Health affairs
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Review Comparative Study
Plan Choice And Affordability In The Individual And Small-Group Markets: Policy And Performance-Past And Present.
The individual and small-group health insurance markets have experienced considerable changes since the passage of the Affordable Care Act in 2010, affecting access, choice, and affordability for enrollees in these markets. We examined how health plan access, choice, and affordability varied between the individual on-Marketplace, individual off-Marketplace, and small-group markets in 2018. ⋯ However, the small-group market maintained greater plan choice and lower premiums-outcomes that appear to be associated with higher insurer participation. States may consider a variety of policy proposals such as reinsurance or the introduction of a public option to increase insurer participation and improve the plan choices offered in the individual market.
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Multicenter Study Comparative Study
Maryland's Experiment With Capitated Payments For Rural Hospitals: Large Reductions In Hospital-Based Care.
In 2010 Maryland replaced fee-for-service payment for some rural hospitals with "global budgets" for hospital-provided services called Total Patient Revenue (TPR). A principal goal was to incentivize hospitals to manage resources efficiently. Using a difference-in-differences design, we compared eight TPR hospitals to seven similar non-TPR Maryland hospitals to estimate how TPR affected hospital-provided services. ⋯ However, for residents of TPR counties, visits to all Maryland hospitals fell by lesser amounts and Medicare spending increased, which suggests that some care moved outside of the global budget. Nonetheless, we could not assess the efficiency of these shifts with our data, and some care could have moved to more efficient locations. Our evidence suggests that capitation models require strong oversight to ensure that hospitals do not respond by shifting costs to other providers.
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Medications such as methadone and buprenorphine are effective treatments for opioid use disorder (OUD), but levels of use remain low. Given the importance of the news media as a source of health information for the public and its role in shaping knowledge about these medications, we examined reporting on OUD medication treatment amid the opioid crisis. Analyzing news media reporting can provide insight into the public dialogue around this issue. ⋯ Fewer than 40 percent of news stories about the medications mentioned that they were underused. Although addiction experts view underuse of OUD medications as a significant barrier to combating the opioid crisis, our findings suggest that underuse has not been framed as a problem in most news media reporting on these medications. Public health and addiction experts need to develop more effective strategies for disseminating information on the value of these medications in reducing opioid-related morbidity and mortality.