost-sharing for hospital services has increased in recent years and this may place a particular burden on small rural hospitals which may have more defaults by patients and more difficulty collecting.
Maryland uses a global budgeting system for hospitals, under which they get a fixed revenue per year, within a corridor. Looking at Medicare utilization, the authors found that use of hospital services in Maryland declined by 11 more percentage points compared to other states. It appears that this payment method has not yet reduced access or lowered quality.
A study looks at non-CV-19 death rates from 2020 to 2024. These studies are essentially worthless, because of over-attribution of deaths to CV-19 and the impact of shutdowns on overall health. They also seem to have great trouble establishing a reasonable trendline from which to determine “excess” deaths. According to the authors, there was excess mortality during the epidemic for many causes, probably due to restricted access to health care and the terror campaign that kept people from seeking care when it was needed. And there remains some elevated excess deaths for many causes through 2024. There is some suggestion this may be due to long CV-19, but that is mythical.
A Medicare Advantage policy to enhance quality bonuses did not actually result in any improvement in quality or lower costs for enrollees. One of the Medicare Accountable Care Organization programs, which pay provider organizations on a partial risk basis, appears to have showed lower spending, while maintaining quality. The Medicare star ratings are designed to incentivize better quality care, but any gains have been concentrated in a few measures, largely related to medication management.
Payments from Medicare and Medicaid may not be adequate to cover the cost of care in Community Health Centers, which are often safety net providers.
