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Some non-profit hospitals have garnered a reputation of being greedy and not serving the poor. People may especially feel this way if a hospital uses aggressive collection techniques or sues low-income patients to recover unpaid charges. KFF Health News published an article where a local hospital was converted to a tax-exempt non-profit entity. The loss of local property taxes meant that a nearby school district had to cut expenses. The school district challenged the non-profit status of the hospital and a state court agreed that the hospital should not be considered non-profit, citing "eye-popping" compensation for executives. The article also referenced a study that found that non-profit hospitals provided charity care worth 2.3% of their expenses, while for-profit hospitals provided 3.8%. Understandably, the "American Hospital Association strongly disagrees with the... analyses."

Some non-profit hospitals have garnered a reputation of being greedy and not serving the poor. People may especially feel this way if a hospital uses aggressive collection techniques or sues low-income patients to recover unpaid charges. KFF Health News published an article where a local hospital was converted to a tax-exempt non-profit entity. The loss of local property taxes meant that a nearby school district had to cut expenses. The school district challenged the non-profit status of the hospital and a state court agreed that the hospital should not be considered non-profit, citing "eye-popping" compensation for executives. The article also referenced a study that found that non-profit hospitals provided charity care worth 2.3% of their expenses, while for-profit hospitals provided 3.8%. Understandably, the "American Hospital Association strongly disagrees with the... analyses."

Theoretically, governments offer tax incentives to encourage hospitals to provide more charity care. However, when non-profit hospitals provide less charity care than for-profit hospitals, people might rightfully ask whether the tax incentives are appropriate. Non-profit hospitals might have a number of reasonable responses. For example, if non-profit hospitals tend to be much smaller than for-profit hospitals, their fixed costs might account for a larger percentage of their budget, making it more difficult to provide as much charity care on a percentage basis.

Nevertheless, the tax incentive does raise questions of accountability, especially when the amount of the charity care ends up being less than the value of the tax breaks (which appears true of the industry in 2020, per the article). It might be easier to account for care by not allowing any hospitals to have non-profit status, and instead, have local and state governments directly subsidize hospital operations. Such a scheme would still require accountability, but would making accounting somewhat easier in that governments (and people in general) can more clearly see how much each hospital is being subsidized.

KFF Health News published an article describing the practices of "white bagging" (where infusion medications are sent to pharmacies to send to medical facilities) and "brown bagging" (where infusion medications are sent to patients). These practices are meant to curb costs, compared to the practice of the medical provider or facility buying the medication and then being reimbursed for it. Understandably, while these practices may save insurers money, they create more overhead for providers to manage. The article discuss delays in treatment and increased administrative burdens on patients; additionally, some patients may end up paying more via cost sharing. The article also points out that some providers have come to rely on profits from reselling costly infusion drugs. Some providers have responded by refusing to treat patients whose insurers require either of these practices.

KFF Health News published an article describing the practices of "white bagging" (where infusion medications are sent to pharmacies to send to medical facilities) and "brown bagging" (where infusion medications are sent to patients). These practices are meant to curb costs, compared to the practice of the medical provider or facility buying the medication and then being reimbursed for it. Understandably, while these practices may save insurers money, they create more overhead for providers to manage. The article discuss delays in treatment and increased administrative burdens on patients; additionally, some patients may end up paying more via cost sharing. The article also points out that some providers have come to rely on profits from reselling costly infusion drugs. Some providers have responded by refusing to treat patients whose insurers require either of these practices.

From a systems perspective, these optimizations from both the insurers and the providers seem to yield an inefficient outcome overall. If true costs were publicly known, the government might be able to design a system where everybody comes out better off. With different parties able to hide costs, at least one party is likely to complain about being penalized unfairly when any government regulation is applied.

KFF Health News published an article about trends in primary care. The article points out that "demand for primary care is up, spurred partly by record enrollment in Affordable Care Act plans" and that "Today, a smaller percentage of physicians are entering the field than are practicing, suggesting that shortages will worsen over time." One approach to the addressing the shortage has been the rise of "retail clinics," which may be staffed by nurse practitioners or physician assistants, but which do not support a long-term between a patient and a specific primary care provider. On the other end of the spectrum, some doctors have been entering "concierge medicine," where providers charge an access fee but offer substantially more availability.

KFF Health News published an article about trends in primary care. The article points out that "demand for primary care is up, spurred partly by record enrollment in Affordable Care Act plans" and that "Today, a smaller percentage of physicians are entering the field than are practicing, suggesting that shortages will worsen over time." One approach to the addressing the shortage has been the rise of "retail clinics," which may be staffed by nurse practitioners or physician assistants, but which do not support a long-term between a patient and a specific primary care provider. On the other end of the spectrum, some doctors have been entering "concierge medicine," where providers charge an access fee but offer substantially more availability.

The article also notes that "People with a regular primary care doctor or practice are more likely to get preventive care, such as cancer screenings or flu shots, studies show, and are less likely to die if they do suffer a heart attack" and that "Physicians who see patients regularly are better able to spot patterns of seemingly minor concerns that could add up to a serious health issue." Hence, while the retail clinic model may offer better access and be more affordable, patient health might end off worse in the long-term, especially in populations that have more chronic or complex conditions. A market-based response to these trends might include increased compensation for primary care providers to help address the shortage. However, reimbursements in the healthcare industry are frequently dictated by forces other than simple supply and demand.

People frequently complain about the outrageous drug prices that patients endure. KFF Health News published an interesting piece, however, describing a case when maybe patients (or payers) are not paying enough: generics. The article reports that "Everyone wants to pay less, and the middlemen who procure and distribute generics keep driving down wholesale prices... As generics manufacturers compete to win sales contracts with the big negotiators of such purchases, such as Vizient and Premier, their profits sink. Some are going out of business."

People frequently complain about the outrageous drug prices that patients endure. KFF Health News published an interesting piece, however, describing a case when maybe patients (or payers) are not paying enough: generics. The article reports that "Everyone wants to pay less, and the middlemen who procure and distribute generics keep driving down wholesale prices... As generics manufacturers compete to win sales contracts with the big negotiators of such purchases, such as Vizient and Premier, their profits sink. Some are going out of business."

In the short-term, middlemen and payers might feel that they are winning by securing lower prices. However, when the long-term supply dwindles such that there are meaningful shortages of live-saving medications, patients can suffer. Likely, a major problem is that there is too much market consolidation within the world of middlemen in this industry (presumably, the pharmacy benefit mangers), and as a result, they command too much market power. Another factor might be long-term contracts that make it difficult for suppliers to raise prices to cover their costs when shortages arise. A controversial way of addressing this problem could be to make insurers somehow liable for medical harm (including deaths) caused by shortages of generic drugs. Similar to provider coverage requirements that are imposed upon insurers (where insurers must have certain number of providers per enrolled patient in areas they sell policies), insurers could be made responsible for the actual acquisition of generics. After all, the theoretical ability to buy a medication at a certain price if it is available is not that helpful when that medication is actually not available. If the shortage of medication leading to medical harm is due to insurers' relentless obsession on short-term savings, it seems fair that they bear at least some of the burden of fixing the problem.

People generally think of aviation as a fairly safe industry, and KFF Health News reported on some people who have wondered whether the healthcare industry can learn from them about how to avoid accidents. For example, in 1999, the Institute of Medicine released a report "that called medical error in hospitals a leading cause of death." The KFF article outlines challenges with establishing a patient safety board, modeled after aviation's National Transportation Safety Board (NTSB). In particular, the hospital industry and medical groups appear to wield much more political power than their aviation counterparts.

People generally think of aviation as a fairly safe industry, and KFF Health News reported on some people who have wondered whether the healthcare industry can learn from them about how to avoid accidents. For example, in 1999, the Institute of Medicine released a report "that called medical error in hospitals a leading cause of death." The KFF article outlines challenges with establishing a patient safety board, modeled after aviation's National Transportation Safety Board (NTSB). In particular, the hospital industry and medical groups appear to wield much more political power than their aviation counterparts.

"Hospitals, nursing homes, and medical professionals pour hundreds of millions of dollars into federal political campaigns each election cycle and spent $220 million lobbying Congress last year," the article reports. The healthcare industry is so large that they can actually afford hundreds of millions of dollars to change policy. The article also points out that healthcare groups employ many people, which can also influence votes. As a result, simple transparency measures may be watered down to become more palatable to hospital and medical groups, even though such information can be helpful to patients who are selecting providers.