A Health Podyssey

On our 100th episode, Leemore Dafny from Harvard Business School joins Health Affairs Editor-in-Chief Alan Weil to discuss her recent research published in Health Affairs examining donations made by pharmaceutical manufacturers to patient assistance charities based on an analysis of drug spending among Medicare Advantage enrollees. Order the September 2022 issue of Health Affairs  for research on...

Today, Health Affairs Editor-in-Chief Alan Weil takes an Excursion with Dr. Toyin Ajayi, co-founder and CEO of Cityblock Health. Dr. Ajayi is a primary care doctor and an entrepreneur. She co-founded a company with a multi-billion-dollar valuation based on meeting the needs of patients, many with quite complex needs, in their communities. Listen to Alan Weil and Toyin Ajayi talk about building a h...

As the COVID-19 epidemic hit the United States, New Jersey was an early hotspot with medical offices closing down, people encouraged to stay at home, and extreme pressure on the health system. The state of New Jersey adopted emergency rules to permit providers from out of state to care for people in New Jersey. This had many implications. Ann Nguyen from Rutgers University joins A Health Podyssey...

Today, nearly 40 million Americans are living with type 2 diabetes, which is more than a 40 percent increase from just a decade ago. Black, Hispanic, American Indian, and Alaskan native adults are much more likely than non-Hispanic white adults to develop diabetes and to die from the disease. Even as there have been important medical advances associated with diabetes, the burden of the disease con...

Paid sick leave is a benefit many of us take as a given, but almost one-quarter of workers in the United States don't get any paid sick leave at all. That puts the employee in a very difficult position - reluctant to not go to work even when sick because they can't afford to lose their wages. Other high-income countries mandate sick leave and in 2012 Connecticut became the first state to adopt a s...

In the United States we have multiple commercial health insurers, each with their own rules regarding filing and documenting claims for payment. Medicare and Medicaid have their own rules and both of those programs rely heavily on insurers who impose their own rules. All this adds up to is significant burden on health care providers who rely upon staff and technology to navigate this complex syste...

There are currently an estimated 37.3 Americans living with diabetes, more than a 40 percent increase from a decade ago. Thus, it isn't surprising that efforts to measure and improve the quality of health care focuses a significant amount of attention on diabetes. Major health care quality datasets all include a number of measures related to the quality of diabetes care. Given the continuing growt...

Finding access to mental health services can be challenging in the United States. The explosion of the demand for services, the inadequate workforce to provide them, and payment levels and methods that don't always support the care people need all contribute to these challenges. There are also longstanding concerns around access to all types of care for people enrolled in Medicaid, primarily due t...

Telemedicine burst onto the scene as the nation locked down at the start of the COVID-19 pandemic. Historically, telehealth, or telemedicine, was tightly restricted both by regulation and by payment policy. But in response to COVID-19's disruption of in-person care, all 50 states and Washington, DC issued temporary waivers that allowed clinicians to administer telehealth care to patients who live...

High prices are an enduring feature of the United States health care system. Traditional market forces haven't seemed to bring them down, which leads some to wonder if we need a new approach. Some may wonder, why not harness the purchasing behavior of consumers who provide downward cost pressure in pretty much every other sector of the economy? Enter the idea of high-deductible health plans - heal...

Listen to Health Affairs Editor-in-Chief Alan Weil interview Andy Slavitt, co-founder of both United States of Care and Town Hall Ventures and former administrator of the Centers for Medicare and Medicaid Services. Andy is the host of the podcast In The Bubble with Andy Slavitt and recently published the book, " Preventable: The Inside Story of How Leadership Failures, Politics, and Selfishness Do...

The concepts that underlie hospice were introduced a few centuries ago but, the modern hospice movement began in London in 1967. In 1982 hospice was added as a Medicare benefit. Today, half of all Medicare decedents enroll in hospice, at a total cost of $20.9 billion to Medicare in 2019. Hospice has a strong evidence base for improving end-of-life experiences for the recipient and the recipient's...

Recently, there's been dramatic growth in the number of nurse practitioners (NPs) and physician assistants (PAs). The number of NPs has more than tripled in the last decade while the number of PAs has almost doubled. Yet, due to particular billing practices in Medicare, it can be difficult to know how care these clinicians are providing. That means there's a lot we don't know about access and qual...

The United States has the highest rate of incarceration of any country in the world. Health care for people in jails and prisons is rarely part of mainstream health care and health policy conversations. But people who are incarcerated have significant health needs and a legal right to medical treatment. In addition, with 10 million people released from jail every year, needs that aren't met while...

When the Institute of Medicine defined health care quality, patient-centeredness was one of the five core dimensions. Yet as many have noted, the health system often seems to be more organized around the needs of providers than patients. This reality is particularly true when it comes to older Americans. An entire system of coverage and care has built up around institutional needs and institutiona...

When medical offices shut down due to the COVID-19 pandemic and people were encouraged or required to avoid public spaces, there was a dramatic and rapid increase in the use of telemedicine.  Telemedicine has the potential to open up access to care, particularly to people who are geographically isolated or have mobility limitations, but it can also exacerbate existing inequities given its relevanc...

The health care sector has gone through various waves of consolidation with hospitals purchasing physician practices and hospitals, physicians, and health insurers merging with each other. We're in the midst of a wave of consolidation. Two years ago, Health Affairs published a paper that found more than half of US physicians and 72 percent of surveyed hospitals were affiliated with one of 637 heal...

More than 40 percent of Medicare enrollees are enrolled in Medicare Advantage (MA) plans, privately-sponsored health plans that provide Medicare benefits often along with other benefits not included in the standard Medicare package such as eye exams, hearing aids, and dental coverage. Medicare Advantage is growing rapidly. On the current trajectory, it's likely that the majority of Medicare enroll...

This episode is sponsored by the Rural Health Research Gateway at the University of North Dakota . Vaccine requirements have been much in the news lately tied to the COVID-19 pandemic, but disputes over requiring vaccines have been with us for decades. How to balance respecting individual autonomy with protecting public health is not a new issue. It's played out in particular force when it comes t...

This episode is sponsored by the Rural Health Research Gateway at the University of North Dakota . March 23 marked the 12th anniversary of the passage of the Affordable Care Act (ACA). This landmark legislation expanded health care access to millions of Americans and accelerated changes in how we organize and pay for health care. Having survived numerous legal challenges and strong political oppos...

This episode is sponsored by the Rural Health Research Gateway at the University of North Dakota . The United States is facing a drug affordability crisis.  Even as we celebrate scientific discovery, the health benefits of drugs are limited due to barriers of affordability, often even for people with health insurance. The RAND Corporation reports that on average drug prices in the United States ar...

This episode is sponsored by the Rural Health Research Gateway at the University of North Dakota . Cancer diagnosis has changed radically in the era of precision medicine. New techniques like multi-cancer early-detection screening tests can detect up to 50 types of cancer from a single blood draw. We generally think of early detection, especially of cancer, as an unambiguously good thing. Given th...

Limited access to transportation is well established as a barrier to people obtaining health care services. If it's hard to get to the doctor, you're less likely to go and that means delays getting needed care, poorer management of chronic conditions, and more use of the emergency room. While health insurance typically covers emergency transportation, say for an ambulance, coverage of non-emergenc...

There's a tremendous amount of consolidation going on in the health care sector. A lot of the research about consolidation focuses on the economics. But, one of the primary arguments people make for bringing disparate parts of the health system together is that it enables clinical integration. Patients, they say, should get better care if the clinicians are talking to each other and sharing inform...

Out of about 5,000 community hospitals in the United States, almost 3,000 are nonprofit. More than a thousand are investor-owned, also called for-profit. The balance are owned by state or local governments. Nonprofit hospitals, like all nonprofit organizations, must have a charitable mission and for hospitals that mission is generally expressed as providing charity care and various benefits to the...