Patient Impacts

1. Out-of-Pocket Prescription Costs

Jalpa Doshi has studied the impacts of both increases and decreases in patients’ out-of-pocket drug costs and finds that even small changes in co-pays can significantly affect whether patients fill prescriptions. While out-of-pocket limits reduce unfilled prescriptions, many patients still cannot afford their medications.

• “Specialty Oral Anticancer Prescription Fill Rates After Medicare Part D Cost-Sharing Changes in 2024” JAMA (2025)
• “Estimating The Impact Of Out-Of-Pocket Cost Changes On Abandonment Of HIV Pre-Exposure Prophylaxis” Health Affairs (2024)

2. Affordability in Traditional Fee-for-Service Medicare

Eric T. Roberts and Paula Chatterjee examined whether Medicare beneficiaries had enough savings to cover the $1,600 hospital deductible. They found that 45% of beneficiaries lacked enough money in checking and savings accounts to cover that cost.

• “Risk for Financial Precarity from Hospitalization: Implications for Targeting Financial Assistance in Medicare” Annals of Internal Medicine (2024)

Cost Drivers

3. Vertical Consolidation (when one company owns units across different aspects of care)

Abby Alpert and colleagues found that vertical integration between insurers and pharmacy benefit managers in the pharmaceutical market can harm competition by raising rivals’ costs and premiums without delivering lower premiums to consumers.

• “Disadvantaging Rivals: Vertical Integration in the Pharmaceutical Market” American Economic Journal: Applied Economics (2026)

4. Horizontal Consolidation (when one company absorbs competitors doing similar work)

Mark V. Pauly and Lawton R. Burns examined 30 years of studies and confirmed that hospital mergers raise prices without improving quality. Atul Gupta and colleagues found that when a multihospital system buys an independent hospital, prices increase and staffing decreases.

• “Hospital Consolidation and Quality: Opening the Behavioral Black Box” Social Science & Medicine (2025)
• “The Corporatization of Independent Hospitals” Journal of Political Economy Microeconomics (2024)

5. Corporate Profits

Victor Roy and colleagues found that large publicly traded U.S. health care companies direct substantial spending toward shareholder payouts—through dividends and buybacks—which may divert resources from efforts to improve affordability, quality, and innovation in health care.

• “Shareholder Payouts Among Large Publicly Traded Health Care Companies” JAMA Internal Medicine (2025)

6. Private Plans in Medicare 

Aaron L. Schwartz, Amol S. Navathe, and Atul Gupta examined past reductions to Medicare Advantage payment rates and suggested that the program may be able to absorb further payment cuts. Zeke Emanuel argues that Medicare Advantage is rife with waste and potential fraud, with private insurers exploiting loopholes to overcharge the government.

• “Growth of Medicare Advantage After Plan Payment Reductions” JAMA Health Forum (2023)
• “The Great Big Medicare Rip-Off” The Atlantic (2022)

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