Market Competition and Healthcare Policy

The Hopkins Business of Health Initiative hosted a panel on October 8, 2025, titled “Setting a New Agenda for Medicare’s Post-Acute Care Payment Policy” as part of the Future of Health Care Delivery Nexus Convening Series. The panel brought together leading researchers, David Grabowski, PhD (Harvard Medical School), R. Tamara Konetzka, PhD (University of Chicago), and Anne Deutsch, RN, PhD (RTI International/Northwestern University), and was moderated by Kathryn Linehan, MPH. They discussed how Medicare’s post-acute care payment systems can better balance fiscal sustainability and patient needs as Medicare Advantage continues to reshape the delivery landscape.

Alexander Capron, Gabriel Danovitch, Kimberly Krawiec, and Elaine Perlman debate whether paying kidney donors would save lives or unravel the system that makes donation possible.

More than 100 leaders from CMS, Congress, plans, providers, and academia spent the day working through one question: how should the relationship between Medicare Advantage payers and providers change to better serve patients, beneficiaries, and taxpayers? The program now enrolls 54% of Medicare beneficiaries and is absorbing the most significant payment recalibration in its 20-year history.

The Medicare Advantage Star Ratings program has operated for decades and directs billions of dollars in quality bonus payments, yet little is known about which measures have driven observed performance improvement over time.

Amy Finkelstein and Liran Einav argue that, for decades, the United States has patched together health insurance coverage rather than building a coherent system—and that this approach has left the country with coverage that remains fragmented, unstable, and incomplete.

A new Johns Hopkins analysis of 205,896 branded medication fills offers the first national look inside the prior authorization process — tracking how long patients wait, who gets approved, and who bears the cost.

A nationally representative study of nearly 30,000 U.S. adults found that medical debt was consistently associated with deferred dental, medical, and mental health care, regardless of insurance coverage. More than half of adults with medical debt put off dental care, one in three delayed medical care, and one in five postponed mental health treatment. Uninsured adults with medical debt were significantly more likely to defer medical care than those with commercial insurance, but the pattern of deferred care held across all insurance categories.

The authors argue that Maryland's next phase of payment reform must move beyond hospital global budgets to engage frontline clinicians in population health, outlining priorities for the new AHEAD model including population-based payments, expanded incentives, and regulatory modernization.

Liz Fowler, Marty Gaynor, and Andrew Ryan examine this question in the context of increased health care consolidation.

Certain behaviors in markets are unambiguously unethical. In other cases, however, voluntary exchanges that can create gains from trade remain contested on moral grounds, because of what is traded or of the price at which the exchange occurs.