Consolidation and Competition
Jane M. Zhu, Hayden Rooke-Ley, and Erin Fuse Brown
The NEJM perspective examines state corporate practice of medicine laws that prevent ownership or control of physician practices by corporate entities. In an accompanying audio interview, Erin Fuse Brown discusses the role of these laws, including the usefulness and how they could be strengthened.
Competition in Commercial PBM Markets and Vertical Integration of Health Insurers with PBMs: 2023 Update (American Medical Association)
José R. Guardado
The AMA report highlights the lack of competition in the PBM industry as a result of both horizontal consolidation and vertical consolidation with health insurers and calls for a retrospective analysis of the Aetna-CVS merger to further study antitrust implications.
Healthcare Prices and Costs
Aditi P. Sen, Jessica Y. Chang, and John Hargraves
New study reveals that self-insured employers pay more for medical procedures than fully insured employers. The reasons may include large providers' market saturation and employers' reliance on third-party administrators to negotiate contracts.
Rising Prices for Hospital Outpatient Care Far Outpace More Affordable Sites (Blue Health Intelligence)
The Blue Cross Blue Shield Association issue brief found that routine healthcare services cost much more at outpatient hospital settings than at doctors' offices and surgery centers due to hospital outpatient department facility fee and calls for site-neutral payment legislation from Congress.
Comparison of Hospital Online Price and Telephone Price for Shoppable Services (JAMA Internal Medicine)
Merina Thomas, James Flaherty, and Jiefei Wang et al.
Using secret shoppers, this Mark Cuban-backed study found significant discrepancies in hospital prices for medical services, depending on whether they were sought by phone calls or online price estimates. The prices obtained also varied between hospitals.
This report found that women spend 18% more per year on out-of-pocket health costs, which equals a total $15.4 billion more than men, only 2% of which are attributable to maternity care.
Medical Billing & Debt
State Protections Against Medical Debt: A Look at Policies Across the U.S. (The Commonwealth Fund)
Maanasa Kona, Vrudhi Raimugia
The report analyzes current state and federal protections against medical debt, focusing on laws and regulations governing hospitals and debt collectors, and discusses where they may fall short.
Nishant Uppal, Steffie Woolhandler, and David U. Himmelstein
The NEJM Perspective piece calls for better policies that address the persistence of medical debt at nonprofit hospitals.
The study analyzed private health insurance claims data and found that 59.4% of ground ambulance rides were out of network in 2022, putting patients at risk of surprise bills, which is not covered by the federal No Surprises Act.