Tag Archives: Costs

Morning News: Canada Election Aftermath, Cost Of Online Shopping Rises

Prime Minister Justin Trudeau remains in power after Monday’s election, but he emerges without the majority he wanted, and with his soft power damaged. He now faces a fourth wave of the pandemic and an emboldened far-right from a weaker position.

 Child labour fell markedly in the 16 years after the turn of the millennium. Now it’s on the rise again. Efforts to prevent children from working can often exacerbate the problem. And we consider one of the more unusual ideas for combating climate change: potty-training cows.

Views: Is U.S. Healthcare System Broken? (Harvard)

Here’s a question that’s been on my mind and perhaps yours: Is the US healthcare system expensive, complicated, dysfunctional, or broken? The simple answer is yes to all.

Below are 10 of the most convincing arguments I’ve heard that our system needs a major overhaul. And that’s just the tip of the iceberg. Remember, an entire industry has evolved in the US just to help people navigate the maddeningly complex task of choosing a health insurance plan.

The cost is enormous

  • High cost, not highest quality. Despite spending far more on healthcare than other high-income nations, the US scores poorly on many key health measures, including life expectancy, preventable hospital admissions, suicide, and maternal mortality. And for all that expense, satisfaction with the current healthcare system is relatively low in the US.
  • Financial burden. High costs combined with high numbers of underinsured or uninsured means many people risk bankruptcy if they develop a serious illness. Prices vary widely, and it’s nearly impossible to compare the quality or cost of your healthcare options — or even to know how big a bill to expect. And even when you ask lots of questions ahead of time and stick with recommended doctors in your health insurance network, you may still wind up getting a surprise bill. My neighbor did after knee surgery: even though the hospital and his surgeon were in his insurance network, the anesthesiologist was not.

Access is uneven

  • Health insurance tied to employment. During World War II, healthcare was offered as a way to attract workers since employers had few other options. Few people had private insurance then, but now a layoff can jeopardize your access to healthcare.
  • Healthcare disparities. The current US healthcare system has a cruel tendency to delay or deny high-quality care to those who are most in need of it but can least afford its high cost. This contributes to avoidable healthcare disparities for people of color and other disadvantaged groups.
  • Health insurers may discourage care to hold down costs. Many health insurance companies restrict expensive medications, tests, and other services by declining coverage until forms are filled out to justify the service to the insurer. True, this can prevent unnecessary expense to the healthcare system — and to the insurance company. Yet it also discourages care deemed appropriate by your physician.

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Sports Business: The High Cost Of Hosting Olympics

In 2018, the Rio games were estimated to have a total cost of $20 billion, far beyond the Rio organizing committee’s initial estimate of $2.8 billion. The city of Rio shelled out $8.2 billion on legacy builds, or builds intended to live well beyond the Olympic’s three-week life-cycle. Cities incurring overrun costs when hosting the Olympics is not just unique to just Rio; according to the Council on Foreign Relations, since 1960, every Olympics saw high overrun costs. As overrun costs become a growing concern, several cities withdrew their 2022 winter Olympic bids in 2014, citing the potential costs. The International Olympic Committee (IOC) enacted the Olympic Agenda 2020 in 2014; the agenda provided new regulations specifically to mitigate cost concerns. However, the IOC was faced with another challenge: hosting the Tokyo Olympics amid the Covid-19 pandemic.

Healthcare: The Costs Of ‘Long-Covid’ Treatment

Covid-19 is a particularly vicious disease. While a significant number of people remain asymptomatic, other patients could go on to develop what researchers are calling post-Covid-19 syndrome. Americans suffering from the condition are running into financial problems due to the inconsistent nature of the U.S. health-care system. CNBC spoke with three people about their experience battling Covid and paying for their treatment. Watch the video above to learn how coronavirus treatment costs add up long after patients leave the hospital.

Video timeline: 0:00​ – Introduction 1:40​ – What the data says 3:28​ – In for the long haul 7:40​ – Government assistance 9:12​ – What’s next?

Prescription Drugs: ‘Why They Remain High-Priced’

By Kerry Dooley Young (September 28, 2020)

There may be few issues that unite Americans ahead of the 2020 election as do their concerns about the cost of prescription drugs.

A clear majority — 75% — of respondents to a July survey said the cost of prescription medicines would be among the factors likely to influence their votes this year, according to a report from Gallup and the nonprofit West Health. Gallup reported on results from 1,007 interviews conducted with adults between July 1 and July 24.

1. What are the 2020 presidential candidates saying they will do to lower drug prices?

Both President Donald Trump, a Republican, and former Vice President Joe Biden, a Democrat, have highlighted insulin costs in their discussions of the need to lower drug prices.

In a January interview with the New York Times editorial board, Biden noted the widespread discontent among Americans about sticker shock often experienced at pharmacies. He spoke of a need for the federal government to act to make medicines more affordable.

“This is a place where I find, whether you’re Republican or Democrat, you think you’re getting screwed on drug prices. And you are, in terms of everything from insulin to inhalers and a whole range of other things,” Biden said. “So, again, can I guarantee that it gets done? No, but I can tell you what, if anybody can get it done, I can, and I think there’s a consensus for it.”

2. Why doesn’t Medicare, the biggest U.S. purchaser of drugs, directly negotiate on drug prices?

Congress has taken different approaches in designing the terms under which the two largest federal health programs, Medicaid and Medicare, buy drugs.

Medicaid is a program run by states with federal contributions and oversight. It covers people with low incomes and disabilities. Almost 67 million people were enrolled in Medicaid as of May 2020, including about 29 million children. In 1990 Congress decided that drugmakers who want to have their products covered by Medicaid must give rebates to the government. The initial rebate is equal to 23.1% of the average manufacturer price (AMP) for most drugs, or the AMP minus the best price provided to most other private-sector payers, whichever is greater. An additional rebate kicks in when prices rise faster than general inflation.

3. What’s the deal with rebates and discounts?

There’s widespread frustration among lawmakers and policy analysts about the lack of clarity about the role of middlemen in the supply chain for medicines. Known as pharmacy benefit managers (PBMs), these businesses describe the aim of their business as making drugs more affordable for consumers. Insurers like Cigna and UnitedHealth operate some of the nation’s largest PBMs, as does pharmacy giant CVS Health, which also owns insurer Aetna.

“They will tell you their mission is to lower drug costs,” said Rep. Earl L. “Buddy” Carter, a Georgia Republican, a pharmacist and a critic of PBMs, in a speech on the House floor last year. “My question to you would be: How is that working out?”

4. What is the “distinctly American” phenomenon of specialty drugs?

Kesselheim also has written on what he terms “Specialty Drugs — A Distinctly American Phenomenon.” That’s the title of a 2020 paper in the New England Journal of Medicine Kesselheim authored with Huseyin Naci, an associate professor of health policy at the London School of Economics.

In this Perspective article, Kesselheim and Naci look at how the “specialty” designation morphed from its origin in the 1970s. It then referred to a need for extra steps for preparation and delivery of new injectable and infusion products.

5. How much does it cost to bring a new drug to market anyway? 

The median cost for a medicine developed in recent years was $985 million, according to a study published in JAMA in March 2020, “Estimated Research and Development Investment Needed to Bring a New Medicine to Market, 2009-2018.”

“Rising drug prices have attracted public debate in the United States and abroad on fairness of drug pricing and revenues,” write the study’s authors: Olivier J. Wouters of the London School of Economics; Martin McKee of the London School of Hygiene and Tropical Medicine; and Jeroen Luyten of Leuven Institute for Healthcare Policy, KU Leuven, Belgium. “Central to this debate is the scale of research and development investment by companies that is required to bring new medicines to market.”

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Digital Health: Americans Open To 24/7 Monitoring Devices, AI Technology To Lower Health Care Costs

Center for the Digital Future at USC Annenberg (Feb 19, 2020):

Center for a Digital Future USCMany Americans are willing to make significant personal tradeoffs to lower their health insurance rates or medical costs, such as agreeing to 24/7 personal monitoring or working with artificial intelligence instead of a human doctor, the Center for the Digital Future at the USC Annenberg School for Communication and Journalism finds.

Among the study’s findings:

  • Nearly 1 in 4 Americans (24%) would work with an artificial intelligence-based technology if it lowered the cost of their health care.
  • Most Americans (80%) think that access to health care is a basic right that should be available to all citizens regardless of their ability to pay. This is a view shared even by a majority of citizens who identify themselves as very conservative (56%).
  • Significant percentages of Americans are willing to make profound lifestyle choices in exchange for lower insurance rates. For example, one-third of Americans would agree to 24/7 personal monitoring by insurance companies or health care professionals if their insurance rates were reduced.
  • Twenty-one percent of Americans said they would stay in their current job if leaving it meant losing their current health coverage.
  • Almost all Americans say health care is a key issue in the 2020 presidential election (92%).
  • Even though Americans say they are satisfied with their current health insurance, they are open to alternatives. Thirty percent of Americans would consider buying health coverage from any company that offers lower costs, including a variety of non-insurance companies such as Amazon, Google, or Costco.

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Healthcare: “2018 Health Care Cost Report” Shows Spending Grew 18% Per-Person From 2014 – 2018

HCCI Releases 2018 Health Care Cost and Utilization Report 

Per-Person Health Care Spending Grew 18% from 2014 to 2018, Driven Mostly by Prices

Health Care Cost Institute 2018 Health Care Cost and Utilization Report Cumulative Change in Spending per Person by Service Category

 

The report examines four groups of health care services and dozens of sub-categories. Of the four major categories, outpatient visits and procedures saw the highest 2018 spending increase (5.5%). Other notable trends include:

  • Inpatient services. 
    • Per-person spending on inpatient admissions rose 11.4% between 2014 and 2018
    • Within each sub-category of inpatient admissions, average prices grew steadily between 2014 and 2018 while utilization trends varied. However, the 2.0% price increase in 2018 was lower than the near 4% annual increases from 2014 to 2017.
  • Outpatient services.
    • ​Increases in prices and use led to a 16% increase in spending from 2014 to 2018.
    • ver that period, ER visit spending increased 32% and spending on observation stays went up 29%.
  • Professional services.
    • ​Spending increased 16% and growth accelerated over the 5-year period, driven by office visits and administered drugs.
    • Psychiatry also saw strikingly high spending growth of 43% from 2014 to 2018, which was driven mostly by increased use.
  • Prescription Drugs.
    • Generic drugs accounted for 88% of all prescriptions. .
    • Out-of-pocket payments for prescriptions for generic drugs was less than one-fifth of out-of-pocket payments on brand drugs.

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Study: 20% Of Surgery Patients Get “Surprise” Out-Of-Network Bills Averaging Over $2000

From a JAMA Network online study (February 11, 2020):

JAMA Network NewsIn this analysis of commercially insured patients who had undergone elective surgery with an in-network surgeon at an in-network facility, approximately 1 in 5 received an out-of-network bill, with a mean potential balance bill of $2011.

In this retrospective analysis of 347 356 surgical episodes among commercially insured patients who had undergone elective surgery with in-network primary surgeons and facilities, 20% of episodes involved out-of-network charges.

The patterns of out-of-network bills varied with the clinical scenario. Simpler ambulatory procedures that tend to involve 1 surgeon (arthroscopic meniscal repair, breast lumpectomy) had fewer out-of-network bills (13%-15% of cases), whereas inpatient procedures (hysterectomy, knee replacement, colectomy, CABG surgery) had more frequent out-of-network bills (24%-33% of cases). These more complex procedures were also associated with larger potential balance bills, in the range of $2000 to $4000.

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