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Vaccine Backsliding Will Ripple Around The Globe. 疫苗倒退将波及全球。
Health affairs (Project Hope) Pub Date : 2025-06-01 DOI: 10.1377/hlthaff.2025.00477
Rabih Torbay
{"title":"Vaccine Backsliding Will Ripple Around The Globe.","authors":"Rabih Torbay","doi":"10.1377/hlthaff.2025.00477","DOIUrl":"https://doi.org/10.1377/hlthaff.2025.00477","url":null,"abstract":"","PeriodicalId":519943,"journal":{"name":"Health affairs (Project Hope)","volume":"44 6","pages":"768"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144210622","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
When A Health Economist Becomes A Cancer Patient. 当一个卫生经济学家变成一个癌症病人。
Health affairs (Project Hope) Pub Date : 2025-06-01 DOI: 10.1377/hlthaff.2024.00943
David Dranove
{"title":"When A Health Economist Becomes A Cancer Patient.","authors":"David Dranove","doi":"10.1377/hlthaff.2024.00943","DOIUrl":"https://doi.org/10.1377/hlthaff.2024.00943","url":null,"abstract":"<p><p>A health economist offers a glimpse into his own health care decision making when he is diagnosed with bladder cancer.</p>","PeriodicalId":519943,"journal":{"name":"Health affairs (Project Hope)","volume":"44 6","pages":"761-765"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144210623","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Stipends From Hospitals To Emergency Medicine And Anesthesiology Clinicians Increased In California, 2002-21. 2002-21年，加州医院给急诊医学和麻醉学临床医生的津贴增加。
Health affairs (Project Hope) Pub Date : 2025-06-01 DOI: 10.1377/hlthaff.2024.01220
Erin Duffy, Sarah Green, Erin Trish
{"title":"Stipends From Hospitals To Emergency Medicine And Anesthesiology Clinicians Increased In California, 2002-21.","authors":"Erin Duffy, Sarah Green, Erin Trish","doi":"10.1377/hlthaff.2024.01220","DOIUrl":"https://doi.org/10.1377/hlthaff.2024.01220","url":null,"abstract":"<p><p>In lieu of hiring physicians, hospitals often contract with medical groups and pay stipends to clinicians to supplement professional services reimbursements from insurers and patients. We measured the prevalence and magnitude of stipends from California hospitals to emergency medicine and anesthesiology clinicians in Hospital Annual Financial Disclosure Reports from the period 2002-21. The prevalence and average magnitudes of stipends, even standardizing for service volume, have risen in both specialties. In 2021, stipends to emergency medicine and anesthesiology clinicians were paid by 81 percent and 57 percent of hospitals in California, respectively. The mean amount hospitals spent on stipends were $4.1 million for emergency medicine and $2.9 million for anesthesiology annually in 2021, among hospitals with any stipend. Standardizing for service volume, the mean amount across all hospitals was $91.42 per emergency visit and $40.11 per fifteen minutes of anesthesiology services in 2021. These findings inform policy discussions on hospital labor costs and professional reimbursement.</p>","PeriodicalId":519943,"journal":{"name":"Health affairs (Project Hope)","volume":"44 6","pages":"754-760"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144210619","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Medicare Advantage Denies 17 Percent Of Initial Claims; Most Denials Are Reversed, But Provider Payouts Dip 7 Percent. 医疗保险优势拒绝17%的初始索赔；大多数拒绝被撤销，但供应商支出下降了7%。
Health affairs (Project Hope) Pub Date : 2025-06-01 DOI: 10.1377/hlthaff.2024.01485
Boris Vabson, Andrew L Hicks, Michael E Chernew
{"title":"Medicare Advantage Denies 17 Percent Of Initial Claims; Most Denials Are Reversed, But Provider Payouts Dip 7 Percent.","authors":"Boris Vabson, Andrew L Hicks, Michael E Chernew","doi":"10.1377/hlthaff.2024.01485","DOIUrl":"https://doi.org/10.1377/hlthaff.2024.01485","url":null,"abstract":"<p><p>This article quantifies the prevalence of claim denials in Medicare Advantage (MA), along with their direct impact on provider revenue. Employing medical claims data from multiple MA plans, covering 30 percent of the entire MA market in 2019, our study found claim denial rates of 17 percent as a share of initial claim submissions. We also found that 57 percent of all claim denials were ultimately overturned. We calculated that denials resulted in a 7 percent net reduction in provider MA revenue, based on the dollar-weighted share of claim denials that were not overturned. However, the indirect impact of denials could be even greater than this direct effect that we measured. This article points to the important role that claim denials play in reducing MA spending and in driving outcome differences between MA and traditional Medicare. However, our analysis did not weigh the cost-saving benefits of claim denials against potential downsides.</p>","PeriodicalId":519943,"journal":{"name":"Health affairs (Project Hope)","volume":"44 6","pages":"702-706"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144210670","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Medicare Site-Neutral Payment Policies: Effects Of Proposals On Hospitals And Beneficiary Groups. 医疗保险站点中立支付政策：对医院和受益群体的影响。
Health affairs (Project Hope) Pub Date : 2025-06-01 DOI: 10.1377/hlthaff.2024.01501
Klara K Lou, Kathryn E Linehan, Lauren N da Fonte, Pikki Lai, Melinda B Buntin
{"title":"Medicare Site-Neutral Payment Policies: Effects Of Proposals On Hospitals And Beneficiary Groups.","authors":"Klara K Lou, Kathryn E Linehan, Lauren N da Fonte, Pikki Lai, Melinda B Buntin","doi":"10.1377/hlthaff.2024.01501","DOIUrl":"https://doi.org/10.1377/hlthaff.2024.01501","url":null,"abstract":"<p><p>Medicare pays hospital outpatient departments higher rates than ambulatory surgical centers and physician offices for providing similar health services. Policy makers are considering aligning payments across sites of care, but concerns have arisen about the potential disproportionate impacts of \"site-neutral\" payments on vulnerable providers and beneficiaries. We assessed the effects of three policy options on types of hospitals and beneficiaries. We found annual Medicare payment reductions ranging from $212 million to $7.36 billion across these options; variation was due to the scopes of services and types of hospital outpatient departments included. Small and rural hospitals paid under Medicare's outpatient prospective payment system would absorb the smallest shares of proposed cuts across the options, commensurate with their outpatient volumes. The effects of the policy options varied little by hospital type; more comprehensive options would yield larger payment reductions from all hospital types. Site-neutral payments would not have substantially different effects on beneficiary groups defined by dual-eligibility status or age.</p>","PeriodicalId":519943,"journal":{"name":"Health affairs (Project Hope)","volume":"44 6","pages":"668-676"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144210674","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Hospital 'Boarding' Of Patients In The Emergency Department Increasingly Common, 2017-24. 2017-24年，医院急诊科病人“寄宿”越来越普遍。
Health affairs (Project Hope) Pub Date : 2025-06-01 DOI: 10.1377/hlthaff.2024.01513
Alexander T Janke, Laura G Burke, Adrian Haimovich
{"title":"Hospital 'Boarding' Of Patients In The Emergency Department Increasingly Common, 2017-24.","authors":"Alexander T Janke, Laura G Burke, Adrian Haimovich","doi":"10.1377/hlthaff.2024.01513","DOIUrl":"https://doi.org/10.1377/hlthaff.2024.01513","url":null,"abstract":"<p><p>When hospital beds are scarce, patients \"board\" in the emergency department until an inpatient bed becomes available. Using national data on 46.2 million hospitalizations, 2017-24, we documented rising burdens of hospital boarding in the US. At the peak in January 2022, 40.1 percent of patients boarded for more than four hours, and 6.3 percent boarded for more than twenty-four hours.</p>","PeriodicalId":519943,"journal":{"name":"Health affairs (Project Hope)","volume":"44 6","pages":"739-744"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144210669","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Trends In Authorized Generic Drug Launches And Their Effects On Competition In Oral-Solid Drug Markets In The US, 2016-23. 2016-23年美国批准的仿制药上市趋势及其对口服固体药物市场竞争的影响
Health affairs (Project Hope) Pub Date : 2025-06-01 DOI: 10.1377/hlthaff.2024.01058
Keith M Drake, Gered Dunne, Aime Mason, Thomas G McGuire, Amie Price
{"title":"Trends In Authorized Generic Drug Launches And Their Effects On Competition In Oral-Solid Drug Markets In The US, 2016-23.","authors":"Keith M Drake, Gered Dunne, Aime Mason, Thomas G McGuire, Amie Price","doi":"10.1377/hlthaff.2024.01058","DOIUrl":"https://doi.org/10.1377/hlthaff.2024.01058","url":null,"abstract":"<p><p>An authorized generic is a brand manufacturer's drug marketed as a generic product. It is the first traditional generic entrant's only potential competition during the 180-day generic exclusivity period. However, the brand manufacturer's ability to withhold its authorized generic represents a valuable bargaining chip that the manufacturer can offer the first traditional generic entrant in exchange for a later start date for generic competition. With data on 146 oral-solid drugs experiencing first generic entry during the period 2016-23, we found evidence for both positive and negative effects of authorized generics on competition. On-invoice prices that pharmacies paid for new generics were 13-18 percent lower when an authorized generic was available. However, authorized generic launches, which were once common, declined markedly in more recent years, which may be partly explained by no-authorized-generic agreements in brand-generic patent litigation settlements. Curtailing these agreements could greatly benefit drug purchasers.</p>","PeriodicalId":519943,"journal":{"name":"Health affairs (Project Hope)","volume":"44 6","pages":"745-753"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144210621","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
CMS's Hospice Star Rating System Limited By Missing Data. CMS的临终关怀星级评定系统因数据缺失而受限。
Health affairs (Project Hope) Pub Date : 2025-06-01 DOI: 10.1377/hlthaff.2024.01414
Amanda C Chen, David C Grabowski
{"title":"CMS's Hospice Star Rating System Limited By Missing Data.","authors":"Amanda C Chen, David C Grabowski","doi":"10.1377/hlthaff.2024.01414","DOIUrl":"https://doi.org/10.1377/hlthaff.2024.01414","url":null,"abstract":"<p><p>Two-thirds of US hospices were not given a star rating when the Centers for Medicare and Medicaid Services (CMS) introduced its hospice star rating system in 2022. Since then, the share of hospices without a star rating has steadily increased, including through the most recent reporting period of 2024. This suggests that the CMS hospice star rating is having limited impact. We provide recommendations for CMS and other policy makers to improve the value for hospice patients of publicly reported star ratings.</p>","PeriodicalId":519943,"journal":{"name":"Health affairs (Project Hope)","volume":"44 6","pages":"716-721"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144210668","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Payment Policy, Medicare Advantage, And More. 支付政策，医疗保险优势，以及更多。
Health affairs (Project Hope) Pub Date : 2025-06-01 DOI: 10.1377/hlthaff.2025.00625
Donald E Metz, The Editorial Staff
{"title":"Payment Policy, Medicare Advantage, And More.","authors":"Donald E Metz, The Editorial Staff","doi":"10.1377/hlthaff.2025.00625","DOIUrl":"https://doi.org/10.1377/hlthaff.2025.00625","url":null,"abstract":"","PeriodicalId":519943,"journal":{"name":"Health affairs (Project Hope)","volume":"44 6","pages":"649"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144210675","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Medicare Advantage Plan Disenrollment: Beneficiaries Cite Access, Cost, And Quality Among Reasons For Leaving. 医疗保险优势计划退出：受益人列举了离开的原因，成本和质量。
Health affairs (Project Hope) Pub Date : 2025-06-01 DOI: 10.1377/hlthaff.2024.01536
Geoffrey J Hoffman, Lianlian Lei, Ishrat Alam, Myra Kim, Lillian Min, Zhaohui Fan, Deborah Levine
{"title":"Medicare Advantage Plan Disenrollment: Beneficiaries Cite Access, Cost, And Quality Among Reasons For Leaving.","authors":"Geoffrey J Hoffman, Lianlian Lei, Ishrat Alam, Myra Kim, Lillian Min, Zhaohui Fan, Deborah Levine","doi":"10.1377/hlthaff.2024.01536","DOIUrl":"https://doi.org/10.1377/hlthaff.2024.01536","url":null,"abstract":"<p><p>Medicare Advantage (MA) is growing in popularity, but it is seeing substantial plan disenrollments among high-risk Medicare beneficiaries. Understanding and addressing factors associated with disenrollment are crucial for improving MA access and quality but are complicated by data issues, including the inability to adequately assess beneficiaries' perceptions of access and quality in MA. Using data from the 2015-20 restricted Medicare Current Beneficiary Survey with information on beneficiaries' perceptions of access, cost, and quality, plus MA contract star ratings and plan generosity data, we assessed factors associated with disenrolling from an MA plan. Enrollees' self-reported inability to access and receive high-quality care, more than perceived burdens of out-of-pocket costs, was associated with MA plan disenrollment, as was an objective measure of plan generosity. Difficulty accessing needed medical care was more strongly associated with MA-to-traditional Medicare exits than MA-to-MA plan switching. Dissatisfaction with access, cost, and quality was much more common for enrollees in poor health. These findings renew concerns about access to high-quality care for high-risk and other MA enrollees.</p>","PeriodicalId":519943,"journal":{"name":"Health affairs (Project Hope)","volume":"44 6","pages":"684-692"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144210672","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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