Blog

The general sentiment from large medical associations seemed to be that as long as patients visited properly credentialed physicians, the patients would essentially not have anything to worry about beyond the standard risks. In the world of plastic surgery, however, it appears that botched surgeries have become so prevalent that even the "The American Society of Plastic Surgeons, which represents 12,000 doctors, is now warning patients to 'do their homework'," as reported by KFF Health News.

Although patients are entitled to lodge formal complaints to the state licensing boards, one member of such a board points out how "the disciplinary process is rigged in favor of doctors, mostly because of the power of medical groups in the state lobbying to thwart change." One tangible recommendation is that boards "should alert the public about doctors under investigation for alleged misconduct." As it stands, "complaints to medical boards about surgeons or other doctors can remain under wraps for years." While publishing allegations can have some negative consequences, not doing so and taking years to investigate the complaints seems to pose too great of a patient safety risk.

Insurers like to portray themselves as gatekeepers who help prevent runaway prices for medical procedures. After all, if they pay less for medical procedures, their costs are less, which theoretically should mean more profit. In this model, the insurers and patients are aligned in wanting low prices at clinics and hospitals.

KFF Health News published a piece explaining that the incentives that insurers face might actually tilt the other way. After providing examples of seemingly outrageous prices, the article explains that "Insurers aren't incentivized to lower prices, because high prices mean they 'get a slice of a bigger pie'... when prices rise, they can pass on the increase to customers in the form of higher premium costs... [which] mean less money for the patient and more profit for the insurer." The article notes that "Medical inflation has steadily outpaced general inflation for years, with bills for many brief, routine procedures reaching tens of thousands of dollars." Patients are affected by the high prices because even with insurance, they often need to pay the deductible or co-insurance, which can amount to several thousands of dollars.

KFF Health News highlighted a Family Connects program in New Orleans, where the city offers mothers of newborns free home visits by nurses. "The nurses arrive with diaper bags filled with newborn essentials, from diapers to nipple cream. They weigh, measure, and examine the babies, and check in with the mothers about their health and well-being. They offer referrals to other programs across the city." As background, "Louisiana is among the worst-performing states in maternal and infant health outcomes," giving officials strong motivation to try a different approach. Research based on the Family Connects programs in other communities show promise: reduced trips to the emergency room, earlier diagnosis of postpartum depression, and cost savings ("Research on North Carolina's program found that every $1 invested in the program saved $3.17 in health care billing before the child turned 2.").

This intervention seems like a positive policy development, in which an early investment yields better patient health and fewer costs later on. This idea has been the premise for other programs as well, but the results do not always fulfill the initial goals.

Providers have been required to publish some pricing information, under the theory that patients armed with better knowledge will naturally select better options. KFF Health News published an article on why pricing transparency efforts might have not gone as smoothly as hoped. One reason is low compliance, with "only about a third of facilities had complied with the regulations" after ten months of the policy being in effect. Another reason is that the data is difficult for patients to use. Lastly, even if this data were readily understandable, it is unclear the extent to which patient selection of healthcare services relies on other factors, such as physician recommendations. Interestingly, the article noted that "Research shows that transparency policies can have mixed effects on prices, with one 2024 study of a New York initiative finding a marginal increase in billed charges."

One of the reasons that companies might not have developed tools for patients to use to easily compare prices across providers is that there might not be a strong enough of a business model to support such efforts. As the article points out, "Two babies might be delivered by the same obstetrician, for example, but the mothers could be charged very different amounts" -- meaning that a website that compared prices could at best offer a range, which ultimately might not be that useful to patients.

Much alarm has been raised about the expiring subsidies for health insurance (specifically, the plans bought off the Affordable Care Act marketplaces), with some people effectively experiencing premiums that doubled. KFF Health News reported on an observed drop of 1.2 million enrollments, which is better than one forecast of 2.2 million. However, the final numbers are not final, since some people might have renewed but find themselves unable to pay for the pricier premiums and those cancellations will become realized later. A few states used state funding to offset the increased premiums, with New Mexico fully replacing the reduction of federal tax subsidies.

One political party was willing to shut the federal government down last fall over the expiring subsidies. It seems that as people face the much higher effective premiums, the other political party might suffer some loss in popularity.