Last Thursday, the Commonwealth Fund released its assessment of how the U.S. health system compares to other developed systems of the world. The title says it all: Mirror, Mirror 2024: A Portrait of the Failing U.S. Health System.
Commonwealth researchers analyzed the performance of health systems in 10 countries (Australia, Canada, France, Germany, the Netherlands, New Zealand, Sweden, Switzerland, the United Kingdom and the United States) applying 70 measures along 5 dimensions (access to care, care process, administrative efficiency, equity, and health outcomes) to compare and contrast. They concluded:
“The top three countries are Australia, the Netherlands, and the United Kingdom, although differences in overall performance between most countries are relatively small. The only clear outlier is the U.S., where health system performance is dramatically lower. The U.S. continues to be in a class by itself in the underperformance of its health care sector. While the other nine countries differ in the details of their systems and in their performance on domains, unlike the U.S., they all have found a way to meet their residents’ most basic health care needs, including universal coverage
Despite their overall rankings, all the countries have strengths and weaknesses, ranking high on some dimensions and lower on others. No country is at the top or bottom on all areas of performance…
Nevertheless, in the aggregate, the nine nations we examined are more alike than different with respect to their higher and lower performance in various domains. But there is one glaring exception — the U.S. Especially concerning is the U.S. record on health outcomes, particularly in relation to how much the U.S. spends on health care. The ability to keep people healthy is a critical indicator of a nation’ capacity to achieve equitable growth. In fulfilling this fundamental obligation, the U.S. continues to fail.
The U.S. continues to be in a class by itself in the underperformance of its health care sector. While the other nine countries differ in the details of their systems and in their performance on domains, unlike the U.S., they all have found a way to meet their residents’ most basic health care needs, including universal coverage.”
My take:
The results are no surprise. But context is key:
- Commonwealth has been conducting health system international comparison studies since 1998. Each year, it modifies its methodology somewhat to account for changes in country policies, the availability of normalizable data, the usefulness of new measures or circumstances like the Covid-19 pandemic in 2020-2021. The 2024 edition relies on surveys of older adults (age 65 and older), primary care physicians, and the general population (age 18 and older) in each nation for 2021, 2022 and 2023 as well as standardized data about outcomes, access, costs from the Organisation for Economic Co-operation and Development (OECD), the World Health Organization (WHO), the U.S. Agency for Healthcare Research and Quality and others. And the methodology uses multivariate statistical tools to quantify correlations and causality necessary to its interpretation of the raw data for each country. Thus, results of the Commonwealth study should be interpreted in the context of multi-year trends vs. a one-year snapshot and accepted as valid and reliable. It’s a solid study.
- The findings are now new. That the U.S. is the most expensive system in the world lagging in accessibility and affordability is widely accepted. Unlike the others, ours is a complex system dependent on private capital plus government funding. Our per capita costs and prices for hospital services, physician services, prescription drugs, technology and insurance are higher than anywhere in the world. Though processes of care in the U.S. system have improved, per capita spending has increased more. It’s the conundrum facing every Westernized health system: populations are aging. Demand is increasing. And improvements in clinical processes are significant in some clinical areas but access, affordability and public satisfaction are in free-fall. The U.S. system is not alone in systemic challenges facing our health system. But cut-and-paste solutions from other countries is a wasted effort. Solutions to the U.S. system’s long-term sustainability require its major factions to work together for the greater good. The will to do appears stronger among outsiders seeking transformative change than insiders seeking protection of the status quo.
The real question prompted by the Commonwealth study is this: is the ineffectiveness of the U.S. system fixable? Private investors, operators and trade groups say yes so long as a transition is smooth and their interests are protected. Systemic change is unwelcome. Healthcare in the U.S. is an industry that does well financially so, for many politicians, pensioners and insiders, they’d prefer it be left alone.
But the majority of Americans, including the majority in the 18-million healthcare workforce, aren’t sure. They see corporate profits, executive compensation, mergers and takeovers as indicators of its corporatization and business acumen but its layoffs, cost-cutting, surprise bills and inexplicable prices as evidence the system puts profit ahead of fixing problems that matter to them.
This study is worth discussion in every Boardroom in healthcare and in every household interested in health reforms. At a minimum, It merits collaborative action led by AHA, AHIP, AMA and others to develop meaningful, long-term solutions to its flaws that subordinate their proprietary preferences for the greater good.
Paul
PS: This week looms large for the health and wellbeing of every American. And our health system It’s not an overstatement. Three topics will dominate the news cycle and elevate the national anxiety about our future:
- Tension in the Middle East between Israel and Hezbollah has escalated to an eminent threat of war. Americans are divided over our alliances in the Middle East and opposed to war. Diplomatic solutions appear fruitless.
- Wednesday, House Majority leader Johnson will call a vote using regular order to secure passage of a Continuing Resolution to fund the Federal Government for 3 months and avoid a government shutdown. The majority distrust Congress and elected officials on both sides. But up to half of federal employees might be furloughed at the end of the month is a budget is not passed.
- And political warfare at home is intensifying with 43 days to the election. Campaign rhetoric is heating up. The majority of Americans are worried about inflation and pocketbook issues and think politics stinks. Like the health system, they’d like something better.
Resources:
Source: David Blumenthal et al., Mirror, Mirror 2024: A Portrait of the Failing U.S. Health System — Comparing Performance in 10 Nations (Commonwealth Fund, Sept. 2024). https://doi.org/10.26099/ta0g-zp66
Peterson-KFF, What drives health spending in the U.S. compared to other countries?, August 2024
Sections in this report
- Quotables
- Hospitals
- Investing
- Legislation
- Litigation
- Payers
- Physicians
- Prescription Drugs
- Public health
- Technology
Quotables
Re: the future of healthcare: “You have to view where healthcare is going outside of an acute care lens. Those structures can get in the way of strategy. If you’re structured around the hospital being the center of the universe, it’s hard to get people, processes, technology and culture pointed in a new direction.”
Mike Slubowski, President and CEO Trinity Health Trinity Health’s plan to grow outpatient care (beckershospitalreview.com)
Re: hospital consolidation impact on competition, prices: “Hospital consolidation is gathering momentum across the country and is poised to grow on a much larger scale than before the pandemic, mirroring trends seen in other industries such as banking.
Proponents argue that merging healthcare providers improves efficiency and care coordination, but critics warn that the lessons from banking consolidation — particularly the notion of institutions becoming “too big to fail” — should serve as a cautionary tale for hospitals…
Ultimately, consolidation in banking led to fewer, larger institutions dominating the market, which reduced competition and gave consumers fewer choices. This led to increased costs and reduced the availability and quality of basic financial services for consumers.
Similarly, an analysis of 1,164 mergers among the country’s 5,000 acute-care hospitals between 2000 and 2020 found that those transactions increased healthcare prices by 5.2%. The study, published in American Economic Review: Insights, found that 90% of hospital markets are highly concentrated.
The study demonstrates that hospital consolidation can decrease competition and drive-up healthcare costs for patients, limit provider choice and reduce care quality. Health systems may need to consider ways to maintain competition and patient choice, even as they merge.”
‘Too big to fail?’: A cautionary tale for health systems
Re: FTC complaint against PBMs: “Today, the Federal Trade Commission brought action against the three largest prescription drug benefit managers (PBMs)—Caremark Rx, Express Scripts (ESI), and OptumRx—and their affiliated group purchasing organizations (GPOs) for engaging in anticompetitive and unfair rebating practices that have artificially inflated the list price of insulin drugs, impaired patients’ access to lower list price products, and shifted the cost of high insulin list prices to vulnerable patients.
The FTC’s administrative complaint alleges that CVS Health’s Caremark, Cigna’s ESI, and United Health Group’s Optum, and their respective GPOs—Zinc Health Services, Ascent Health Services, and Emisar Pharma Services—have abused their economic power by rigging pharmaceutical supply chain competition in their favor, forcing patients to pay more for life-saving medication. According to the complaint, these PBMs, known as the Big Three, together administer about 80% of all prescriptions in the United States.”
Re: innovation in medical care: “We need to rethink how to improve safety in the post-pandemic world, which includes employing the tenets of implementation science and learning how to adapt prior learnings from safety science to today’s reality. This will require a willingness to “fail intelligently” in order to innovate and learn. In this context, psychological safety is particularly important. Being willing to try something new, in a safe and controlled setting, is critical in the context of the high-stakes field of medicine.”
Lee A. Fleisher, MD, ML professor emeritus of Anesthesiology and Critical Care at the University of Pennsylvania Perelman School of Medicine, and a visiting fellow at the Duke-Margolis Institute of Health Policy. Amy C. Edmondson, PhD, is Novartis professor of Leadership and Management at Harvard Business School.
‘Failing Wisely’ Can Promote a Safer Healthcare System | MedPage Today
Re: health system transformation: “Why haven’t we shifted to true healthcare? The answer is simple: Sickcare is profitable. While patients face rising costs and delayed care, industry giants thrive. A recent KFF survey found unexpected medical bills are a top financial worry, and one in four people have skipped or delayed care due to cost. Patients lose while healthcare elites profit, with revenues outpacing the rising costs nationwide…
Healthcare is in dire need of disruption, yet its complexity and high barriers to entry have deterred innovators…
As health tech leaders, we must challenge ourselves to think in this new healthcare paradigm. Subtle shifts in how we talk about our work will make a world of difference. Moving from “how do I maximize CMS reimbursement” to “how inexpensively can I get this in patients’ hands” is a powerful change. So, too, is transitioning from “What can I do to help extend the life of the extremely sick?” to “How can I keep patients from ever needing a hospital in the first place?…
The current system’s beneficiaries are disincentivized to change, and patients lack the power to do so. Real change will come from those disrupting the status quo. Advances in AI and a focus on prevention offer a way forward, promising not just financial rewards, but a healthier population, less strain on healthcare, and a future where “healthcare” truly means care. The time for creative destruction in healthcare is now. We must embrace innovation, challenge outdated models, and demand a healthcare system that prioritizes wellness, not just treatment. It’s a bold vision, but one that’s within reach if we collectively choose to pursue it.”
Disrupting the U.S. “Sickcare” System – MedCity News
Re: Board effectiveness: “Board effectiveness isn’t about making everybody think and say the same things. I believe in creating an environment that fosters honest and candid discussions. It is about having courageous conversations that illuminate common threads but also highlight our differences. This allows the board to identify areas where a new way of thinking might be needed. One of our board’s principles is ‘listen first to understand, then to be understood.’ That’s where we start. When you get people listening to understand what you’re saying, rather than trying to get their point across, they tend to view things differently. “
Michele Richardson, JD Hidden Treasures: Mining vs Managing Health System Boards | Deloitte US
Consumers
Aflac’s Wellness Matters Survey: The second annual Wellness Matters Survey was conducted among a nationally representative sample of 2,000 employed U.S. adults ages 18-65 in April 2024 by Kantar Profiles on behalf of Aflac. Highlights:
- 60% of respondents (up 20% from 2023) have avoided common recommended health screenings. Millennials avoid important health screenings at higher rates: pap smear (40% millennial women; 34% women overall); STD screening (32% millennials; 23% overall); full body skin cancer exam (31% millennials; 27% overall); and blood test (39% millennials; 32% overall).
- Gen Z and millennials have a more positive outlook on most aspects of health than Gen X or baby boomers, specifically about how they look and feel, their weight/body mass index, and their financial health, but baby boomers report the most positive outlook on their mental health. Men continue to have a more positive outlook about their current health status than women.
- The majority of men have a positive outlook regarding all aspects of their current health as seen in 2023. Among women, while the majority feel positive about all aspects of their health, they are significantly more likely than men to feel somewhat/very negative about each aspect with weight/BMI (29%) and financial health (26%) being the most negative.
Aflac Wellness Matters Survey 2024www.aflac.com/docs/cancer-campaign-wellness-matters/aflac-wellness-matters-survey.pdf
Gen Z employment: “According to data from the Federal Reserve Bank of New York, the unemployment rate of recent college graduates between the ages of 22 and 27 has been higher than the overall US unemployment rate every month since January 2021.
This means young college grads have been more likely to be unemployed than the broader population, even as the job market has returned to a more normal post-pandemic state over the past two years.
It’s largely due to bad luck: While older workers locked in jobs during the hiring spree of the Great Resignation, the youngest workers are entering the labor market at a time when hiring has slowed significantly, especially for jobs that require a college degree…
In 2023, the hiring rate for jobs that typically require a college degree — among workers between age 20 and 29 — declined 20% year-over-year, according to ADP data. The overall hiring rate — across all jobs and ages — fell 15% over this period.
Additionally, aside from 2020 and 2021, the ratio of job openings to unemployed people — an indicator of job availability — is at its lowest level since 2018.”
Jobs for Recent College Grads Struggling the Most Amid Slower Hiring – Business Insider
Census: Household composition: The 2020 Census Supplemental Demographic and Housing Characteristics File (S-DHC) released last Thursday shows that about 99% of people in coupled households (212 million) lived in opposite-sex couple households, while the remaining 1% lived in same-sex couple households.
Roughly 88% of those in coupled households lived in married-couple households (189 million). The majority (187 million or about 99%) were in opposite-sex married-couple households, and about 2 million were in same-sex married-couple households. About 8% of the household population (26 million) lived in cohabiting-couple households in 202.0 Most (about 25 million or 95%) lived in opposite-sex cohabiting-couple households, and about 1 million were in same-sex households.
Majority of Household Population Lived in Coupled Households in 2020 (census.gov)
Study: OOP exposure with FSA, HSA insurance: “Of the 17 038 families included in the study sample, 2628 held FSAs (weighted 17%) and 1845 (weighted 13%) held HSAs. In regression-adjusted models, families with FSAs spent a mean of 20% or $2033 (95% CI, $789-$3276) more on health care annually than non–account holding families, largely due to increased insurer-paid expenses. Families with HSAs spent a mean of 44% or $697 (95% CI, $521-$873) more on out-of-pocket expenditures and had insignificantly higher insurance-paid expenditures than families without accounts, resulting in overall expenditures comparable to those of non–account holders.
Participation in FSAs is associated with higher health care expenditures and tax expenditures, while HSAs are not associated with reduced expenditures. Tax policy could be better targeted to enhance insurance coverage and health care accessibility.
Hospitals
KFF Investigation of Ballad Health: “Government documents obtained by KFF Health News reveal that Tennessee officials, in closed-door negotiations, are attempting to hold the monopoly more accountable after years of complaints and protests from patients and their families.
Ballad, a 20-hospital system in northeastern Tennessee and southwestern Virginia, was created six years ago through monopoly agreements negotiated with both states. Since then, Ballad has consistently fallen short of the quality-of-care goals…
Despite these failures, Tennessee has given “A” grades and annual stamps of approval to Ballad that allow the monopoly to continue. This has occurred, at least in part, because Ballad is graded against a scoring rubric that largely ignores how its hospitals actually perform.”
Tennessee Tries To Rein In Ballad’s Hospital Monopoly After Years of Problems – KFF Health News
CDC launches hospital diagnostic error initiative: Last week, the Centers for Disease Control and Prevention is launching a program to help hospitals reduce diagnostic errors and provide more safe, accurate patient care, the agency announced Tuesday.
Missed, delayed or wrong diagnoses can occur due to a variety of factors, including communication breakdowns and technological issues… Every year, diagnostic errors contribute to around 371,000 deaths and 424,000 permanent disabilities, according to a 2023 study published in The BMJ, a peer-reviewed medical journal.
The agencies advise hospitals to: set aside resources for a diagnostic excellence team and committee; track and report any incorrect diagnoses; involve patients in care decisions; and put protocols in place to ensure the right diagnostic tests are ordered, interpreted, communicated and acted upon.
Core Elements of Hospital Diagnostic Excellence (DxEx) | Patient Safety | CDC
Investing
Private equity deal focus shifting: “firms are struggling to find buyers for physician groups in the wake of increased oversight and financial pressure.
Rising interest rates, lower evaluations and tougher regulations have scuttled potential private equity-led physician group deals. Healthcare attorneys say a softening sellers’ market has irked doctors, many of whom were promised a pay boost once private equity-backed management services organizations flipped a physician practice to another buyer.
Over the past decade, an increasing number of physicians have left their private practices to work for corporations, including private equity-funded management services organizations, health systems and insurers…
Healthcare private equity activity was sluggish in the second quarter, accounting for just 10% of all private equity deal value, according to Pitchbook. That fell below the five-year quarterly average of 15%, the data analytics company found.
Antitrust scrutiny is also expected to shift more PE investment from healthcare delivery to digital health, healthcare information technology companies and other sectors of the industry, Pitchbook analysts said.”
Private-equity firms cool on physician groups | Modern Healthcare
OpenAI funding: Friday, OpenAI finalized its choice of investor in its $6.5 billion funding round which would value the company at $150 billion. Thrive Capital is leading with a $1.25 billion commitment, which represents 38% of its most recent growth fund This would be the largest venture capital round of all time, topping the $6 billion raised earlier this year by Elon Musk’s xAI.
OpenAI to Decide Which Backers to Let Into $6.5 Billion Funding – Bloomberg
M&A 2024: Global M&A activity is up 16% year-over-year, including 23% in the U.S. and 30% in Europe, per new data out today from LSEG. Most dealmakers believe the increases would be significantly higher if not for enhanced antitrust enforcement, which has caused many merger talks to die in their cribs.
LSEG Analytics https://thesource.lseg.com/thesource/getfile/index/ac087d9c-a5f6-4202-b8b3-8a55fd3856ce?utm_source=newsletter&utm_medium=email&utm_campaign=newsletter_axiosprorata&stream=top
Legislation
House Energy and Commerce Committee bills passed last week: In addition to a 2-year extension of the telehealth bill ( Telehealth Modernization Act of 2024), the committee passed these bills:
- The Ensuring Access to Medicaid Buy-in Program Act of 2024which removes Medicaid restrictions for adults with disabilities, improving home and community-based services.
- Medicare and Medicaid Fraud Prevention Act of 2024that requires state Medicaid programs to check whether providers are deceased through state databases on a quarterly basis.
- Chronic Disease Flexibility Coverage Act that gives statutory authority to high-deductible health plans to offer expanded preventive care. This includes beta blockers, blood pressure monitors, glucometers, inhalers and cholesterol drugs. The list of services could be expanded further in the future.
House Ways and Means Committee advances 2-year telehealth extension bill
Small biotech: Last Thursday, Sen. Bill Cassidy (R-LA) introduced a bill to let some small drugmakers avoid Medicare price negotiations. The Inflation Reduction Act allows Medicare to negotiate prices after pills have been on the market for nine years, while biologics are protected for 13 years. The differential is supposed to account for the extra time that it typically takes to develop biologics, which are more complicated than small-molecule medicines. The IRA exempts some small biotechs from Medicare negotiation. However, that exemption expires after 2028, and it only applies to drugs that were on the market in 2021. Cassidy’s bill would exempt “research and development-intensive small biotech manufacturers” after the current exemption expires. It also would create a new way of determining what qualifies as a small biotech by basing that calculation on a company’s research and development expenditures.
Top GOP senator proposes changes to Medicare drug price negotiations | STAT (statnews.com)
Litigation
Medicaid overpayments in IN: Indiana managed care organizations and health systems are blamed for defrauding the state Medicaid system by up to $1 billion per a newly unsealed whistleblower lawsuit. Implicated in the lawsuit is Anthem, the largest managed care company in Blue Cross Blue Shield Association; CareSource, one of the country’s largest managed health plans; and Coordinated Care, a subsidiary of Centene; and MDwise.Health systems named are Indiana University Health, Ascension Health, Lutheran Health Network and other regional hospitals.
The insurers are accused of misusing Medicaid funds by violating standard hospital billing rules, paying for services after patients already died, improperly paying chiropractic office visits and improperly bundling dental and opioid treatment claims. Insurers knew reporting higher expenditures in the encounter data would result in greater capitated payments in the future.
Medicaid Fraud Indiana Anthem Blue Cross Indiana University Health
Payers
NCQA 2024 quality ratings for insurers: The National Committee for Quality Assurance (NCQA) released its 2024 Health Plan Ratings based on data from calendar year 2023. Highlights:
“This year’s Ratings showed a slight increase in 5-star plans, with 5 out of 1,019 rated plans achieving the highest rating. Three were commercial and two were Medicare plans. There was also a slight increase in Medicaid and Medicare plans that achieved 4- and 4.5-star ratings, compared to 2023, demonstrating improvement across several health quality measures.”
NCQA Unveils 2024 Health Plan Ratings – NCQA
State Medicaid budgets: “Nationally, states spent 12.9%, or a total of $250 billion, of their own resources on Medicaid in fiscal year 2022—2.7 percentage points lower than the 15-year average. Alaska’s Medicaid spending was the furthest above its 15-year average (1.2 percentage points), and New York’s Medicaid spending was the furthest below its 15-year average (−6.6 percentage points).
Every state except Alaska spent a smaller share of its own dollars on Medicaid in fiscal 2022 than it had, on average, over the previous 15 years. Differences ranged from 6.6 percentage points in New York to approximately a quarter of a percentage point in New Hampshire.”
Medicare Advantage Status: Per the Better Medicare Alliance’s 2024 “State of Medicare Advantage Report.”
- Medicare Advantage total enrollment is 33.8 million, or 55% of Medicare population, in 2024 vs. 31 million in 2023.
- There are 3,959 MA plans being offered in 2024. The average beneficiary has access to 43 plans this year, and 99.7% have access to at least one.
- The average MA monthly premium is $18.50.
- 56% of MA members are enrolled in an HMO plan and 43% in a local PPO.
- 95% of MA members are satisfied with their healthcare quality.
- 31% of MA enrollees identify as Black, Latino or Asian, compared to 18% of Medicare enrollees.
- 52% of MA members have annual incomes of less than $24,500.
- MA enrollment in rural areas is 1.8 million.
- Special needs plans enrollment is 5.8 million people, with enrollment increasing 14% since 2023.
- MA members spend $2,541 less on out-of-pocket costs and premiums compared to Medicare enrollees.
- Over 98% of MA enrollees are enrolled in a plan that also includes prescription drug coverage, and 99% offer at least one supplemental benefit.
- Among all MA plans, 99% offer vision, dental and hearing coverage.
https://bettermedicarealliance.org/publication/state-of-medicare-advantage-2024/
Study: Price variation in FSA, HSA populations: Researchers compared the health care and health-related tax expenditures among families holding FSAs, HSAs, or neither types of accounts using Medical Expenditure Panel Survey and Trilliant Health claims analytics covering January 1, 2011, to December 31, 2019. Findings:
“Nationally, there were 1756 UnitedHealthcare rates for MS-DRG 470 across 1124 unique acute care hospitals. There is substantial variation in the negotiated institutional rates paid by UnitedHealthcare to acute care hospitals for MS-DRG 470. The negotiated rates varied by a factor of almost 10, ranging from $11 203 to $106, 427. Although the median (IQR) rate was $29 536 ($22 780-$38 420), the most common rate was $42 436 (n = 18).
At the market level, the negotiated rates for MS-DRG 470 varied substantially by payer and hospital, ranging from a minimum of $15 244 for BCBSIL at Ingalls Memorial Hospital to a maximum of $38 328 for UnitedHealthcare at Northwestern Medicine Central DuPage Hospital. Within the same hospital, the rates paid by BCBSIL and UnitedHealthcare differed by a mean (SD) of $5178 ($4097), equivalent to 20.4% of the mean (SD) negotiated rate of $25 425 ($6193). There was no discernable pattern when comparing rates across payers, with UnitedHealthcare negotiating higher rates to 17 of the 28 hospitals examined and BCBSIL to 11 hospitals.
This research demonstrates what is possible with the novel health plan price transparency data and reveals significant variation in rates within and between payers. This variation exists both nationally and within markets, even within the same hospital across different payers. Due to the novelty of this dataset, this analysis is exploratory and limited in scope… Whereas much of payment reform initiatives have focused on “value-based care,” national efforts to hold commercial payers accountable to a reasonable “market rate” could meaningfully reduce wasteful spending.”
Physicians
Physicians’ Foundation Survey: The 2024 Survey of America’s Current and Future Physicians surveyed 1,723 physicians, residents and medical students between June 17 and July 16, 2024. Highlights:
- 83% of physicians said they were at full capacity or overextended and overworked in their current practice
- 52% of physicians reported being at full capacity and 31% said they were overextended and overworked — a decrease of 2% compared to the previous year.
- The majority of physicians who reported being overextended were employed, female, Hispanic or in racial groups categorized as “other.”
- Physicians who are independent, older and male tended to have more time to see patients.
- 59% of residents report being at full capacity and 27% report being overextended and overworked.
- 71% of residents and 59% of medical students said that changing or removing questions that stigmatize accessing behavioral healthcare from the licensure process would be helpful. Still, medical students are far more likely to seek mental health care (49%) than residents (33%) or physicians (18%), indicating a shift in the attitudes and behaviors of future physicians.
2024 Survey of America’s Current and Future Physicians https://physiciansfoundation.org/wp-content/uploads/2024-Survey-of-Americas-Current-and-Future-Physicians.pdf
Study: Private equity ownership: “Private equity (PE) firms have been acquiring physician practices at an increasing rate, raising concerns about such firms’ penetration at the physician level into local markets and the impact on health care quality and prices. However, limited knowledge exists about the extent of PE firms’ control in local markets. By linking data on PE acquisitions to physician data and using full-time-equivalent physicians as the base of assessment, we estimated the local market share of each PE firm within ten physician specialties at the Metropolitan Statistical Area (MSA) level. PE-acquired physician practice sites increased from 816 across 119 MSAs in 2012 to 5,779 across 307 MSAs in 2021. Single PE firms had significant market share, exceeding 30% in 108 MSA specialty markets and exceeding 50% in 50 of those markets. The findings raise concerns about competition and call for closer scrutiny by the Federal Trade Commission, state regulators, and policy makers.”
Polling
Pew, NORC: Political stress:
- 60% of U.S. adults find it stressful and frustrating to discuss politics with people who hold different views — up 10 points from the relatively innocent days of 2019, before rampant election denialism.
- 60% limit how much political news they consume to avoid feeling overloaded or fatigued, according to a poll out last weekfrom the AP-NORC Center for Public Affairs Research and USAFacts.
Note: Per the American Psychological Society, politics “is increasingly recognized as a significant source of chronic stress, affecting both mental and physical health negatively across a broad swath of the population.”
Too much? Many Americans feel the need to limit their political news, AP-NORC/USAFacts poll findshttps://apnews.com/article/poll-election-news-fatigue-77f2bf012502b9aea1d9d38173ace4ec?utm_source=newsletter&utm_medium=email&utm_campaign=newsletter_axiosam&stream=top
USAFacts https://usafacts.org
Prescription Drugs
Weight loss drug impact on surgery: Glucagon-like peptide 1 (GLP-1) receptor agonists like semaglutide (Ozempic, Wegovy) and tirzepatide (Mounjaro, Zepbound), were originally approved for type 2 diabetes before their obesity indications. But the evidence that they could help millions of Americans lose weight (and prevent major heart events for those individuals with cardiovascular disease) has begun to reshape the healthcare landscape in unexpected ways.
One of the most striking shifts has been in the area of bariatric surgery, where once-steady demand for weight-loss procedures has declined significantly (by as much as 30% at some facilities) as more patients turn to these potent medications to shed pounds. This change is so pronounced that some bariatric surgery programs have closed .
This trend is not just about GLP-1 medications, however.
It represents a broader transformation in how the country and its providers are approaching weight management and the treatment of related conditions. While these drugs may be shrinking surgery volumes, they also are opening the door to new possibilities for reducing the need for other drugs and procedures, a shift that will ultimately, and significantly, influence healthcare utilization and costs.”
Is Wegovy Shrinking Bariatric Surgery, Too? | MedPage Today
Public health
Peterson: Healthcare spending per capita, by spending category, 2021
US vs comparable countries
| Spending Category | United States | Comparable Country Average | % Difference
|
| Inpatient and outpatient care | $7,500 | $2,969 | +253% |
| Long-term care | $924 | $1,301 | -29% |
| Preventive care | $589 | $426 | +28% |
| Prescription drugs and medical goods | $1,635 | $944 | +42% |
| Administration | $925 | $245 | +278% |
Peterson-KFF, What drives health spending in the U.S. compared to other countries?, August 2024
AACR: Cancer treatment outcomes: “The spectacular progress being made against cancer is resulting in a steady decline in cancer death rates, and a consistent rise in the number of people who live longer and fuller lives after a cancer diagnosis. In fact, the overall cancer death rate in the United States has fallen by 33% between 1991 and 2021, a reduction that translates into averting more than 4.1 million deaths from cancer. The drop in overall cancer mortality is attributable to reductions in smoking, as well as improvements in early detection and treatment of certain cancers…
Thanks to the research-driven advances, more than 18 million individuals with a history of cancer were alive in the United States as of January 1, 2022, and the number is projected to rise to 26 million by 2040.
Even though significant progress has been made, cancer continues to be an ongoing public health challenge in the United States and around the world. In the United States alone, it is estimated that more than two million new cancer cases will be diagnosed in 2024. Among the challenges we face is that the advances have not been uniform for all types and stages of cancer. As one example, while the overall cancer incidence in the United States has stabilized in recent years, cases of certain cancer types, such as pancreatic cancer, uterine cancer, and human papillomavirus (HPV)-associated oral cancers, are increasing. Furthermore, the age- and sex-specific incidence of certain cancers is on the rise. For instance, a growing concern among public health experts is the rising incidence of early-onset colorectal cancer—cancer in adults younger than 50 years. Another significant challenge we face is the disproportionately higher burden of cancer in US racial and ethnic minority groups and other medically underserved populations…”
Reducing Cancer Risk | AACR Cancer Progress Report 2024
Study: hypertension awareness: “Our study looked at the hypertension control cascade among U.S. adults with uncontrolled hypertension. The cascade includes hypertension awareness, hypertension treatment recommendations, and use of antihypertensive medication…
57.8 million adults in the United States are unaware that they have hypertension, and among 35 million adults who are aware that they have hypertension, and were eligible for receiving antihypertensive medication treatment, 71% of those — which corresponds to 24.8 million Americans — took medication but had hypertension that remained uncontrolled.
Over Half of Adults With Uncontrolled Hypertension Unaware of Their Condition | MedPage Today
AACR Study: Cancer and alcohol: “Adults under age 50 have been developing breast cancer and colorectal cancer at increasingly higher rates over the last six decades, and alcohol use may be one factor driving the trend, according to a scientific report published last week.
The report, by the American Association for Cancer Research, highlights scientific breakthroughs that have led to new anticancer drugs and improved overall survival. But the authors also described a troubling pattern: Even as cancer death rates have declined, the overall incidence of several cancers has been rising inexplicably, with an especially alarming increase among younger adults in cancers of the gastrointestinal system, like colorectal cancer.
The report estimates that 40% of all cancer cases are associated with modifiable risk factors. It recommends reducing alcohol consumption, along with making lifestyle changes such as avoiding tobacco, maintaining a healthy diet and weight, exercising, avoiding ultraviolet radiation and minimizing exposure to pollutants.”
Deep Links Between Alcohol and Cancer Are Described in New Report – The New York Times (nytimes.com)
Rural health access: Key findings from the Huntsman Cancer Institute and the University of Utah’s Community Health Assessment Survey, which focused solely on patients in rural and frontier areas across five states.
- 34% of rural patients said they have easy access to medical specialists.
- 48% of rural residents said they had seen a physician in the past year vs. U.S. average of 85%.
- 40% of rural women of the recommended age had never had a mammogram, compared to the national average of 22%.
- One-third of respondents said more telemedicine could help access to care, but only 81% have access to high-speed internet, compared to 91% of Americans nationwide. About 10% of rural areas said they did not have cell coverage.
- 68% said they were not aware of programs to help pay for medical costs.
Huntsman Cancer Institute and the University of Utah, August 9, 2024
Technology
Analysis: :Change Healthcare cyberattack: “On February 21, 2024, Change Healthcare, a data processing firm owned by UnitedHealth Group, was the target of a cyberattack by the ransomware group ALPHV Black Cat.1 An active ransomware operation, ALPHV Black Cat is thought to also be behind a 2021 attack on Colonial Pipeline that disrupted the nationwide fuel supply chain….
The Change Healthcare cyberattack exposes some gaps in this strategy. First, large billing processers and vertically integrated health plans affect more patients than care delivery organizations, and Department of Health and Human Services strategy needs to expand beyond HDOs and address issues related to these other covered entities. Second, in addition to patient safety risks from cyberattacks, there are important economic risks, especially in attacks targeting entities responsible for payments and financial flows. A parallel strategy for preempting economic harms needs to be developed alongside a strategy for preventing patient harm.”
Report: Impact of AI on industry productivity: Large companies adopting artificial intelligence (AI) are expected to boost operating profit margins 2% over the next five years, equivalent to approximately $55 billion in annual cost …. “AI will likely spur profit gains among 23 out of 25 industry groups around the globe during that time span, with software and semiconductor firms yielding revenue increases of 25% and 34%, respectively. “
Bank of America
