Virginia decided this week to expand Medicaid under the ACA. Individuals up to the 138% of the FPL will be eligible; this is estimated to help 400,000 low-income Virginians.
At the recommendation of Sarah Kliff at Vox.com, an oldie-but-goodie on price negotiation between insurers and health care providers. Insurance companies are often unable to achieve the goal of constraining health care prices:
“Even in markets with dominant health plans, insurers generally have not been aggressive in constraining rate increases, perhaps because the insurers can simply pass along the costs to employers and their workers.”
Here’s a pretty wonky topic: the Quality-Adjusted Life Year, or “QALY.” This measure attempts to factor in all patient outcomes (both living longer and living better) as well as treatment costs, in helping to inform discussions about whether treatments are cost-effective. The QALY has many critics – often pointing out the difficulty of measuring many of the factors it depends on, or reacting philosophically to its attempt to put a dollar value on human life extension – but many defenders as well.
A recent JAMA viewpoint discussed its current role in health care evaluation.
“By reflecting both longevity and quality of life, QALYs provide a useful, although imperfect, measurement standard…Moreover, alternatives to QALYs have their own ethical challenges because any decision rule for allocating resources is fraught with discriminatory implications. Individuals who dislike QALYs tend not to offer solutions beyond nebulous comments about the need to place patients at the forefront of decisions.1,7 However, avoiding QALYs does not remove the need to confront trade-offs; it simply masks them.”
So-called “narrow networks” are a strategy employed by may insurance companies to save money, by shuttling their beneficiaries towards lower-cost providers. A perspective on how this practice may impact on cancer care:
“Although narrow networks are more likely to limit access to specialty cancer centers, there are no published reports suggesting that patients enrolled in narrow network plans experience worse cancer-specific outcomes. In fact, the benefits associated with increased access to affordable health insurance by offering lower-cost narrow network plans may be profound for patients with cancer, many of whom already face a high financial burden associated with their diagnosis.”
A lengthy but worthwhile of exploration of the data on “wasted” health care in the US, recently published on the Health Affairs blog:
“Despite those limitations, we can draw several intriguing insights into variations in waste and who bears the brunt of that unnecessary spending:
- Private insurers—and ultimately employers and individuals who pay premiums—account for a disproportionate share of the waste attributable to administrative complexity and billing bureaucracy.
- Patients and private insurers may be particularly exposed to the cost of unnecessary or low-value outpatient services, such as diagnostic imaging for uncomplicated headaches.
- Given its membership demographics, Medicare is heavily impacted by the cost of failures of care coordination, in hospital and skilled nursing facilities.”
