Blog

With drug prices already so high, policymakers have been looking for ways to save on medications. One plan has been to allow distributors to import drugs from abroad, taking advantage of the difference in drug pricing across countries. Kaiser Health News reported on some recent state efforts to move forward on drug importation.

With drug prices already so high, policymakers have been looking for ways to save on medications. One plan has been to allow distributors to import drugs from abroad, taking advantage of the difference in drug pricing across countries. Kaiser Health News reported on some recent state efforts to move forward on drug importation.

The idea of importing drugs from other countries seems to have bipartisan support. However, some states have applied for approval and are still waiting for permission from the FDA. The reasons for the delay might not be entirely clear, but it seems likely that the current administration is concerned about the political backlash from pharmaceutical companies that might ensue if the applications were approved. At the same time, delaying meaningful steps to curb the rise of drug prices might engender its own political backlash from ordinary voters.

Colorado launched Colorado Option: an insurance plan administered by private insurance companies, but with the state mandating certain benefits and an overall reduction in premiums over time. Kaiser Health News reported on the plan's rollout. State officials seem intent on gaining better value by insisting on both richer benefits and price reductions. The option apparently requires "unlimited free visits for primary care, mental health care, substance use, and perinatal services, as well as coverage of diabetes supplies like glucose monitors and syringes at no cost," which seems more generous than most insurance plans. Starting with the second year, plans that do not achieve premium reduction targets are subject to review by the Division of Insurance.

Colorado launched Colorado Option: an insurance plan administered by private insurance companies, but with the state mandating certain benefits and an overall reduction in premiums over time. Kaiser Health News reported on the plan's rollout. State officials seem intent on gaining better value by insisting on both richer benefits and price reductions. The option apparently requires "unlimited free visits for primary care, mental health care, substance use, and perinatal services, as well as coverage of diabetes supplies like glucose monitors and syringes at no cost," which seems more generous than most insurance plans. Starting with the second year, plans that do not achieve premium reduction targets are subject to review by the Division of Insurance.

It is unclear how much pressure the review will exert. A state representative that sponsored the legislation seems to believe that insurance companies will try hard to avoid the rate review, but what is not apparent is how much more information those reviews will reveal than is currently available to state regulators. Regardless, it is good to see state governments trying to find new solutions to rising health costs.

Kaiser Health News (KHN) published some letters to the editor, which captured some readers' reactions to various stories that KHN had previously published. One story discussed how a patient (who happened to be a doctor) was charged several thousand dollars for a procedure that was never performed.

Kaiser Health News (KHN) published some letters to the editor, which captured some readers' reactions to various stories that KHN had previously published. One story discussed how a patient (who happened to be a doctor) was charged several thousand dollars for a procedure that was never performed.

An interesting reaction to that particular story was from a retired orthopedic surgeon who was not surprised that such "upcoding" happens. Another reader had a similar experience and had the case dismissed, although the reader's insurance company seemed uninterested in fighting the fictitious charge. The reader accused insurance companies of being complicit in supporting incorrect billing because insurance companies benefit from higher medical costs (since their profits are limited as a percentage of their premiums). If the accusation is generally true, patients seem to be in a very difficult position when over-billed.

Other reactions for other stories were interesting as well. If these letters are representative of the general feedback, it seems that there is substantial dissatisfaction with the current medical billing landscape.

The holiday season is already upon us! Happy Thanksgiving!

The holiday season is already upon us! Happy Thanksgiving!

We have a lot to be thankful for this year, and hope that you do as well.

As another example of a conflict of interest in health care, Kaiser Health News published accusations that a large hospital chain created incentives to encourage doctors to admit more patients. Hospitalizations are expensive for patients (or at least their payers), but can be helpful to hospitals' bottom lines. Who decides whether a patient in an emergency room gets admitted? Doctors who might be employed by the hospital (or might have some other formal relationship). To be clear, critics of the hospital chain were the ones making the accusations; Kaiser Health News was only reporting on those accusations. As is typical for many Kaiser Health News articles, this article starts with a personal encounter of someone with the healthcare system and in this case, reports that patient regrets agreeing to be hospitalized. Although the patient had insurance, she was still expected to pay several thousand dollars.

As another example of a conflict of interest in health care, Kaiser Health News published accusations that a large hospital chain created incentives to encourage doctors to admit more patients. Hospitalizations are expensive for patients (or at least their payers), but can be helpful to hospitals' bottom lines. Who decides whether a patient in an emergency room gets admitted? Doctors who might be employed by the hospital (or might have some other formal relationship). To be clear, critics of the hospital chain were the ones making the accusations; Kaiser Health News was only reporting on those accusations. As is typical for many Kaiser Health News articles, this article starts with a personal encounter of someone with the healthcare system and in this case, reports that patient regrets agreeing to be hospitalized. Although the patient had insurance, she was still expected to pay several thousand dollars.

A single story is not enough to substantiate accusations of a widespread policy. However, the article references a whistleblower who indicated that the hospital chain threatened his employment if he did not admit more patients. Attorneys representing the whistleblower also found higher rates of admission among Medicare patients at the hospitals in this chain versus other hospitals. Surprisingly, the federal government declined to pursue the case.