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1.
J Health Econ ; 66: 241-259, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31299558

RESUMO

Price transparency initiatives have recently emerged as a solution to the lack of health care price information available to consumers. This paper uses the staggered and nationwide diffusion of a leading internet-based price transparency platform to estimate the effects of price transparency on provider prices. I find a 1-4% reduction in provider prices for homogenous services, laboratory tests, but find no price response for differentiated services, office visits. Price responses are driven by active consumer use of price information. This paper demonstrates how reducing consumer search costs can spur limited firm price competition in health care markets.

2.
Med Care ; 57(9): 680-687, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31295166

RESUMO

BACKGROUND: Properties of social networks and shared patient networks of physicians are associated with important outcomes, including costs, quality, information exchange, and organizational effectiveness. OBJECTIVES: To determine whether practice consolidation affects size, strength, and stability of US practice-based physician shared patient networks. RESEARCH DESIGN: We used a dynamic difference-in-differences (event study) design to determine how 2 types of vertical consolidation (hospital and health system practice acquisition) and 2 types of horizontal consolidation (medical group membership and practice-practice mergers) affect individual shared patient network characteristics, controlling for physician fixed effects and geographic market (metropolitan statistical area). SUBJECTS: Practice-based US physicians whose practices consolidated 2009-2014 are identified via health system, hospital, and medical group affiliation information and appearance/disappearance of listed practice affiliations in the SK&A Physician Database. MEASURES: Outcomes measured were network size (number of individual physicians with whom a physician shares patients within 30 d), strength (average number of shared patients within those relationships), and stability (percent of shared patient relationships that persist in the current and prior year), all generated from Medicare Shared Patient Patterns (30-d) data. RESULTS: Shared patient network stability increases significantly after acquisition of practices by horizontal practice-practice mergers [ßt=1=0.041 (P<0.001), ßt=2=0.047 (P<0.001), ßt=3=0.041 (P<0.001), ßt=4=0.031 (P<0.05), where t is the number of years after the consolidation event]. These effects were robust to sensitivity analyses. Shared patient network size and strength are not observably associated with practice consolidation events. CONCLUSIONS: Practice consolidation can increase the stability of physician networks, which may have positive implications for organizational effectiveness.


Assuntos
Redes Comunitárias/estatística & dados numéricos , Assistência ao Paciente/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Prática Profissional/organização & administração , Redes Comunitárias/organização & administração , Humanos , Médicos/organização & administração , Padrões de Prática Médica/organização & administração , Atenção Primária à Saúde/organização & administração , Estados Unidos
3.
J Health Econ ; 65: 246-259, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31082768

RESUMO

We study the introduction of reference pricing to the California Public Employees' Retirement System. Reference pricing changes the relative price of using a hospital versus an ambulatory surgery center (ASC) for patients receiving a colonoscopy, leading to as good as random variation in patients' use of ASCs. We find a 10 percentage point increase in the share of patients using an ASC, leading to a $2300 to $1700 reduction in prices paid for patients who switch to ASCs. Our results suggest that the use of ASCs has a causal effect on prices paid and has no negative effect on patient health outcomes.

4.
J Med Econ ; 22(9): 869-877, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31012392

RESUMO

Aims: Many new mobile technologies are available to assist people in managing chronic conditions, but data on the association between the use of these technologies and medical spending remains limited. As the available digital technology offerings to aid in diabetes management increase, it is important to understand their impact on medical spending. The aim of this study was to investigate the financial impact of a remote digital diabetes management program using medical claims and real-time blood glucose data. Materials and methods: A retrospective analysis of multivariate difference-in-difference and instrumental variables regression modeling was performed using data collected from a remote digital diabetes management program. All employees with diabetes were invited, in a phased introduction, to join the program. Data included blood glucose (BG) values captured remotely from members via connected BG meters and medical spending claims. Participants included members (those who accepted the invitation, n = 2,261) and non-members (n = 8,741) who received health insurance benefits from three self-insured employers. Medical spending was compared between people with well-controlled (BG ≤ 154 mg/dL) and poorly controlled (BG > 154 mg/dL) diabetes. Results: Program access was associated with a 21.9% (p < 0.01) decrease in medical spending, which translates into a $88 saving per member per month at 1 year. Compared to non-members, members experienced a 10.7% (p < 0.01) reduction in diabetes-related medical spending and a 24.6% (p < 0.01) reduction in spending on office-based services. Well-controlled BG values were associated with 21.4% (p = 0.03) lower medical spending. Limitations and conclusions: Remote digital diabetes management is associated with decreased medical spending at 1 year. Reductions in spending increased with active utilization. It will be beneficial for future studies to analyze the long-term effects of the remote diabetes management program and assess impacts on patient health and well-being.


Assuntos
Diabetes Mellitus Tipo 2/economia , Diabetes Mellitus Tipo 2/terapia , Autogestão/economia , Autogestão/métodos , Telemedicina/economia , Telemedicina/métodos , Adolescente , Adulto , Glicemia , Automonitorização da Glicemia , Criança , Análise Custo-Benefício , Diabetes Mellitus Tipo 2/sangue , Feminino , Gastos em Saúde/estatística & dados numéricos , Recursos em Saúde/estatística & dados numéricos , Serviços de Saúde/estatística & dados numéricos , Humanos , Revisão da Utilização de Seguros , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Dispositivos Eletrônicos Vestíveis , Adulto Jovem
5.
Health Aff (Millwood) ; 38(3): 440-447, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30830823

RESUMO

Employers and insurers are experimenting with benefit strategies that encourage patients to switch to lower-price providers. One increasingly popular strategy is to financially reward patients who receive care from such providers. We evaluated the impact of a rewards program implemented in 2017 by twenty-nine employers with 269,875 eligible employees and dependents. For 131 elective services, patients who received care from a designated lower-price provider received a check ranging from $25 to $500, depending on the provider's price and service. In the first twelve months of the program we found a 2.1 percent reduction in prices paid for services targeted by the rewards program. The reductions in price resulted in savings of $2.3 million, or roughly $8 per person, per year. These effects were primarily seen in magnetic resonance imaging and ultrasounds, with no observed price reduction among surgical procedures.

7.
Health Aff (Millwood) ; 37(9): 1503-1508, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-30179546

RESUMO

The California drug transparency bill (SB-17), signed into law in October 2017, seeks to promote transparency in pharmaceutical pricing, enhance understanding about pharmaceutical pricing trends, and assist in managing pharmaceutical costs. This article examines the legal and regulatory aspects of SB-17, explores legal challenges to the law, compares it to other state efforts to address rising drug prices, and discusses how California can maximize the impact of SB-17 by coupling the law with other incentives. While SB-17 might not significantly reduce drug prices, the new law represents a meaningful step for one state seeking to negotiate the political and legal boundaries of state action to rein in drug prices.


Assuntos
Controle de Custos/métodos , Custos de Medicamentos/legislação & jurisprudência , Farmacoeconomia , Legislação de Medicamentos , Medicamentos sob Prescrição/economia , California , Humanos
8.
Health Aff (Millwood) ; 37(9): 1409-1416, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-30179552

RESUMO

California has heavily concentrated hospital, physician, and health insurance markets, but their current structure and functioning is not well understood. We assessed consolidation trends and performed an analysis of "hot spots"-markets that potentially warrant concern and scrutiny by regulators in terms of both horizontal concentration (such as hospital-hospital mergers) and vertical integration (hospitals' acquisition of physician practices). In 2016, seven counties were high on all six measures used in our hot-spot analysis (four horizontal concentration and two vertical integration measures), and five counties were high on five. The percentage of physicians in practices owned by a hospital increased from about 25 percent in 2010 to more than 40 percent in 2016. The estimated impact of the increase in vertical integration from 2013 to 2016 in highly concentrated hospital markets was found to be associated with a 12 percent increase in Marketplace premiums. For physician outpatient services, the increase in vertical integration was also associated with a 9 percent increase in specialist prices and a 5 percent increase in primary care prices. Legislative proposals, actions by the state's attorney general, and other regulatory changes are suggested.


Assuntos
Comércio/estatística & dados numéricos , Assistência à Saúde/estatística & dados numéricos , Instituições Associadas de Saúde/estatística & dados numéricos , Trocas de Seguro de Saúde/estatística & dados numéricos , Patient Protection and Affordable Care Act/economia , Atenção Primária à Saúde/estatística & dados numéricos , Adulto , California , Assistência à Saúde/tendências , Gastos em Saúde , Política de Saúde , Humanos , Seguro Saúde/economia , Patient Protection and Affordable Care Act/estatística & dados numéricos , Atenção Primária à Saúde/economia , Estados Unidos
9.
J Health Econ ; 61: 111-133, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-30114564

RESUMO

This paper examines how health care providers respond to a reference pricing insurance program that increases consumer cost sharing when consumers choose high-priced surgical providers. We use geographic variation in the population covered by the program to estimate supply-side responses. We find limited evidence of market segmentation and price reductions for providers with baseline prices above the reference price. Finally, approximately 75% of the reduction in provider prices is in the form of a positive externality that benefits a population not subject to the program.


Assuntos
Custo Compartilhado de Seguro , Mecanismo de Reembolso , Procedimentos Cirúrgicos Operatórios/economia , Artroscopia/economia , California , Extração de Catarata/economia , Colonoscopia/economia , Custo Compartilhado de Seguro/economia , Custo Compartilhado de Seguro/métodos , Competição Econômica , Honorários Médicos , Humanos , Mecanismo de Reembolso/economia , Mecanismo de Reembolso/organização & administração , Reembolso de Incentivo/economia , Reembolso de Incentivo/organização & administração
10.
J Health Econ ; 56: 201-221, 2017 12.
Artigo em Inglês | MEDLINE | ID: mdl-29111500

RESUMO

This paper examines the effects of the reference pricing program implemented by the California Public Employees Retirement System (CalPERS) in 2012. The program uses targeted cost-sharing to incentivize patient price shopping. We find that the program leads to a 10.3% increase in the use of low-price providers and reduces the average cost per procedure by 12.5%. We further estimate that the program reduces medical spending by $218.8 per procedure, which we estimate is approximately 53.7% of the excessive spending that is due to patient choice of higher price providers caused by insurance coverage, at the expense of a $94.3 (or 12.5%) reduction in consumer surplus. The cost savings from the reference pricing program is about two to three times as large as the reduction from implementing a high-deductible health plan, while the accompanying consumer surplus reduction is much smaller under reference pricing.


Assuntos
Comportamento de Escolha , Dedutíveis e Cosseguros , Planos de Assistência de Saúde para Empregados , Princípios Morais , Participação do Paciente , Algoritmos , California , Redução de Custos , Feminino , Humanos , Revisão da Utilização de Seguros , Cobertura do Seguro , Masculino
11.
N Engl J Med ; 377(7): 658-665, 2017 08 17.
Artigo em Inglês | MEDLINE | ID: mdl-28813219

RESUMO

Background In the United States, prices for therapeutically similar drugs vary widely, which has prompted efforts by public and private insurers to steer patients toward the lower-priced options. Under reference pricing, the insurer or employer establishes a maximum contribution it will make toward the price of a drug or procedure, and the patient pays the remainder. Methods We used difference-in-differences multivariable regression methods to analyze changes in prescriptions and pricing for 1302 drugs in 78 therapeutic classes in the United States, before and after implementation of reference pricing by an alliance of private employers. We assessed trends for the study group relative to those for an employee group that was not subject to reference pricing. The study included 1,122,741 prescriptions that were reimbursed during the period from 2010 through 2014. Results Implementation of reference pricing was associated with a higher percentage of prescriptions that were filled for the lowest-priced reference drug within its therapeutic class (difference in probability, 7.0 percentage points; 95% confidence interval [CI], 4.0 to 9.9), a lower average price paid per prescription (-13.9%; 95% CI, -23.8 to -2.7), and a higher rate of copayment by patients (5.2%; 95% CI, 0.2 to 10.4) than in the comparison group. During the first 18 months after implementation, spending for employers was $1.34 million lower and the amount of copayments for employees was $0.12 million higher than in the comparison group. Conclusions Implementation of reference pricing was associated with significant changes in drug selection and spending for a population of patients covered by employment-based insurance in the United States. (Funded by the Agency for Healthcare Research and Quality and the Genentech Foundation.).


Assuntos
Custo Compartilhado de Seguro , Prescrições de Medicamentos/estatística & dados numéricos , Substituição de Medicamentos/tendências , Medicamentos sob Prescrição/economia , Honorários por Prescrição de Medicamentos , Prescrições de Medicamentos/economia , Substituição de Medicamentos/economia , Planos de Assistência de Saúde para Empregados/economia , Humanos , Análise de Regressão , Estados Unidos
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