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This Week in Health Care Reform

 January 4, 2019

New data shows the US spending more than any other country on hospital care; a year-long investigation turns up valuable insights on health care costs; drugmakers return to their old ways in the New Year; telehealth surges, but gaps remain; and, increased attention to social determinants of health fuels a focus on wellness.


Week in Review

Hospital Spending: Just prior to the end of last year, newly released data from the Organization for Economic Co-operation and Development (OECD) provided a stark reminder of the pervasive gap in health care spending between this country and other wealthy, developed nations.  While the glaring difference between what we pay for prescription drugs versus what other countries pay continues to dominate the headlines, according to the analysis, the United States also spends considerably more on hospitals per capita than any of the other three dozen countries in the OECD.  Experts have been drawing attention to this trend, specifically citing the rapid pace of hospital mergers, as driving up costs for consumers.  But, as of January 1st, a new regulation has taken effect, requiring hospitals – who, themselves, have been called out for not even knowing what their own services cost – to post the prices of their services online in the hopes that a greater emphasis on transparency will lead to increased consumerism – namely, by putting enhanced decision-making tools in the hands of patients. 

Health Care Costs:
 A recent report pegged the cost of non-fatal health care injuries at a dizzying $1.8 trillion annually.  Granted, in addition to medical spending, that number also includes lost productivity and the impact to quality of life.  Still, it’s hard to argue that any substantive discussion on health care reform must, by necessity, begin with an in-depth look at health care costs.  That’s precisely what one reporter set out to do more than a year ago, asking readers to submit their emergency room bills to get a better sense of the variability and unpredictability that marks one of the more frequent ways people interact with the health care system.  Among the takeaways from her analysis: It’s increasingly difficult for patients to be their own advocates in an emergency room setting; charges can be ridiculous – up to, and including, being billed for just sitting in a waiting room; and, going to an in-network hospital doesn’t mean you’ll be automatically seen by in-network doctors.  But, perhaps the most compelling lesson imparted from her exhaustive research: Prices are high – even for common items that can be purchased in a drugstore.

Rx Price Hikes: As expected, drugmakers rang in the New Year by hiking up prices on hundreds of medicines.  After suspending such increases for the latter half of 2018, dozens of pharmaceutical manufacturers wasted no time raising prices on scores of drugs Tuesday morning.  Experts point to the coordinated resumption of these price-hiking practices as evidence that the pharmaceutical industry has changed little despite the increased public scrutiny and inflamed rhetoric.  But, the start of the New Year brings with it the convening of a brand new legislative session overseen by a brand new Congress – and, perhaps most saliently, one populated by elected officials determined to find common purpose in lowering the out-of-control cost of prescription drugs.

Telehealth Gaps:
The last year saw continued advances in the adoption and integration of telehealth services into our larger health care delivery model, but gaps remain.  For instance, although telemedicine visits increased sharply, the vast majority of patients in this country still receive care in person rather than remotely.  As stakeholders work to capitalize on the promise made possible through technological developments in the digital space, experts are left to ponder what it will take in order for telehealth to achieve its full potential.

Social determinants of health (SDoH) continue to inform our thinking in regards to whole-person health, while reshaping our vision of what a comprehensive health care system should look like.  While that evolution has come in fits and starts, it would seem that our appreciation and acceptance of the role that non-medical factors play in our overall health and well-being have both found traction as stakeholders work to fold SDoH into their programmatic design.  Most recently, that saw Department of Health & Human Services (HHS) Secretary Alex Azar deliver prepared remarks in which he suggested that HHS may soon allow federal health programs to address social factors more directly – primarily by giving them flexibility to increase access to affordable housing and nutritious foods.   

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Looking Ahead

As we take our first cautious steps into 2019, health policy experts offer up their predictions for what will largely be driving the health care conversation in the year to come, not to mention from where we’re likely to see the most action. 

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