Category: Health Care Access

OxyContin Abuse: Stopping the Dealers Helps; Suing the Drugmaker Does Not

One of the biggest challenges with the regulation of prescription drugs is how to prevent the abuse of addictive ones. OxyContin, a powerful painkiller is probably the best known example. There are two ways to reduce the abuse of OxyContin: Punish the inventor and manufacturer of this valuable medicine; or go after those to take advantage of addicts who need help.

HSAAlthough OxyContin is widely prescribed by physicians and valued by patients who need powerful pain relief, trial lawyers decided that the medicine, not the addiction, was the problem. Years ago, the decided they could make some money by suing the manufacturer, Purdue Pharma. Back in 2008, Heartland Institute’s Lawsuit Abuse Fortnightly reported on the cost of this effort:

If anyone doubts tort claims are a burden on American drugmakers, consider the fees for Purdue Pharma L.P.’s defense of 1,400 lawsuits in 32 states, alleging that OxyContin, its prescription painkiller, is addictive.

Absurd? Online Appointments for Hospital Emergency Rooms

Readers of this blog know that we don’t think that ObamaCare will do anything to reduce ER overcrowding. Indeed, we think ObamaCare will increase the burden on ERs.

The latest absurdity: Booking ER appointments online. According the San Francisco Chronicle, a woman recalled seeing:

Dignity Health television commercials featuring a woman sitting in a hospital waiting room and then cutting to the same woman sitting on her living room couch as words come up on the screen: “Wait for the ER from home.”

Dignity isn’t the only network employing the strategy. In an era of increased competition driven by the nation’s Affordable Care Act, hospital executives around the country are hoping online appointments will attract patients eager to avoid long waits in a crowded and often chaotic environment.

Understanding Waiting Times for Health Care

In Sunday’s New York Times, Elizabeth Rosenthal discusses evidence that waiting times for medical care in the U.S. do not always compare favorably with those of other developed countries:

“I fully expect wait times to be going up this year for Medicaid and Medicare and private insurance because we are expanding access to care, but we’re not really expanding the system of providers,” said Steven D. Pizer, a health care economist at Northeastern University in Boston.

Unfortunately, the article evolves into an apologetic for waiting times as a good thing. I would also quibble with Ms. Rosenthal’s description of U.S. health care as “market-based” which it certainly is not. I don’t think I’ve met anyone, pro- or anti-ObamaCare, who does not expect waiting times to increase as long as ObamaCare exists. So, we better get used to them. How to explain them?

There is no Patient Privacy

Dr. Deborah Peel is probably the nation’s foremost advocate for patient privacy. The Texas psychiatrist has worked tirelessly to include privacy protections in all of the health reform ideas of the past twenty years.

She recently gave a presentation at TEDx where she informed the geek community of how extensive medical data breaches have become. Not just extensive but perfectly legal and even encouraged by our government. Bottom line ― there is no medical privacy anywhere in American health care.

Does Public Health Coverage Augment Private Coverage or Crowd It Out?

Expansion of government health care programs like Medicaid is sold with the explicit argument that expansion will cover the uninsured. However, expansion may also cause people who are already insured to cancel their insurance or let it lapse so that they can take advantage of a less expensive to them government program. Academic studies of the size of the crowd-out effect arrive at a variety of conclusions ranging from Lo Sasso and Buchmueller’s estimate of a 50 percent crowd-out rate for SCHIP to an 8 percent rate for Dague et al.

Wisconsin runs its own population survey of health coverage. It samples from all Wisconsin households with landline phones (weights adjusted to represent what is known of the cell only population). The response rate is 47 percent, and 2,462 households were interviewed in 2011.

Here are two graphs showing what the survey has found over the last decade. What is most striking is that if the overall rate of coverage has increased, the increase is small. The increase in public coverage of children of about 25 percentage points mirrors a similar loss in private coverage; and the same effect ― but slightly smaller ― is observed in working-age adults.



ObamaCare Subsidies for Illegal Aliens?

Health Affairs is a reliable barometer of the direction of mainstream health policy. The following is from the abstract of a May 2014 article:

iStock_000004348658XSmallUndocumented immigrants were excluded from the health benefit Marketplaces created by the Affordable Care Act partly because of claims that they contribute to problems such as high costs and emergency department (ED) crowding. This article examines the likely health care use and costs of undocumented immigrants in California in 2009-10. Using data from the 2009 California Health Interview Survey (CHIS), we developed a model that estimated the state’s adult and child undocumented immigrant population…We found that undocumented immigrants in California, and the uninsured among them, had fewer or similar numbers of doctor visits, ED visits, and preventive services use compared to U.S. citizens and other immigrant groups. Allowing undocumented immigrants to purchase insurance in the Marketplaces and ensuring receipt of low-cost preventive services can contribute to lower premiums and reduce resource strains on safety-net providers.

Simply Sending Vets on Waiting Lists to Private Hospitals Won’t Solve VA Crisis

Hospitals around the country face a tough dilemma: Does their duty to serve U.S. military veterans who are unable to get timely care at Veterans Affairs Department healthcare facilities outweigh the headache of dealing with the VA’s relatively low and slow payments? For some, the answer is no.

Under the VA’s new Accelerating Care Initiative, VA facilities must offer a referral to a non-VA provider for any new patients who are on a wait list or have an appointment more than 30 days out. The first referrals were expected to start May 30.

Under that initiative, the Veterans Affairs Department is expected to reimburse providers at the equivalent of Medicare rates. That has been the VA’s reimbursement policy for years, private hospital officials say. They complain that those rates cover only about 88% of their costs in treating veterans.

Latest VA Audit: 57,000 Vets Awaiting Medical Appointments; 63,000 Enrolled but Never Seen for Care

Nationwide, an estimated 57,436 veterans are waiting to be scheduled for care, and another 63,869 have enrolled in the VA healthcare system over the past 10 years and have not been seen for an appointment, according to a fact sheet about the audit findings. The VA is “moving aggressively” to contact these veterans.

The 59-page report determined that the VA’s scheduling process was overly complicated, causing confusion among scheduling clerks and frontline staff. In addition, the 14-day policy for new appointments wasn’t an attainable goal due to the growing demand for services.

(Ilene MacDonald, FierceHealthcare)

Using Marketable Vouchers to Speed Up Drug Approvals

The Food and Drug Administration recently approved a new drug for leishmaniasis, an extremely rare disease which is spread by sand flies in poor countries. Why would a for-profit company invest in inventing a drug for which there is no way to make a profit?

Tvoucherhe FDA offers a prize to any firm that invents a therapy for one of sixteen rare diseases: A priority review voucher (PRV). A company that wins a license for a neglected drug wins a PRV that it can use to get priority review for another drug: Perhaps a new treatment for depression or cancer that will bring in billions of dollars of revenue. In that case, the PRV will be worth between $150 million to $300 million. The company which invented the drug for leishmaniasis makes no bones about the value of the PRV to its business:

Knight Therapeutics, of Montreal, is eager to cash in on the voucher. “We’re going to try to sell it for as much as we can,” Jeffrey Kadanoff, Knight’s chief financial officer, tells Shots. “We’d love to make a big headline.” (NPR)

The PRV is best explained by one of the economists who thought it up, Professor David Ridley of Duke University’s Fuqua School of Business, in this video. The PRV is not perfect, but it is an excellent innovation. It reduces some of the deadweight loss of the FDA’s bureaucratic inertia by redirecting some of the energy devoted to overcoming it to the benefit of the world’s least fortunate patients.

Provider Networks Shrinking in All Markets

No matter what kind of health plan consumers choose, they will find fewer doctors and hospitals in their network — or pay much more for the privilege of going to any provider they want. These so-called narrow networks, featuring limited groups of providers, have made a big entrance on the newly created state insurance exchanges, where they are a common feature in many of the plans.

doctor-mom-and-sonSmaller networks are also becoming more common in health care coverage offered by employers and in private Medicare Advantage plans. Insurers, ranging from national behemoths like WellPoint, UnitedHealth and Aetna to much smaller local carriers, are fully embracing the idea, saying narrower networks are essential to controlling costs and managing care. Major players contend they can avoid the uproar that crippled a similar push in the 1990s.

“We have to break people away from the choice habit that everyone has,” said Marcus Merz, the chief executive of PreferredOne, an insurer in Golden Valley, Minn., that is owned by two health systems and a physician group. “We’re all trying to break away from this fixation on open access and broad networks.”

(Reed Abelson, New York Times)