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Kaiser Health News ran an interesting story about some providers using pricing tools to help patients select drugs. The story is a nice one about giving providers and patients a tool at the time of decision (and not when the patients are picking up medications at the pharmacies); if one medication is too expensive, the provider might be able to find a different pharmacy that sells it for less, or potentially prescribe a different (but equivalent) medication altogether. It is a sign of the times that insurers are making these tools available to providers to help patients potentially save (which would in turn help insurers themselves save).
One of the issues with these tools is that it takes providers time to use them, and that likely explains the low adoption rate among doctors who can use Humana's tool. However, some of the larger provider organizations have a financial interest in helping ensure that patients choose more cost-effective solutions: some medical groups share in the medical savings that they help achieve. If the trend towards providers participating in risk-sharing continues, more and more practices might have a stronger incentive to use these pricing tools.
Kaiser Health News reported on three states formulating plans to import medications from Canada. Prior legislation (the 2003 Medicare Modernization Act) allows importation of drugs from Canada, but appears to require verification by the secretary of Health and Human Services. Understandably, the previous secretaries have opposed importation (large downside risk to the officials involved in case something goes wrong, and probably limited upside for the officials if everything goes well). Thus, the support offered by the current president seems significant. It remains to be seen if anything will come of these plans, and whether perhaps a national plan will come into play.
It is ironic that Americans end up paying more for medications that, in many cases, they helped fund the initial research, but it is understandable that pharmaceutical companies want to maximize their profits. Allowing importation of medications from other countries might have the intended effect of lowering drug prices nationally, but might also have the unintended effect of raising prices internationally.
The president recently signed an executive order to advance the disclosure of healthcare pricing. Details still need to be worked out, but this order seems to be an extension of a previous order mandating that hospitals post their list prices online. This order seems to mandate disclosure of prices that have been negotiated between hospitals and insurers, which would give patients a more accurate picture of the charges.
So far, I have not read too much of the effects of the previous executive order. It could be that the it takes time for the publication of list prices to have some effect, or it could be that the publication is difficult enough for consumers to find and understand and insufficiently related to out-of-pocket costs that they will not have much effect. This executive order seems like it would certainly be a step in the right direction. Even better would be mandating pricing disclosures at physician offices, where a substantial portion of non-emergency care takes place.
Kaiser Health News published an article describing how Texas recently passed legislation to protect patients from surprise medical bills, a topic of recent interest. Patients can be surprised by medical bills even when they go to an in-network facility, since that facility might employ or consult an out-of-network physician. While the state government does not mandate prices, the new legislation appears to require that the hospital and the insurer settle their disputes without involving the patient.
This protection seems quite reasonable in that once a patient has checked whether a facility is in-network (or not, in the case of an emergency), the patient has done what s/he can to minimize costs. That a hospital is unable to verify before the procedure that all involved providers are in-network or that an insurer was unwilling to establish an agreement with emergency providers in the area seem to fall within the responsibility of the providers and insurers, not the patient. The article reports that more than a dozen states have enacted some legislation or regulation against surprise medical billing, and some have suggested that the federal government may eventually take up the cause.
In what might be a bit of a silver lining to health care's high prices, Kaiser Health News published a piece about churches wiping out others' medical debt for a small fraction of the actual loan value. An example listed in the article is one church paying $22,000 to wipe out $2.2 million of medical debt for others.
This story is a feel-good story of people using leverage to wipe out what is commonly a huge source of stress for others. Unfortunately, the ratio of the amount paid to the nominal loan value speaks to how high the original medical bills were to begin with. Someone not having insurance likely also does not the means to pay for a major medical procedure. Hospitals might try to bill patients for the expensive procedures, only to realize over time that the patients are unable to pay. The medical institutions might then sell the debt for very little to debt collectors, who then in turn might sell the debt after they have tried collecting. One might imagine that a better system would be one in which prices for medical procedures were more affordable to begin with and fewer people had to deal with the stress of outsized medical debt.