As these data are only available through early December , it is not yet clear how the latest spike in hospitalizations due to COVID — which resulted in some hospitals again reaching capacity — affected utilization into early Although most employer health plans cover telemedicine services, our analysis found that telemedicine uptake before the coronavirus pandemic remained low.
In , 2. However, with social distancing, changes to provider payment for telehealth, and recommendations to call ahead to providers, telemedicine use has increased with the pandemic, according to analysis by IQVIA. Even so, as the chart above demonstrates, telehealth use was not large enough to fully offset the drop in in-person care.
An analysis by IQVIA found that oncology visits for newly diagnosed cancer patients began to increase in summer, but and had still not reached baseline in October. If cancer cases are missed or patients are diagnosed at later stages, this could have long-term impacts on both health outcomes and costs. Similar patterns can be seen for other serious and chronic diseases. The sustained decrease in health services utilization, including preventive services, may lead to more serious diagnoses and increased disease burden in the future.
Individual market insurers are required to file detailed premium justifications to state regulators for the coming year. In their rate filings, most insurers pointed to remaining uncertainty surrounding pent-up demand for delayed or forgone health services in , the costs associated with distributing coronavirus vaccinations, and the direct costs of treating people with COVID Of those insurers that specified a rate impact due to the pandemic, most said the pandemic would have a net-zero effect on their costs in , with some insurers saying they expect costs to drop and others expecting costs to increase.
This variation in expectations across insurers illustrates the remaining uncertainty of how the pandemic will continue to affect the U. In response, a number of insurers preemptively offered premium relief and voluntarily waived cost-sharing for COVID treatment and certain other services.
Visit the Dashboard. More broadly, any Medicare for all system would be influenced by the decisions and actions of parties concerned — patients, health care providers and political actors — in complex, hard-to-predict ways. Gerald Friedman , a professor of economics at the University of Massachusetts, Amherst, whose estimates were frequently cited by the Bernie Sanders presidential campaign in Analysts at the RAND Corporation , a global policy research group that has estimated the effects of several single-payer health care proposals.
Kenneth E. Thorpe , the chairman of the health policy department at Emory University, who helped Vermont estimate the costs of a single-payer proposal there in Analysts at the Urban Institute , a Washington policy research group that frequently estimates the effects of health policy changes. Right now, individuals and employers pay insurance premiums; people pay cash co-payments for drugs; and state governments pay a share of Medicaid costs.
In a system like one introduced as a bill by Mr. Sanders or another from Representative Pramila Jayapal and the Congressional Progressive Caucus, nearly all of that would be replaced by federal spending. Other Democrats who are supporting coverage expansion through Medicare have offered more modest proposals that would preserve some out-of-pocket spending and a role for private insurance.
The economists made their calculations using different assumptions and methods, and you can read more about those methods at the bottom of this article. The biggest difference between the Mercatus estimate and the Urban one is related to how much the new system would pay doctors, hospitals and other medical providers for health services.
In our current system, doctors, hospitals and other health care providers are paid by a number of insurers, and those insurers all pay them slightly different prices. In general, private insurance pays medical providers more than Medicare does. Under a Medicare for all system, Medicare would pick up all the bills.
Paying the same prices that Medicare pays now would mean an effective pay cut for medical providers who currently see a lot of patients with private insurance. But if rates are too low, hospitals already facing financial difficulties could be put out of business. Neither Mr. So our estimators offered their best guess of what they thought such a plan might do.
Thorpe said he picked a number higher than current Medicare prices for hospitals, because he thought anything lower would be unsustainable. Blahous said he constructed his starting estimate at precisely Medicare rates, though he thought the real number would most likely be higher. He also reran his calculations with a more generous assumption: At percent of Medicare, around the average amount all health insurers pay medical providers now, the total shot up by hundreds of billions of dollars, about an additional 1.
Patients in the United States pay the highest prices in the world for prescription drugs. But it also reflects national preferences: An effective negotiator needs to be able to say no, and American patients tend to want access to the widest array of cutting-edge drugs, even if it means paying more.
But politics would still be a constraint. A system willing to pay for fewer drugs could probably get bigger discounts than one that wanted to preserve the current set of choices. That would mean, though, that some patients would be denied the medications they want.
All of our economists thought a Medicare for all system could negotiate lower prices than the current ones. Roughly one-quarter, or 27 percent, of hospitals lost money in in , with public hospitals most likely to experience losses, at 40 percent. Total margins were negative for 26 percent of for-profit hospitals and 25 percent of nonprofit hospitals. That amount suggests that stronger rate regulation could save Americans tens of billions of dollars on hospital expenditures, even if rates were tailored to keep afloat loss-making hospitals that are crucial to patient access.
Geographic variation in health care expenditures is well documented. Per capita health care expenditures in high-spending regions of the United States are about 40 percent higher than those in lower-spending regions.
Among the privately insured population, for whom reimbursement rates are negotiated between insurers and providers, prices play a much larger role in spending variation.
Pricing data for employer-sponsored plans show wide geographic variation in what hospitals are paid for care. Analyses of commercial claims from the Heath Care Cost Institute demonstrate the huge range of the price of care both within and across metropolitan areas. Nevertheless, the cost of high-priced care is passed on to consumers through health insurance premiums. The hospital markets with the least competition have health insurance marketplace premiums that are 5 percent higher than the average, a recent Health Affairs study found.
There is a wide and growing gap between public and private rates. Although public and private reimbursement rates have indisputably diverged over time, 24 precise payment ratios depend on how supplemental governmental payments to hospitals are counted. According to the nonpartisan Medicaid and CHIP Payment and Access Commission, Medicaid reimbursement levels are generally higher than those of Medicare if supplemental payments are counted toward Medicaid payments. Without considering disproportionate share DSH payments to hospitals serving indigent populations, hospitals are reimbursed 93 percent of cost for Medicaid patients.
If DSH payments are included, Medicaid payments are percent of cost. Some recent studies have documented that private payment rates are much higher than of Medicare. Congressional Budget Office researchers estimated that the price of an inpatient stay was on average percent of the Medicare rate in A separate but related question is how payment rates relate to marginal costs: If a hospital has an empty bed, can it expect to make or lose money by filling it with an additional patient?
When rates are too low relative to the incremental cost of serving that patient, then hospitals have financial incentive to turn the patient away. Studies suggest that Medicare reimbursements are well above incremental cost. A persistent argument in the debate over hospital payment is that hospitals engage in cost-shifting, raising prices on private payers to compensate for insufficient payment from public programs.
In support of the latter theory, a MedPAC analysis found that hospitals that face greater price pressure have lower costs. Relatively efficient hospitals, which MedPAC identified by cost and quality criteria, had higher total margins 8 percent than less efficient hospitals 5 percent.
Given the disparity between the public and private reimbursement levels, the average payment a hospital receives depends on its payer mix. According to the AHA, A number of studies have reported hospital reimbursements by payer relative to Medicare levels; 37 the results are synthesized in Table 2.
Combining the AHA-reported payer mix with published estimates of rates relative to Medicare, CAP estimates that hospitals receive approximately percent of Medicare rates across their main payers. Payment reforms could achieve even greater savings if hospitals that currently lack competition were pressured to operate more efficiently and lower their costs.
Given that hospitals currently enjoy an 8 percent margin, average reimbursement across the major payers could be reduced down to percent of Medicare rates while still enabling the industry as a whole to cover its current costs. Several policy options could bring down hospital costs, many of which have already been implemented at the federal or state level, bringing down prices and slowing the growth of hospital expenditures. Hospital payment rates could be brought down directly through all-payer rate setting, reference pricing, or regulations to cap rates.
Federal policies to improve competition in hospital markets—including stronger antitrust enforcement, fairer payment rules, and greater transparency—could also bring down prices and tame the growth of American hospital costs. At a minimum, congressional and state legislators should act to stop the one of the most egregious billing practices associated with hospital care: surprise billing.
For much of the past two decades — with the exception of the period surrounding the economic downturn — growth in utilization outpaced growth in pharmaceutical prices. Due to the way drugs are selected for inclusion in the price index, it can take some time for new drugs to be incorporated into the index. From to , per capital national health expenditures grew faster than the Personal Consumption Expenditure Price Index inflation.
Starting in , health spending growth slowed to a similar rate as inflation and remained relatively stable at about 3 percent growth per year.
Per capita health spending slowed slightly from to , declining 0. Visit the Dashboard. Dashboard Interactives Video About Us. Health services spending growth fell in early Before the pandemic, total health expenditures increased substantially over the past several decades.
On a per capita basis, health spending has grown substantially. Health spending growth has outpaced growth of the U. Health spending growth has slowed, and is now more on pace with economic growth.
In recent years, spending on hospitals, physicians, and prescriptions has slowed to a similar pace. Hospital and physician services represent half of total health spending. Per capita out-of-pocket expenditures have grown since
0コメント