Research conducted by the Schaeffer Center has salience in the media and national conversations concerning the impact of health care on individuals. Three journalists with The New York Times reached out to Schaeffer Center experts for insight into pressing health policy issues this week.
Disparity in life expectancy between the rich and the poor:
The growing inequality in life expectancy between the wealthy and the poor is increasingly documented and debated. In an article connecting these disparities in life expectancy and other factors, Dana Goldman gives insight into the relationship between health technologies and population-level health improvements. Some of his research has examined how the introduction of blood pressure medication in the 1950s helped close the gap in life expectancy between black and white males. But, the opposite can also happen explained Goldman—“medical improvements can also drive disparities when they disproportionately benefit affluent Americans; for example, cutting-edge cancer treatments.”
Goldman was on the committee commissioned to write a National Academy of Sciences report published last fall that documented the health disparities driving these differences in life expectancy and the resulting impact on public programs which was noted in the article.
Enrollment in the Affordable Care Act marketplace compared to Medicare Advantage:
Health insurance markets generally have proven hard for economists to predict. A New York Times article examined the unexpectedly slow enrollment in the Affordable Care Act marketplace plans in comparison to the unexpected surge in enrollment seen in Medicare Advantage plans over the last few years. These trends can be explained by multiple factors, writes the journalist: “Insurers know the Medicare population, know the rules of the program and have found ways to manage care that improve the health of Medicare patients and the financial health of the companies. They know much less about their new marketplace customers, many of whom were previously uninsured, and Congress, still bitterly divided over the health law, has done little to stabilize it.”
Goldman points out an important component insurers consider: “In the Affordable Care Act marketplace, there has been an enormous amount of churning — people dropping out, going into other plans — so it’s been very difficult for insurers to predict spending,” said Goldman. “By contrast, Medicare Advantage is a very predictable business.”
This predictability helps to explain why insurance carriers are willing to accept more Medicare enrollees over younger but more volatile marketplace enrollees.
New, novel health plan design:
As the health care industry continues to change to meet the new demands of consumers and policy, new payment models and designs are being experimented with. The New York Times ran an article on a new health system, Intermountain Healthcare, which is rolling out a new business design: “Its new health plan, SelectHealth Share, is guaranteeing to hold yearly rate increases to one-third to one-half less than what many employers across the country typically face.” The system claims it can make this promise through its system of tracking and analyzing costs, quality of patient care, and a system of improving treatments and reducing unnecessary expenses.
Paul Ginsburg pointed to the importance of a long-term contract to enable hospitals and doctors to effectively manage chronic disease. Without the assurance that patients will switch if their health plan changes or skip an appointment because of a deductible, “it makes it very difficult to engage enrollees early enough to detect their chronic diseases and manage them,” Ginsburg explained.
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