Health care spending, payment rates and more.
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Dear John,
This month's issue of Health Affairs features original research about
state-level health care spending, payment rates for dialysis, Medicaid
waivers, the health care workforce, global health systems, social
determinants of health, and more.
Read The Issue
Spending And Payment
Building on the federal government's estimates of state-level health
expenditures, which only run through 2014, Emily Johnson and coauthors
estimate state spending through 2019
.
Between 2013 and 2019, after adjusting for inflation, "annualized per
person spending growth for each state ranged from 1.0 percent in
Washington, D.C., to 4.2 percent in South Dakota."
Enrollment by patients with end-stage renal disease in Medicare
Advantage
(MA) plans is likely to grow rapidly because of recent federal policy
changes.
Eugene Lin and coauthors find that the largest MA plans pay about
one-quarter more
than Medicare fee-for-service rates for dialysis, with the highest
markups paid to large dialysis chains.
Victor Van de Wiele and coauthors review drug patents approved in 2019
and 2020
and find that "numerous patents covered aspects of the drug beyond its
chemical compound."
They conclude that "patent reform, rather than changes to nonpatent
exclusivities, is the key to ensuring timely generic entry."
State Medicaid programs have expanded access to home and community based
services through waivers.
Meghan Skira and coauthors find that between 1999 and 2017, waivers
covered a wider range of services
,
including an increase in coverage for services that support
self-direction. Section 1915(c) waiver spending increased across all
service categories during this period.
Looking at data from five years after the launch of the Medicare Shared
Savings Program, José Figueroa and coauthors find that accountable care
organization participation
among Medicare beneficiaries "was associated with small savings among
those with [serious mental illness], including schizophrenia and related
psychotic disorders, bipolar disorder, and major depressive disorder."
After Virginia expanded Medicaid in 2019, newly enrolled members had
decreased financial concern about nonmedical needs, such as housing and
food, and decreased concern about medical costs and medical debts,
according to Hannah Shadowen and coauthors
.
There were larger reductions in concerns for non-Hispanic Black and
African American enrollees relative to White enrollees, and larger
reductions for members in rural than nonrural areas.
Read More
Workforce
In March 2020 New Jersey enacted the COVID-19 Temporary Emergency
Reciprocity Licensure Program, allowing out-of-state licensed
practitioners to continue providing telehealth or in-person services to
New Jersey patients.
Analyzing survey responses from more than 10,000 temporary licensees
,
Ann Nguyen and coauthors find that participating practitioners
"originated from every state in the US, provided both COVID-19 and
non-COVID-19-related care, [and] served a combination of new and
existing patients."
In related Perspectives, Brendan Carr and Nicholas Gavin note that New
Jersey's temporary licensure program
reveals a need to consider surge capacity, to have a broadened
understanding of access, and to maintain local care priorities.
Bianca Frogner argues that states should move toward uniform licensure
requirements
to ensure continuity of care and make temporary licensure programs
permanent.
Humayun Chaudhry says that policy makers need to understand the
individual and combined effects of pandemic-era policy
and translate this understanding into sustained pandemic preparedness
efforts.
Read More
Global Health Policy
Using survey data from fifty-six low- and middle-income countries during
2006-18, Simiao Chen and coauthors find that only 20.3 percent of
respondents report that they are covered by health insurance
.
"Only seven [countries] achieved health insurance coverage greater than
50 percent," they report. Sub-Saharan Africa has the lowest proportion
covered, at 7.7 percent.
Barak Richman and coauthors conducted a cross-national analysis of
billing
and insurance-related health care costs
at six provider locations in five
nations.
"Billing costs range from a low of $6 in Canada for a nonsurgical
inpatient
bill to a high of $215 in the US for an inpatient surgical bill," they
find.
Although countries with lower costs have different health systems, "they
each contain national structures that standardize how payers compensate
providers."
Read More
Determinants Of Health
Using data from the period 2011-19, Yanlei Ma and coauthors conclude
that implementation of statewide paid sick leave mandates is associated
with a 5.6 percent reduction in state emergency department visit rates
,
with the largest reduction among Medicaid patients.
Charlotte Probst and coauthors examine changes in US life expectancy
between 2000 and 2018
that are attributable to alcohol.
They find that "deaths from liver disease and cirrhosis, suicides, and
motor vehicle accidents were...more concentrated among men and women
without college degrees than among those with a college degree or more."
Read More
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