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KFF Health News published an article about trends in primary care. The article points out that "demand for primary care is up, spurred partly by record enrollment in Affordable Care Act plans" and that "Today, a smaller percentage of physicians are entering the field than are practicing, suggesting that shortages will worsen over time." One approach to the addressing the shortage has been the rise of "retail clinics," which may be staffed by nurse practitioners or physician assistants, but which do not support a long-term between a patient and a specific primary care provider. On the other end of the spectrum, some doctors have been entering "concierge medicine," where providers charge an access fee but offer substantially more availability.

KFF Health News published an article about trends in primary care. The article points out that "demand for primary care is up, spurred partly by record enrollment in Affordable Care Act plans" and that "Today, a smaller percentage of physicians are entering the field than are practicing, suggesting that shortages will worsen over time." One approach to the addressing the shortage has been the rise of "retail clinics," which may be staffed by nurse practitioners or physician assistants, but which do not support a long-term between a patient and a specific primary care provider. On the other end of the spectrum, some doctors have been entering "concierge medicine," where providers charge an access fee but offer substantially more availability.

The article also notes that "People with a regular primary care doctor or practice are more likely to get preventive care, such as cancer screenings or flu shots, studies show, and are less likely to die if they do suffer a heart attack" and that "Physicians who see patients regularly are better able to spot patterns of seemingly minor concerns that could add up to a serious health issue." Hence, while the retail clinic model may offer better access and be more affordable, patient health might end off worse in the long-term, especially in populations that have more chronic or complex conditions. A market-based response to these trends might include increased compensation for primary care providers to help address the shortage. However, reimbursements in the healthcare industry are frequently dictated by forces other than simple supply and demand.

People frequently complain about the outrageous drug prices that patients endure. KFF Health News published an interesting piece, however, describing a case when maybe patients (or payers) are not paying enough: generics. The article reports that "Everyone wants to pay less, and the middlemen who procure and distribute generics keep driving down wholesale prices... As generics manufacturers compete to win sales contracts with the big negotiators of such purchases, such as Vizient and Premier, their profits sink. Some are going out of business."

People frequently complain about the outrageous drug prices that patients endure. KFF Health News published an interesting piece, however, describing a case when maybe patients (or payers) are not paying enough: generics. The article reports that "Everyone wants to pay less, and the middlemen who procure and distribute generics keep driving down wholesale prices... As generics manufacturers compete to win sales contracts with the big negotiators of such purchases, such as Vizient and Premier, their profits sink. Some are going out of business."

In the short-term, middlemen and payers might feel that they are winning by securing lower prices. However, when the long-term supply dwindles such that there are meaningful shortages of live-saving medications, patients can suffer. Likely, a major problem is that there is too much market consolidation within the world of middlemen in this industry (presumably, the pharmacy benefit mangers), and as a result, they command too much market power. Another factor might be long-term contracts that make it difficult for suppliers to raise prices to cover their costs when shortages arise. A controversial way of addressing this problem could be to make insurers somehow liable for medical harm (including deaths) caused by shortages of generic drugs. Similar to provider coverage requirements that are imposed upon insurers (where insurers must have certain number of providers per enrolled patient in areas they sell policies), insurers could be made responsible for the actual acquisition of generics. After all, the theoretical ability to buy a medication at a certain price if it is available is not that helpful when that medication is actually not available. If the shortage of medication leading to medical harm is due to insurers' relentless obsession on short-term savings, it seems fair that they bear at least some of the burden of fixing the problem.

People generally think of aviation as a fairly safe industry, and KFF Health News reported on some people who have wondered whether the healthcare industry can learn from them about how to avoid accidents. For example, in 1999, the Institute of Medicine released a report "that called medical error in hospitals a leading cause of death." The KFF article outlines challenges with establishing a patient safety board, modeled after aviation's National Transportation Safety Board (NTSB). In particular, the hospital industry and medical groups appear to wield much more political power than their aviation counterparts.

People generally think of aviation as a fairly safe industry, and KFF Health News reported on some people who have wondered whether the healthcare industry can learn from them about how to avoid accidents. For example, in 1999, the Institute of Medicine released a report "that called medical error in hospitals a leading cause of death." The KFF article outlines challenges with establishing a patient safety board, modeled after aviation's National Transportation Safety Board (NTSB). In particular, the hospital industry and medical groups appear to wield much more political power than their aviation counterparts.

"Hospitals, nursing homes, and medical professionals pour hundreds of millions of dollars into federal political campaigns each election cycle and spent $220 million lobbying Congress last year," the article reports. The healthcare industry is so large that they can actually afford hundreds of millions of dollars to change policy. The article also points out that healthcare groups employ many people, which can also influence votes. As a result, simple transparency measures may be watered down to become more palatable to hospital and medical groups, even though such information can be helpful to patients who are selecting providers.

Not only is the country's demographics changing, but KFF Health News reported on a trending change within the medical community. The concentration of allopathic doctors (with the MD credential) appear to be dropping in rural areas, while that of osteopathic doctors (with the DO credential) appear to be growing in rural areas. (The article specifically reported on Iowa, but it would not be surprising if this trend held true for other states as well.) What is particularly interesting is the growth in number of each type of physician: "From 1990 to 2022, [osteopathic physician] numbers more than quadrupled, from fewer than 25,000 to over 110,000, according to the Federation of State Medical Boards. In that same period, the number of MDs rose 91%, from about 490,000 to 934,000."

Not only is the country's demographics changing, but KFF Health News reported on a trending change within the medical community. The concentration of allopathic doctors (with the MD credential) appear to be dropping in rural areas, while that of osteopathic doctors (with the DO credential) appear to be growing in rural areas. (The article specifically reported on Iowa, but it would not be surprising if this trend held true for other states as well.) What is particularly interesting is the growth in number of each type of physician: "From 1990 to 2022, [osteopathic physician] numbers more than quadrupled, from fewer than 25,000 to over 110,000, according to the Federation of State Medical Boards. In that same period, the number of MDs rose 91%, from about 490,000 to 934,000."

People talk about the projected physician shortage as America's population ages, so the growth in osteopathic medical schools (and therefore the number of graduates) could be one component of helping meet that challenge. It is also interesting that osteopathic physicians tend to be oriented around primary care, while allopathic doctors seem to increasingly specialize.

As another example of how automation can benefit a company, but create more hassle for its customers, KFF Health News published an article about how some insurers seem to be rejecting claims in bulk (one insurer denied 49% in 2021 and another denied 80% in 2020). The author collected some cases where the rationale for the rejections did not make sense (e.g. including rejecting a procedure that was not actually claimed).

As another example of how automation can benefit a company, but create more hassle for its customers, KFF Health News published an article about how some insurers seem to be rejecting claims in bulk (one insurer denied 49% in 2021 and another denied 80% in 2020). The author collected some cases where the rationale for the rejections did not make sense (e.g. including rejecting a procedure that was not actually claimed).

Presumably, some patients will be too busy to contest the rejections and the insurers in question will benefit financially. Even if all of the wrongful rejections were ultimately resolved correctly, patients and providers still end up spending time (and maybe even money) to challenge the rejections. Assuming that these rejections were due to software that streamlines the process, automation in this case works asymmetrically in favor of the company (saving on some claims) while pushing additional administrative burden on others. If insurers were responsible for meaningfully compensating patients for lost time in challenging a rejection, they would probably be much more careful about their rejections.

The article ends with a discussion about the government being tasked with oversight and enforcement, but not actually doing so. Given the lack of penalties, it is perhaps not surprising that some insurers might test the boundaries to see how they can benefit.