Market Competition and Healthcare Policy

Since the beginning of the COVID-19 pandemic in 2020 policymakers have consulted epidemiologists and economists to determine the best course of action.

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.

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?

Medicare beneficiaries frequently select suboptimal Medicare Advantage plan products or elect traditional fee-for-service Medicare due to choice paralysis, cognitive impairments, and consumer health insurance illiteracy. Medicare Advantage Chronic Condition Special Needs Plans (C-SNPs) offer an opportunity to tie disease to both plan design and marketing, simplifying consumer choice architecture.

Mario Macis, PhD of Carey Business School and member of HBHI’s Leadership Committee won a 2020 HBHI pilot grant on “Social Support for Markets in Health and Healthcare: Insights from the COVID-19 Pandemic.” His efforts produced a working paper which was disseminated in April 2022 by the National Bureau of Economic Research (NBER) as well as two research networks in Germany.

Price surges often generate social disapproval and requests for regulation and price controls, but these interventions may cause inefficiencies and shortages. To study how individuals perceive and reason about sudden price increases for different products under different policy regimes, we conduct a survey experiment with Canadian and U.S. residents.

Facing unprecedented uncertainty and drastic trade-offs between public health and other forms of human well-being, policy makers during the Covid-19 pandemic have sought the guidance of epidemiologists and economists.

Medicare Advantage and the Maryland all-payer model