Findings Briefs

Large geographic variations in Medicare costs have long been documented; however, the size and source of this variation has been the subject of dispute. Casemix adjustment, or controlling for area population health, is critical to developing Medicare geographic cost variation estimates, yet there is a lack of consensus on the ideal casemix control method.
 

For millions of uninsured Americans, hospital emergency departments (EDs) are one of the few options for medical care, both urgent and non-urgent.  Yet this care may come at a significant price.  Unlike their insured counterparts, uninsured and other “self-pay” patients receive hospital bills based on “billed charges.”

The Medicare Outpatient Prospective Payment System (OPPS) was established by the Balanced Budget Act of 1997 as an attempt to simplify and reduce Medicare payments for hospital outpatient services by creating a new fee schedule. HCFO researchers studied the effects of the OPPS on how much outpatient care is provided by Florida hospitals and who pays for it.

Over the past two decades, a wave of hospital mergers and acquisitions has resulted in many highly concentrated hospital markets across the United States.  This phenomenon has raised concerns that consolidated hospitals are using their increased bargaining power to secure higher prices from health plans, thereby adding to the nation’s already unmanageable health care costs.

Medication adherence is critical to the management of chronic conditions. Yet, many patients forgo medication when confronted with unmanageable or rising medication costs, a phenomenon termed cost-related nonadherence.

Policymakers seeking to slow the growth in Medicare spending are increasingly exploring care coordination interventions involving beneficiaries with multiple chronic conditions.  In a HCFO-funded study, researchers took a closer look at the programs in the Medicare Coordinated Care Demonstration in order to assess which interventions worked and for whom.

Rising prescription drug costs continue to be an issue of importance to patients, health insurers, and the federal government. One popular cost containment solution is encouraging the use of generic drugs over brand-name drugs.

Health care costs consume a growing percent of the U.S. gross domestic product, and economic literature has demonstrated that ultimately individuals pay these costs, either through taxes, reduced wages, or direct out-of-pocket and premium payments. In a HCFO-funded study, researchers explored the distribution of the individual family’s financial burden from the combination of public and private health care spending.

Pharmaceuticals represent a rapidly growing area of health care expenditures. These rising costs have led many payers to implement prior authorization as one type of cost control policy.