Come for the politics, stay for the snark.

Celebrate the fucking wins.

The words do not have to be perfect.

With all due respect and assumptions of good faith, please fuck off into the sun.

“Jesus paying for the sins of everyone is an insult to those who paid for their own sins.”

“The difference between stupidity and genius is that genius has its limits.”

The cruelty is the point; the law be damned.

This country desperately needs a functioning fourth estate.

The desire to stay informed is directly at odds with the need to not be constantly enraged.

Those who are easily outraged are easily manipulated.

Some judge needs to shut this circus down soon.

At some point, the ability to learn is a factor of character, not IQ.

Nothing says ‘pro-life’ like letting children go hungry.

Republicans firmly believe having an abortion is a very personal, very private decision between a woman and J.D. Vance.

The media handbook says “controversial” is the most negative description that can be used for a Republican.

Anne Laurie is a fucking hero in so many ways. ~ Betty Cracker

If you can’t control your emotions, someone else will.

If you don’t believe freedom is for everybody, then the thing you love isn’t freedom, it is privilege.

Accused of treason; bitches about the ratings. I am in awe.

These are not very smart people, and things got out of hand.

Too often we hand the biggest microphones to the cynics and the critics who delight in declaring failure.

We cannot abandon the truth and remain a free nation.

Since we are repeating ourselves, let me just say fuck that.

“In the future, this lab will be a museum. do not touch it.”

Their shamelessness is their super power.

You are here: Home / Anderson On Health Insurance / High cost can be high value

High cost can be high value

by | 11 Comments

This post is in: 

A new article just came out in JAMA this morning. The authors look at the thirty day cost of care for Medicare beneficiaries dependent on whether or not they go to academic medical centers or community hospitals.

In this cross-sectional study of more than 1.2 million hospitalizations, major teaching hospitals had higher initial hospitalization costs than nonteaching hospitals, but the total costs of care at 30 days were lower at major teaching hospitals largely because of lower costs for post–acute care services and readmissions.

This is a big finding if it is generalizable to younger populations. Right now, quite a few insurers attempt to control costs by narrowing their networks. Narrowing networks can produce savings in one of two ways. One is the insurer leverages competetive hospital markets to get a price concession. In North Carolina, BCBS North Carolina put their ACA networks out for bid between Duke, UNC and Wake-Med. Those three systems are all high end, comprehensive systems. UNC won the ACA contract to be BCBS-NC’s sole tertiary care hospital system in the Research Triangle. UNC, from what I heard, put in a significantly lower bid than Duke. This lower bid helped BCBS-NC cut their ACA rates substantially in 2019.

The other way premiums can be cut is to screen out sick people from any product offered by a given insurer. Mark Shepard has an excellent paper that showed an incredible amount of adverse selection due to the presence of a single high end hospital in Massachusetts. Other research shows significant adverse selection by the presence of a sole specialty hospital. Excluding a high cost hospital lowers premiums for the people who don’t want access to that high cost hospital but it makes people who want/need access to a high cost and highly specialized care portfolio worse off.

This paper suggests that we need to re-evaluate how we think about attributing costs and benefits of academic medical centers. They may be expensive up front but over a reasonable short time frame, they could be quite cost effective at the value they provide.

Reader Interactions

11Comments

  1. 1.

    TenguPhule

    Speaking of high costs…..

    US homeopaths claim ‘therapies’ prevent measles and ‘cure’ autism

    Thousands of American children are being put on homeopathic alternatives to vaccination by practitioners who claim they can prevent measles and “cure” autism, the Guardian has learned.

    At least 200 homeopaths in the US are practicing a controversial “therapy” known as Cease that falsely asserts that it has the power to treat and even cure autism. The acronym stands for Complete Elimination of Autistic Spectrum Expression.

    The “therapy” relies in part on administering high doses of vitamin C. Advocates falsely say it repairs the harm caused by vaccination – a double untruth as most vaccines are safe and there is no link between vaccines and autism, a condition for which there is no cure.

    In addition 250 homeopaths, some of whom also practice Cease, are promoting “homeoprophylaxis” that advertises itself as an “immunological education program”. More than 2,000 American children have been put on the program which claims to build natural immunity against infectious diseases, though there is no scientific evidence that it works.

    Parents who opt to follow Cease or homeoprophylaxis are potentially exposing their children, as well as others around them, to life-threatening illness. The implicit message behind both therapies is that vaccines are harmful and should be avoided.

    The snake oil folks are going to injure and kill a lot of children with stupid and ignorant parents.

  2. 2.

    FlyingToaster (Tablet)

    Our HMO plan steers us clear of the Partners and specialty hospitals here in Boston. (Mass General, Brigham & Women’s, Dana Farber, Childrens, etc.) We are fine with it because all of our doctors are at/with Mt. Auburn (part of Harvard Med School). We want to be at a teaching hospital, but we don’t have to be at one in the expensive parts of town.

    And if we need specialty care, we can still end up referred over there, and it’s covered (with pre-approval).

  3. 3.

    taumatugo

    No matter the healthcare pie is sliced, the middle man will not let go of its share. It is gouging taken to the umpteen degree. A great deal of complexity is how the profit before care miscreant take advantage of the bumper sticker mentality consumers.

  5. 5.

    john fremont

    Just think , 20 years ago people were telling us we needed colloidal silver! We know so much more now! What a time to be alive!

  10. 10.

    Ohio Mom

    @Steve in the ATL: Yes, I just got an email telling me that today! And yesterday, and the day before that…which reminds me, time to empty the email Trash file.

    @TenguPhule: Not only could there never be a cure for autism (for many reasons I don’t have time to go into), there could never even be A treatment for autism because there are multiple autisms with different etiologies, presentations, prognoses, etc.

    What autism really needs is a very strong social service safety net, so people with autism can have whatever supports they need to live their best lives. But you knew that.

Comments are closed.