Category: Health Care Access

Medicaid Expansion Also Expands ER Use

A new report in the New England Journal of Medicine found that Medicaid expansion in Oregon actually increased use of the emergency room (ER) by people newly covered by Medicaid. Policy experts had expected ER use to fall as people gained coverage and could have a usual source of care, such as a primary care physician.  Within the first 15 months after gaining coverage, ER use spiked by about 40%, and remained high for subsequent years. It did not appear the people using the emergency room were necessarily substituting ER visits for primary care physicians (PCP) visits. Rather, PCP visits and ER visits appeared to be complementary.

Mercatus senior research fellow Brian Blase covers the implications in much more detail at Forbes. Blase points out that the value of Medicaid benefits is less than the cost, enrollees are misusing their benefits (ER visits when primary care would suffice). ER overuse makes it harder for those truly in need of emergency care to be seen in a timely manner. It is also arguably why the cost of  Medicaid expansion is far above initial projections.


Is It Now Okay to Sell Your Kidney in the U.S.?

man-in-wheelchairThere is a global shortage of many organs for transplantation. How about just increasing the supply of organs through a free market? The idea of allowing people to sell their organs for personal gain grosses many of us out. Although, it is legal to sell our plasma, and many poor Americans find it profitable to do so.

The moral case for a market in organs has been made by Professors Kathryn Shelton and Richard B. McKenzie at the Library of Economics & Liberty. Yet, it is illegal to sell your organ for transplantation in the U.S. Or is it? A major insurer may have found a side door into this market, by offering up to $5,000 to kidney donors to cover their travel expenses. Clever, eh?

Is this the Insurance Casualty Model; Or Just a Dirty Trick?

The health insurance “Casualty Model” is alive and well in Georgia — but only as a punishment for not signing an in-network agreement or accepting usual and customary reimbursement for emergency room treatments.  At issue is a Georgia hospital (and one in Los Angeles) that are not part of the Blue Cross and Blue Shield of Georgia network. Because neither of the hospitals are part of the insurer’s network, when covered individuals go to the hospitals’ emergency rooms, the insurer sends reimbursement checks for emergency care directly to enrollees. The enrollees are then supposed to endorse the checks over to the hospital.  This is similar to the casualty model when an insurer provides funds for a covered claim and the covered individual shops around and receives a service at the provider of their choice. When someone slid into my car during an ice storm a few years ago, an adjuster came to my office and calculated an estimate. I received the check and was told I could get my car repaired almost anywhere for the estimated amount.

Texas’ Largest Insurer to Increase Premiums 60%

An article by Ricardo Alonso-Zildivar of the Associated Press claims Texas’ largest health insurer plans to raise premiums by as much as 60 percent next year. The article assures us few people will be harmed — most enrollees have their premiums capped as a percentage of household income. Thus, it’s actually taxpayers who will get gouged. The article does admit that some people — those who are too wealthy to qualify for premium subsidies — may suffer sticker shock next November when they price their coverage for 2017.

Health Status Related to Income Not Insurance

Women joggingAn extremely thorough analysis of changes in incomes and mortality in the United States, 2001 through 2014 presents some sobering conclusions for those who think fixing our health system will make us healthier. The research, let by Raj Chetty of Stanford University, ran data on incomes and mortality through a battery of statistical tools.

It is well understood that people in high-income households are healthier than those in low-income households. The latest research demonstrates how important incomes are to health status. Forty-year old men in households in the highest quartile of income (mean = $256,000 annually) had an average life expectancy just under 85 years in 2001. This increased by 0.20 years (a little over ten weeks) by 2014. For those in the lowest quartile ($17,000), life expectancy was about 76 years in 2001, and it only increased 0.08 years (a little over four weeks) by 2014.

Obamacare is likely to accelerate this gap, because it significantly reduces incentives for people in low-income households to increase their incomes.

A ‘Free Health Clinic’ for Montana State Employees

Before he left office, then-Montana Gov. Brian Schweitzer decided Montana’s 11,000 state workers, retirees and their dependents needed an employee health clinic. Before leaving office he had one created without consulting the legislature. For those of you who have not heard of the concept, it’s sort of like the school nurse, except there are doctors and real medical equipment involved. At most employee health clinics, physician visits are either free or involve no cost-sharing. Montana employees aren’t required to use the clinic; they can continue to see their own doctors with the normal cost-sharing.

When You Need Care Now But aren’t Likely to Die, Urgent Care is the Answer

According to a Wall Street Journal article, urgent care centers are becoming Americans medical home away from home – mainly evenings and weekends when their primary care providers are not available.  About two-thirds of patients at urgent care centers have a family physician.

There are an estimated 10,000 urgent care centers in the United States and another 1,400 are expected by 2020. Increasingly, traditional providers are getting in on the act. Hospitals are building, acquiring or partnering with urgent care providers. Walk-in patients are welcome, although many allow patients to make an appointment. Wait times are 30 minutes or less whereas a wait in the emergency room can run eight times that length. The average cost at an urgent care center is about $150, compared to $1,354 for an emergency room visit. Centers are usually open evenings and weekends when doctors’ offices are closed.

When a retail clinic won’t do, this sounds like a much better solution that non-emergent ER visits or waiting a week for a physician visit.  It would be even better if these facilities were integrated so you could choose the level of provider (and price level) you need. As one of the commenters said in the WSJ article, why doesn’t every hospital have one of these next to the emergency room?  I’d go even farther; why doesn’t every hospital have one of these with a retail clinic inside next to the ER?

Retail Clinics Raise Medical Spending??? So What!

Many health policy wonks had hoped that retail clinics would reduce medical spending. Yet, an article in the health policy journal, Health Affairs, claims that retail clinics, like CVS Minute Clinics, don’t save money.   Although, the article did confirm that retail clinics are less expensive than a traditional physician visit, it found retail clinics are associated with an increase in medical spending of $14 per year by those who use them.

Dr. Pharmacist Will See You Now

A recent article in the International Business Times outlines how pharmacists are pushing for a bigger role in health care. According to the article, Washington recently became the first state to recognize pharmacists as health care providers, and require that insurers reimburse them for consultations. Beginning next year pharmacists in Washington can bill insurers for appointments just like doctors and nurse practitioners.

Hooray! Cheap Lab Tests Coming to a Walgreens Near You! No Physician Required!

A recent Huffington Post article explains how a 31-year old college dropout wants to alter your relationship with your doctor — but in a good way. Elizabeth Holmes, a self-made billionaire, is in the process of shaking up the stodgy laboratory testing industry. The first of her tests have received clearance from the U.S. Food and Drug Administration, with others to follow.