The Source Blog

This last round up of the summer features articles on a range of topics including (1) competition in healthcare markets|(2) strategies for reducing healthcare costs|(3) pharmaceutical pricing|(4) ACOs|(5) other ACA aspects and effects|(6) post-Gobeille strategies|and (7) antitrust enforcement. We hope everyone is settling into school and work after some time off. Happy (almost) fall! Competition in health care markets: In Choice and Competition in Public Service Provision, by Timothy J. Besley and James M. Malcomson, published by the Center for Economic Policy Research, looks broadly at markets involving services like […]

This month, we saw articles and reports that approached the health care cost conundrum from all angles: price transparency|how the ACA fits in|lowering costs, generally|healthcare markets and market places|and the consumer side of things. Add these to your summer reading list! Price Transparency We at The Source were delighted to have provided research on state legislation for HCI3 and Catalyst for Payment Reform’s Report Card on State Price Transparency Laws — July 2016. This was the fourth edition of the Report Card, first issued in 2013. The Report Card carefully […]

Last week’s big news was that the Department of Justice and a number of states have challenged Aetna’s proposed merger with Humana. As in any merger challenge, the way that the relevant product and geographic markets are defined is crucial to the court’s determination of whether the merger should be enjoined. According to the DOJ’s (and other states’) complaint, this merger would combine one of the two largest insurers of Medicare Advantage (Humana) with the fourth largest (Aetna). This, the complaint alleges, would further concentrate 364 county Medicare Advantage markets that are […]

July 2016 Update: In April, the U.S. Court of Appeals for the 11th Circuit overturned the district court’s February 2015 decision dismissing the class-wide allegations in this case. The case charges certain Florida medical centers and Nashville, Tenn.-based HCA with billing exorbitant and unreasonable fees for emergency radiological services covered in part by Florida Personal Injury Protection (“PIP”) insurance. Under Florida’s No Fault Car Insurance Law, drivers are required to have $10,000 in PIP insurance, and the complaint alleges that patients covered by PIP who received radiological services at emergency rooms following […]

At long last, a three-judge panel has ruled in favor of the plaintiffs/appellants in their Ninth Circuit appeal of the dismissal of the putative class action Sidibe v. Sutter Health, filed in federal district court in San Francisco in September 2012 and dismissed in June 2014. The Ninth Circuit heard arguments on July 8, and issued this unpublished opinion a week later. The district court dismissed the third amended complaint on the grounds that the plaintiffs’ geographic market definition, one of the bases for claims brought under the Sherman Antitrust […]

June’s articles ran the gamut of the Source’s favorite topics: price transparency, new payment models, provider markets and pricing, state strategies, and reforming the entire U.S. healthcare system. PRICE TRANSPARENCY The Society of Medical Decision Making published an interesting study on how consumers respond to healthcare pricing information, Presenting Comparative Cost Information to Consumers: Easier Said Than Done by Jessica Greene, PhD and Rebecca M. Sacks, MPH. Participants in the study were provided online cost and quality information in various forms, and then asked to select a provider. Not surprisingly, […]

Update: On June 16, 2016, 10 weeks after holding hearings on the proposed Anthem-Cigna merger, Insurance Commissioner Jones reported his department’s determination that the merger would be anti-competitive and that access, quality, and affordability would suffer as a result of the transaction. The text of the press release is as follows: SACRAMENTO, Calif. – California Insurance Commissioner Dave Jones today urged the U.S. Department of Justice to block the merger deal between Anthem, Inc., and Cigna Corporation. After an extensive review of the Anthem and Cigna merger, Commissioner Jones issued detailed findings that […]

Last week, the Justice Department’s Antitrust Division, along with the North Carolina Attorney General’s Office, filed suit against Carolinas Healthcare System (“CHS”), challenging the large provider’s use of certain contract provisions in its agreements with insurers. DOJ claims that CHS, the dominant and most expensive provider in the Charlotte, North Carolina area, uses its market power to insist that the four largest insurers in the area agree not to steer their subscribers to lower-cost/higher-value providers. The last major DOJ case involving insurer-provider contracts was the Antitrust Division’s 2010 challenge to […]

Happy June! In May, healthcare scholars discussed the usual topics of healthcare price, transparency, and hospitals. And, since the third open enrollment period ended February through April 2016, journals and foundations published multiple reports and articles on state marketplaces. Enjoy! HEALTHCARE PRICE The Journal of Applied Clinical Medical Physics published an article that seeks to answer the question: Why is health care so expensive in the United States? In this op-ed, the author, a “medical physicist” presents his opinions on why healthcare is so expensive in the United States. He […]

States Can Contain Health Care Costs. Here’s How. By RICHARD M. SCHEFFLER and SHERRY GLIED May 2, 2016 THE architects of the Affordable Care Act counted on competition in the health insurance market to keep costs down and quality high. While the law has accomplished many of its coverage and cost-containment goals, its vision of a more competitive insurance market seems to be fading. To continue reading, see the op-ed in the New York Times.