Market Competition and Healthcare Policy

Are Medicare Advantage plans’ provider networks associated with beneficiaries’ receiving care from primary care clinicians with lower rates of avoidable hospital stays?

This article is the latest in the Health Affairs Forefront series, Provider Prices in the Commercial Sector, featuring analysis and discussion of physician, hospital, and other health care provider prices in the private-sector markets and their contribution to overall spending therein.

As of 2020, 70% of Medicaid beneficiaries (57 million) were insured through Medicaid managed care (MMC), in which a private insurer covers a beneficiary’s medical care in exchange for fixed payments from state Medicaid agencies.1 A key role of MMC insurers is to negotiate prices with hospitals. MMC prices have important implications for government health expenditures and access to care for Medicaid beneficiaries. However, little is known about MMC prices.2 We used hospitals’ self-disclosed pricing information to characterize MMC hospital prices.

The Hopkins Business of Health Initiative (HBHI) had its Washington DC debut at a September 22 Open House at Johns Hopkins University’s (JHU) beautifully renovated 555 Pennsylvania Avenue building. The location was a testament to JHU’s commitment to engaging in debates of national and global policy. The event introduced HBHI and JHU to the community of national leaders working specifically on health policy in the nation’s capital, welcoming them to HBHI’s new “spiritual home.”

We study the effects of changing Medicaid reimbursement rates for primary care services on behavioral health outcomes—defined here as mental illness and substance use disorders.

There is much debate about the effects of pharmaceutical direct to consumer advertising (DTCA) on health care use. In this paper, we inform this debate by examining the effects of DTCA on office visits, as well as treatment courses resulting from those visits, for five common chronic conditions (hypertension, hyperlipidemia, diabetes, depression, and osteoporosis). In particular, we examine whether office visits result in use of drug therapy and/or continued office visits over time.

Despite growth in private equity (PE) acquisitions of physician practices in the US, little is known about how changes in ownership influence workforce composition. Using clinician-level data linked to practice acquisition information, we estimated changes in clinician workforce composition in PE-acquired practice sites relative to non-PE-acquired independent practice sites for dermatology, ophthalmology, and gastroenterology specialties.

Findings suggest that Basaglar was not less expensive for patients than Lantus. Empirical evaluation of biosimilar costs prior to automatic substitution is necessary.

In this cross-sectional analysis of the top 1000 generics in Colorado’s all-payer claims database in 2019, 45 high-cost generics that had lower-cost therapeutic alternatives of same clinical value were identified. Overall, high-cost generics were 15.6 times more expensive than their therapeutic alternatives (median values); if the lower-cost alternatives had been used, total spending would have been reduced by 88.3%.

Around 150 million Americans rely on employers for access to health care. Can the companies who employ them help foster an affordable system that improves our health and doesn't drive us crazy in the process?