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.
Bruce Landon and coauthors update the data and refine the methods others have used to compare the performance of MA plans 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 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 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.
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.
Exploring the fate of unprofitable rural hospitals, 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 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, 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"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."
Alexandra Makhoul and coauthors find that despite preventive services being available at no charge 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, 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.
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.
Read the brief to learn more about the evolution of health care, public health, and policy toward nutrition security.
About Health Affairs
Health Affairs is the leading peer-reviewedjournalat the intersection of health, 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, Health Affairs Today, and Health Affairs Sunday Update.
Project HOPE 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.
