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Dear John,
The April issue of Health Affairs includes articles examining Medicare
Advantage (MA); traditional Medicare; hospital finances and prices; the
cost and availability of preventive services, including contraception
and HIV preexposure prophylaxis; and more.
Read The Issue
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Medicare
Bruce Landon and coauthors update the data and refine the methods others
have used to compare the performance of MA plans
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with that of traditional Medicare.
They find that by 2017, even as the share of enrollees in Medicare
Advantage almost doubled from that level in 2010, "MA plans were able to
achieve better performance on most clinical quality metrics and equal or
better performance on most patient-reported quality measures while
maintaining lower overall utilization compared with traditional
Medicare."
The benchmark rates against which MA plans bid play a central role in
determining the level of rebates that are passed through to enrollees.
By examining the effects of benchmark changes
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across markets from 2012 to 2019, Michael Chernew and coauthors estimate
that a $1,000 per year decrease in benchmark rates would yield about a
$60 increase in annual premiums and a $27 increase in annual
deductibles, along with modest increases in other forms of cost sharing.
Do practice changes associated with growing enrollment in Medicare
Advantage spill over to enrollees in traditional Medicare?
Fangli Geng and coauthors examine MA penetration rates across health
care markets
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and determine that as Medicare Advantage expands, postacute care use in
both it and traditional Medicare declines, without a corresponding
increase in hospital readmissions.
This negative association is stronger in markets with a higher rate of
traditional Medicare beneficiaries enrolled in accountable care
organizations.
J. Wyatt Koma and coauthors find that approximately eight million
Medicare enrollees
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who are younger than age sixty-five report significant access and cost
concerns.
Younger enrollees are more likely than older enrollees to report having
had trouble accessing health care in the past year, more likely to
report dissatisfaction with out-of-pocket spending, and more unsatisfied
with the quality of medical care they receive.
Read More
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Hospitals
Exploring the fate of unprofitable rural hospitals
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Caitlin Carroll and coauthors find that 77 percent remained open during
2010-18, whereas 7 percent closed, 4 percent merged with another
hospital in the same market, and 13 percent merged with another hospital
in a different market.
Closures and mergers were less common in markets with three or fewer
competitors than in larger markets.
Yang Wang and colleagues examine prices publicly reported by 2,379
hospitals
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in September 2022 and find that for the same procedures at the same
hospital and in the same service setting, "on average, cash prices and
commercial negotiated rates [are] 64 percent and 58 percent of the
corresponding chargemaster prices."
In areas with stronger hospital market power or weaker insurer market
power, cash prices are more likely to be lower than negotiated rates.
Using 2019 Internal Revenue Service data
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Ge Bai and coauthors determine that the 37.3 percent of US nonprofit
hospitals that compensate their trustees have lower
charity-care-to-expense ratios than those that do not compensate their
trustees.
While average trustee compensation across all US nonprofit hospitals
increased by 46 percent from 2011 to 2019, the average
charity-care-to-expense ratio decreased by 21 percent.
Third-party tracking, typically installed on websites to add
functionality, is lightly regulated.
Ari Friedman and coauthors find that
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"nearly all hospitals allow third parties to capture data about how
patients and other users navigate their websites."
Hospital website home pages initiate a median of sixteen data transfers
to numerous third parties, "including some of the largest technology and
social media companies, advertising firms, and data brokers."
Read More
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Prevention
Alexandra Makhoul and coauthors find that despite preventive services
being available at no charge
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to people enrolled in individual-market Affordable Care Act-compliant
plans, 21-61 percent of enrollees in these plans, depending on the
service received, incur costs that same day.
Colonoscopies are the most common source of same-day fees, while fees
are much less likely for mammograms and annual wellness visits.
Medicaid accounts for 75 percent of all public funds spent on
contraceptive services and supplies.
Using newly available 2018 Medicaid claims data
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Maria Rodriguez and colleagues find that age-adjusted county-level rates
of most or moderately effective contraceptive use vary from 10.8 percent
to 44.4 percent, and rates of long-acting reversible contraception vary
from 1.0 percent to 9.6 percent.
Although HIV preexposure prophylaxis (PrEP) is highly effective in
reducing rates of HIV acquisition, cost remains a barrier to access.
Robert Bonacci and coauthors find that 49,860 US adults (4 percent) with
PrEP indications
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have uncovered costs for PrEP, totaling about $102 million in 2018.
Order The Issue
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Join Health Affairs Unlimited to access our current and past issues
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Join us tomorrow for discussion about current workforce exodus trends in
state and local public health departments and what must be done to
forestall a crisis in America's public health workforce.
Thanks to the support from the de Beaumont Foundation, the Lunch and
Learn tomorrow will be open for everyone to attend.
Additional events this month include:
* Professional Development: "From the Hill to the White House with
Elizabeth Jurinka"
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on April 18
* Journal Club: "Increasing Marketplace Enrollment For Zero-Premium
Plans
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on April 26
View Full Event Schedule
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Our podcasts frequently feature the authors that are published in the
journal, and most recently, we covered topics like the global supply
chain of generic pharmaceuticals
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and the controversy around pharmacy benefit managers
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Check out our podcasts, and subscribe on Spotify
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or wherever you prefer to listen.
Listen
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In a new Health Policy Brief, Dariush Mozaffarian outlines how measuring
and addressing nutrition security
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can help achieve health and health equity.
Read the brief to learn more about the evolution of health care, public
health, and policy toward nutrition security.
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About Health Affairs
Health Affairs is the leading peer-reviewed journal
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health care, and policy. Published monthly by Project HOPE, the journal
is available in print and online. Late-breaking content is also found
through healthaffairs.org <healthaffairs.org>, Health Affairs Today
<[link removed]>, and Health Affairs Sunday
Update <[link removed]>. Â
Project HOPE <[link removed]> is a global health and
humanitarian relief organization that places power in the hands of local
health care workers to save lives across the globe. Project HOPE has
published Health Affairs since 1981.
Copyright © Project HOPE: The People-to-People Health Foundation, Inc.
Health Affairs, 1220 19th Street, NW, Suite 800, Washington, DC 20036, United States
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