Last week LDI hosted a day-long conference on Medicare for All & Beyond. Our goal was to participate in one of today’s most pressing conversations in health care—how to expand health insurance to the 28 million people in the United States who are currently uninsured. We welcomed close to 300 people from across the spectrum to participate in this conversation, to consider the critical questions underlying today’s debate, and to look in depth at the challenges we face in expanding insurance coverage in our country. The conference gave us all plenty to mull over.
An increasing source of public unhappiness with the private health insurance system in the U.S. involves the prevalence of large “surprise bills.” This happens when an out-of-network provider does not take your insurance company’s reimbursement as payment in full, and instead bills you extra. Politicians, ever eager to help, have proposed new regulatory legislation. But a key source of confusion about the phenomenon and the remedies is what causes it — who has allowed this to happen?
In our study of nearly a million patients with newly diagnosed breast, colon or lung cancer, the Affordable Care Act’s Medicaid expansion was associated with decreased rate of uninsurance and a shift toward earlier-stage cancer diagnosis. Despite concerns that coverage expansions would result in longer waits for treatment, my colleagues and I found no evidence that Medicaid expansion worsened access to timely cancer-directed therapies.
Once a casualty of the battles to pass the Affordable Care Act (ACA), the “public option” has reappeared in the current health reform debate. This concept is not new; in some states, a public option for children has existed for decades. In this post, we examine the current status of buy-in programs that allow families whose income exceeds the eligibility limit for Medicaid or the Children’s Health Insurance Program (CHIP) to purchase public coverage for their children. Properly designed, targeted, and marketed, buy-in programs could be a cost-effective way of moving toward universal coverage for children.
Private equity acquisition of physician medical groups has come under increasing scrutiny for its potential role in expanding the use of “surprise” medical bills. Due to limited data availability, empirical study of private equity acquisition has been challenging, with most existing evidence coming from industry reports and a growing chorus of opinion articles in academic journals. In a new JAMA research letter, we describe acquisition of physician medical practices by private equity firms across specialties from 2013-2016.
The phrase “social determinants of health”—long a concept among population health scientists—first caught fire in the health care community about five years ago. It signaled a newfound interest in the idea that health care ought to broaden its focus to include the social factors—homelessness, hunger, isolation—that lead to poor health and high health care costs. Despite hyper-partisan debates around health care, many agreed on the idea that if health care addressed upstream social problems—instead of just waiting for people to show up in the emergency department—Americans could live better and longer at lower cost.
Every year, about 500,000 patients present to emergency departments (EDs) across the country for deliberate self-harm, making the ED an important setting for suicide prevention services. Despite the need, less than 50% of hospitals offer certain evidence-based safety planning and other self-harm management practices. In a series of studies, my colleagues and I assessed the availability of key mental health services to ED patients after an episode of deliberate self-harm, and sought to understand how ED Directors perceived quality of care in the presence (or absence) of these practices.
After five years, a small experiment to improve care for frail elderly patients receiving primary care in the home has delivered some savings to Medicare—although it might be too small to know for sure. Authorized by the Affordable Care Act, the Independence at Home Demonstration (IAH) is part of a broader strategy of testing innovative ways to pay for value in health care—tying additional payment to higher quality care and cutting wasteful spending.
The conclusion of this study in the American Economic Review by LDI Senior Fellow Matthew Grennan and Robert Town might surprise you: in the case of stents, the slower, more rigorous process that the FDA requires for getting a device to market may actually be better than the faster process used in the European Union.
Low back pain is a major cause of disability among adults and a top reason patients are prescribed opioids. However, a recent study by LDI Associate Fellow Jina Pakpoor and colleagues finds that patientswith new low back pain are receiving opioids less frequently, though prescribing rates remain uneven across the country. Given opioids’ limited effectiveness for low back pain and risk of harm to patients, these results are heartening.
Over the last decade, medical cannabis has moved from the fringe to the mainstream—at least in some states. Nearly 900,000 Americans were registered cannabis patients in 2017, which is more than a ten-fold increase since 2009. By the end of 2020, over two-thirds of states and the vast majority of Americans will live in a state with legal access to either medicinal or recreational marijuana. Despite the rapid changes in the legal status and evidence supporting the use of cannabis to treat a range of conditions, physicians and trainees report remain ill-equipped to recognize and advise patients who may benefit from medical cannabis.
Two years ago, when I joined the Camden Coalition of Healthcare Providers, I met with a client we’d been serving for nearly 18 months. When we first met Sarah, she was in the early days of recovery from heroin addiction, just starting to self-manage her medical conditions. She was living with her infant in a shelter. Following intensive work with the Camden Coalition and our partners, we were able to support Sarah’s successful transition to stable housing—and along with it, reliable food, peer support, and behavioral health care.
One benefit of teaching hospitals is obvious: they train the next generation of clinicians. But that training comes at a cost: teaching hospitals tend to have higher-priced clinical care than other hospitals. In the era of value-based care, the question is whether the additional spending produces better patient outcomes, and if so, whether the clinical benefit is worth the cost.
We have some answers in two recent papers (here, and here) by a team of LDI Senior Fellows led by Jeffrey Silber and Lee Fleisher. In general, they find that the value of teaching hospitals is greatest for high-risk surgical and medical patients, where better outcomes justify slightly higher costs. Let’s take a look at what they found.