At DocSpot, our mission is to connect people with the right health care by helping them navigate publicly available information. We believe the first step of that mission is to help connect people with an appropriate medical provider, and we look forward to helping people navigate other aspects of their care as the opportunities arise. We are just at the start of that mission, so we hope you will come back often to see how things are developing.
An underlying philosophy of our work is that right care means different things to different people. We also recognize that doctors are multidimensional people. So, instead of trying to determine which doctors are "better" than others, we offer a variety of filter options that individuals can apply to more quickly discover providers that fit their needs.Got questions?
Kaiser Family Foundation released the results of a survey (accompanying commentary) conducted in February, asking Americans about their sentiments regarding prescription drug costs. Highlights include each of the following ideas garnering at least 80% support among respondents: requiring drug ads to include list prices, making it easier for generic drugs to be sold, allowing Medicare to negotiate drug prices, and allowing the importing of drugs from Canada. If these sentiments are truly reflective of the broader population (and if these issues are important to voters), there is hope that elected officials might change some of the current policies.
Fortunately, two-thirds of the respondents who report taking prescription medicines report that paying for their prescriptions is very easy or somewhat easy. On the other hand, almost 30% of respondents (presumably of those who report taking prescription medication) say that they do not take medicine as prescribed because of costs (e.g. not filling a prescription or reducing doses). Prescription drug cost is likely to be one of the issues raised under the broader issue of rising healthcare costs in the next election.
The New York Times published an excellent survey of the political landscape for healthcare in the US. Predictably, many Republicans oppose the Affordable Care Act and want to repeal at least parts of it (there is a lawsuit underway to nullify the key provisions). The main group that the article profiles is a coalition of healthcare stakeholders (including the American Medical Association, the American Hospital Association, America's Health Insurance Plans, and the Pharmaceutical Research and Manufacturers of America) that mostly want the Affordable Care Act to stay the same. The healthcare industry is understandably concerned about consolidation of the purchasing power, especially into the hands of the government, given Medicare's history of reimbursing physicians less than other payers. Further to the left are proposals to expand Medicare, either through a "Medicare for All" proposal (authored by Senator Bernie Sanders) or through a more moderate Medicare buy-in proposal. Interestingly, the "Medicare for All" proposal prohibits employers from duplicating benefits, meaning that the effort goes a long way towards weaning Americans off of employer-based coverage.
Clearly, many people think the current healthcare landscape is broken; however, people disagree on the right approach to fix it.
Kaiser Health News published two interesting articles this month that highlighted patients' struggles with medical bills: the earlier one reviewed some legislative proposals intended to limit patient liability in the case of surprise medical billing and emergency care, while the later one recounted some patient experiences with visiting the emergency room. The sustained interest and coverage regarding medical bills suggest that the nation will likely see some movement in this area, especially if the Democratic party gains control of both Congress and the presidency.
The second article highlights how visiting an out-of-network emergency room can be financially devastating. Normally, insurance will limit a person's annual expenses to a number known as the annual maximum out-of-pocket, which is $7,900 for individuals with ACA Marketplace plans in 2019. However, out-of-network medial care is not subject to that limit, even if that care might be emergency care. Hence, emergencies can be very expensive.
Kaiser Health News published an article delving into why more approved generics are not making their way to the marketplace. In theory, streamlining FDA approval for generic drugs should mean more competition on the market, leading to reduced prices. However, the article points out that many approved generics are not even making it to the market, meaning that the emphasis on streamlining generics is not having the intended effect.
The article lists several reasons that manufacturers might not sell the generics after they get approval. One seemingly mundane reason is that approval can take six to eight years, by which time the manufacturers may have turned their attention elsewhere or the market conditions might have changed. Streamlining the approval process should help in this regard. Other reasons seem less innocent: some generics manufacturers are approved, receive exclusivity for six months, and then accept money from the competing name-brand manufacturer to not sell. This practice seems anti-competitive, and the head of FDA has expressed hope that Congress can change the laws so that such companies forfeit their exclusivity if they do not actually sell the generics. It is apparent that there are other factors in play as well; approving generics is only one step.
There is naturally some antagonism between providers (who understandably want to be paid more) and insurers (who understandably want to pay out less). Kaiser Health News highlighted some conflicts between large provider networks and large insurers.
Payment schedule contracts can last a year or longer, and given the volume, a few percentage points can mean a lot for either side. Unfortunately, patients do not always know whether they will be able to keep their doctors until after the open enrollment period has passed, meaning that they have imperfect information. Regardless of which side might "win" a given negotiation, the consolidation of provider networks and insurers can result in deteriorating markets.