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KFF Health News reports that to address a looming shortage of physicians, some states have made it easier for physicians trained in other countries to practice in the US. The previous requirements seem wasteful: "Until recently, every state required physicians who completed a residency or similar training abroad to repeat the process in the U.S. before obtaining a full medical license." The article reports that "at least nine states have dropped this requirement for some doctors with international training" with over "a dozen other states are considering similar legislation." Nevertheless, foreign-trained doctors sill need to "pass the standard three-part exam that all physicians take to become licensed in the U.S."

KFF Health News reports that to address a looming shortage of physicians, some states have made it easier for physicians trained in other countries to practice in the US. The previous requirements seem wasteful: "Until recently, every state required physicians who completed a residency or similar training abroad to repeat the process in the U.S. before obtaining a full medical license." The article reports that "at least nine states have dropped this requirement for some doctors with international training" with over "a dozen other states are considering similar legislation." Nevertheless, foreign-trained doctors sill need to "pass the standard three-part exam that all physicians take to become licensed in the U.S."

Some supporters see this relaxing of requirements as a way of addressing physician shortages, particularly in certain areas, since a number of laws "require the [foreign-trained] doctors to work for several years in a rural or underserved area." Requirements such as those can benefit some rural hospitals that experience difficulties when trying to hire qualified physicians.

Some opponents seem to believe that the way to address the physician shortage is to instead better compensate physicians and to accelerate training "for nurse practitioners and physician assistants who want to become doctors." In a landscape in which health insurance premiums have generally outpaced inflation for decades and where many are uninsured due to the cost of health insurance, simply raising physician compensation seems to be an difficult solution. Other solutions, such as the suggested expansion of loan repayments, might help.

KFF Health News reported on some efforts underway in California to rein in drug prices. For context, "state data shows California health plan drug costs have grown by more than 50% since 2017. California insurers spent 11% more on pharmaceuticals in 2023 than in 2022, with specialty and brand-name drugs driving the increase."

KFF Health News reported on some efforts underway in California to rein in drug prices. For context, "state data shows California health plan drug costs have grown by more than 50% since 2017. California insurers spent 11% more on pharmaceuticals in 2023 than in 2022, with specialty and brand-name drugs driving the increase."

The legislature proposed a bill to subject pharmacy benefit managers (PBMs) to licensing requirements and to "require them to pass along 100% of the rebates they get from drug companies to the health plans and insurers that hire them to oversee prescription drug benefits." The governor appears to oppose that bill, in favor of the state manufacturing its own generic drugs, along with requiring more transparency. Regardless of which approach (or perhaps another) ultimately changes the landscape, the proposals signal an ongoing concern with high prescription drug costs.

The article also raised some potential anti-competitive practices, where PBMs "appeared to steer the most profitable prescriptions away from competitors and to their affiliated pharmacies, which they reimbursed at markups exceeding 1,000% for some drugs." This practice apparently causes reimbursement from some insurers to some pharmacies to be less than what it costs the pharmacy to buy certain medications.

There has been much frustration with insurers denying claims, and KFF Health News published a piece about legislation that California is considering to curb that practice. The article opens with a child with "a grapefruit-sized tumor" being denied treatments recommended by doctors. Denials can be appealed through a process known as independent medical review (IMR). Surprisingly, the majority of appeals in one year resulted in overturned initial denials in a solid majority of the cases: "In 2023, state data show, about 72% of appeals made to the Department of Managed Health Care, which regulates the vast majority of health plans, resulted in an insurer's initial denial being reversed."

There has been much frustration with insurers denying claims, and KFF Health News published a piece about legislation that California is considering to curb that practice. The article opens with a child with "a grapefruit-sized tumor" being denied treatments recommended by doctors. Denials can be appealed through a process known as independent medical review (IMR). Surprisingly, the majority of appeals in one year resulted in overturned initial denials in a solid majority of the cases: "In 2023, state data show, about 72% of appeals made to the Department of Managed Health Care, which regulates the vast majority of health plans, resulted in an insurer's initial denial being reversed."

The proposed legislation would levy fines on "insurers whose denials are overturned more than half the time." That would certainly be a better system than the status quo, but it seems to impose a large penalty only at a specific threshold. Another design would be to award patients a more modest amount to compensate them for their time and potentially delayed care -- that change would help recognize the costs imposed on patients by the current system. Designing the incentives to be too patient-friendly, however, will result in higher costs, which in turn will cause premiums to rise.

Some providers and patients have encountered much frustration from the challenges of prior authorization and other cost-saving measures of insurers. KFF Health News published an article of how enough people in Montana have been exasperated by insurers' practices that the there is now bipartisan legislation being considered to regulate different aspects of prior authorization.

Some providers and patients have encountered much frustration from the challenges of prior authorization and other cost-saving measures of insurers. KFF Health News published an article of how enough people in Montana have been exasperated by insurers' practices that the there is now bipartisan legislation being considered to regulate different aspects of prior authorization.

In principle, prior authorization helps protect against fraudulent providers who bill for unnecessary procedures by giving insurers a way of preemptively denying certain treatments that they deem unnecessary. However, the cost of prior authorization (paperwork and delays) is borne by many physicians and patients, not just ones that try to cheat the system. Additionally, others have noted that some insurers spend very little time reviewing decisions, adding costs to the system by asking doctors to appeal denials. In the article, one doctor is quoted as saying that she spends twelve hours a week on prior authorization -- which seems excessive.

Proposed remedies include eliminating "retroactive denials -- when insurers refuse to pay for treatment they'd authorized" (unclear why that practice is allowed) and prohibiting requiring prior authorization for most generic drugs. Although not proposed in the article, perhaps another way of handling the issue is to set up an state-level arbitration committee, and make it easy for doctors to appeal to them, potentially trigger fines for insurers when the committee rules in favor of the patient. It is understandable that more patient-friendly practices will result in higher costs, but perhaps there could be some system-level savings when doctors and insurers need not spend as much time arguing about approval for specific treatments.

KFF Health News published a profile piece of one woman, Gloria Sachdev, who has worked over the years to reduce the growth of healthcare costs in Indiana. She pushed to get a baseline of how healthcare costs in Indiana compared to those of other states: "Rand published a study in 2019 that analyzed the prices paid by private health plans to more than 1,500 hospitals across the nation. ... Indiana landed at the top of the list, with the highest hospital prices among the 25 states initially studied." Since then, the state legislature "enacted laws to combat consolidation, banning large hospital systems from tacking on extra fees, restricting employers from imposing non-compete contracts on primary care physicians, and requiring health care companies to report pending mergers to the state's attorney general." Since then, "Indiana had fallen from the top spot to the state with the ninth-highest prices."

KFF Health News published a profile piece of one woman, Gloria Sachdev, who has worked over the years to reduce the growth of healthcare costs in Indiana. She pushed to get a baseline of how healthcare costs in Indiana compared to those of other states: "Rand published a study in 2019 that analyzed the prices paid by private health plans to more than 1,500 hospitals across the nation. ... Indiana landed at the top of the list, with the highest hospital prices among the 25 states initially studied." Since then, the state legislature "enacted laws to combat consolidation, banning large hospital systems from tacking on extra fees, restricting employers from imposing non-compete contracts on primary care physicians, and requiring health care companies to report pending mergers to the state's attorney general." Since then, "Indiana had fallen from the top spot to the state with the ninth-highest prices."

It seems that the fight against consolidation of hospitals and health systems is a major factor in the apparent success. Consequently, the legislature is now considering repealing its Certificate of Public Advantage law, which apparently allows proposed mergers to be "shielded from federal anti-monopoly restrictions."