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Kaiser Health News published an article about a patient whose drug costs changed after selecting a drug plan. Although the article is about a Medicare drug plan, the possibility seems to be relevant to all insurance plans. This dynamic is unfortunate for the patient, who might select a plan during open enrollment because of drug pricing specifically relevant to him or her, only to discover that the prices change before the next opportunity to change insurance plans. Insurers would probably respond that they do not set drug prices, and therefore should not be held responsible for price increases.

Kaiser Health News published an article about a patient whose drug costs changed after selecting a drug plan. Although the article is about a Medicare drug plan, the possibility seems to be relevant to all insurance plans. This dynamic is unfortunate for the patient, who might select a plan during open enrollment because of drug pricing specifically relevant to him or her, only to discover that the prices change before the next opportunity to change insurance plans. Insurers would probably respond that they do not set drug prices, and therefore should not be held responsible for price increases.

Changing drug prices during a year seems to contrast with how insurers negotiate year-long (or multi-year) contracts with healthcare providers. Hence, office visits and procedures seem like they might be more stable in price during a single year. Theoretically, insurers could also negotiate annual terms for drugs, making their pricing stable. In this case, it appears that the insurer in question might have supplied incorrect information to Medicare's Plan Finder. If the insurer supplied incorrect pricing information, then it does seem that they should be held responsible for the price difference since the patient in the article selected the plan based on that information and cannot change plan selection during the year. Another policy change that could be more patient-friendly is to require insurers give 30 days' or 60 days' notice of price changes of relevant drugs and allow patients to change plans in the case of price increases.

Kaiser Health News published a look at one family's decision to seek medical treatment in Mexico even though they lived in the US. Essentially, because of high medical costs in the US, and because of various cost-sharing mechanisms, the family faced medical bills that were a meaningful fraction of their annual income. When the third member of the family needed medical attention, they decided to save money by seeking treatment in Mexico.

Kaiser Health News published a look at one family's decision to seek medical treatment in Mexico even though they lived in the US. Essentially, because of high medical costs in the US, and because of various cost-sharing mechanisms, the family faced medical bills that were a meaningful fraction of their annual income. When the third member of the family needed medical attention, they decided to save money by seeking treatment in Mexico.

Many procedures (beyond an office visit) may cost the patient thousands of dollars, even after insurance. While the local medical center offered financial assistance, figuring out how much would be owed in the context of an urgent condition (in this case, a dislocated shoulder) seems impractical. The article notes that this family is far from alone in their decision. As medical costs continue to be high, a variety of people will try to figure out workarounds that they can live with.

Kaiser Health News published a Perspective that illuminates how some patient assistance programs for drugs work. Pharmaceutical manufacturers first mark up their prices, which raises the patient copay amount. To address patients' financial concerns, pharmaceutical manufacturers will give money to charities to offset the patient copay for the drugs that they sell. This arrangement seems like a win-win: patients pay virtually nothing for their prescription drugs and the manufacturers get to keep charging high prices and additionally, the manufacturers get to deduct the money given to charities. Who loses? The payers who pay high prices for the drugs, and perhaps in the long-term, the patients who end up paying higher premiums because of the high prescription drug prices.

Kaiser Health News published a Perspective that illuminates how some patient assistance programs for drugs work. Pharmaceutical manufacturers first mark up their prices, which raises the patient copay amount. To address patients' financial concerns, pharmaceutical manufacturers will give money to charities to offset the patient copay for the drugs that they sell. This arrangement seems like a win-win: patients pay virtually nothing for their prescription drugs and the manufacturers get to keep charging high prices and additionally, the manufacturers get to deduct the money given to charities. Who loses? The payers who pay high prices for the drugs, and perhaps in the long-term, the patients who end up paying higher premiums because of the high prescription drug prices.

Interestingly, the federal government "severely limits the use of such assistance to patients covered by government insurers" for Medicare patients (and perhaps Medicaid). Perhaps it would be the interest of commercial insurers to follow suit as an industry. If patients were faced with high copay without these patient assistance programs, more of them would consider cheaper alternatives, saving some cost for the overall system. However, at the same time, some of the patients who truly benefit from the more expensive drugs (e.g. they experience strong side effects from the cheaper alternatives) may face some financial difficulties without the patient assistance programs.

Kaiser Health News published an article about psychiatric residential treatment facilities preferring residents from certain other states because the compensation for those residents are higher than that of in-state residents. In one example, "133 of 150 psychiatric beds were filled with patients covered by out-of-state Medicaid plans last summer," even though experts suggest that children who are treated close to home are more likely to experience successful outcomes. This preference for out-of-state residents is understandable given that some of those states reimburse over twice as much as the South Carolina does. Instead, it seems that some number of children from South Carolina are being sent to some other states where, presumably, some providers charge even less. Paying less can result in sub-optimal outcomes in unexpected ways.

Kaiser Health News published an article about psychiatric residential treatment facilities preferring residents from certain other states because the compensation for those residents are higher than that of in-state residents. In one example, "133 of 150 psychiatric beds were filled with patients covered by out-of-state Medicaid plans last summer," even though experts suggest that children who are treated close to home are more likely to experience successful outcomes. This preference for out-of-state residents is understandable given that some of those states reimburse over twice as much as the South Carolina does. Instead, it seems that some number of children from South Carolina are being sent to some other states where, presumably, some providers charge even less. Paying less can result in sub-optimal outcomes in unexpected ways.

South Carolina appears to be addressing the problem by raising its reimbursement rates, although there are concerns that other states might feel increased pressure to raise theirs. Perhaps with the increased reimbursements, facilities will be able to better recruit and retain staff (a problem for many industries currently), and perhaps even new competitors will join in.

Kaiser Health News published an article that captured some nurses' reaction to the recent case in which a former nurse was charged and convicted of felonies for a medication mistake that she admitted to. Not being in the profession, it is difficult to assess how badly a nurse needs to perform in order to administer the wrong drug. On one hand, someone who was living is no longer living because a professional made a mistake that s/he was trained not to make. On the other hand, I have heard how difficult some software for healthcare providers has been, causing "alert fatigue" by overwhelming providers with too many warnings.

Kaiser Health News published an article that captured some nurses' reaction to the recent case in which a former nurse was charged and convicted of felonies for a medication mistake that she admitted to. Not being in the profession, it is difficult to assess how badly a nurse needs to perform in order to administer the wrong drug. On one hand, someone who was living is no longer living because a professional made a mistake that s/he was trained not to make. On the other hand, I have heard how difficult some software for healthcare providers has been, causing "alert fatigue" by overwhelming providers with too many warnings.

The rise in tension comes at an unfortunate time when many healthcare institutions are short of nursing staff. At the same time, I do not know of a great policy approach to handle these types of mistakes. Physicians, for example, can be disciplined by medical boards, which are often comprised of fellow physicians who might be reluctant to discipline colleagues. Physicians can be sued for malpractice, but those decisions might be made by juries who have little exposure to clinical matters beyond the testimonies presented. At the same time, physicians have also complained about very expensive malpractice insurance, due in part to frivolous lawsuits. In the end, it does seem that some medical expertise will be needed to assess how negligent a provider might be, so perhaps nursing will undergo a similar transformation that the physicians previously experienced.