The choice of price index has major implications for comparative analysis. Despite their widespread use internationally, general price indices likely underestimate the contribution of price growth to overall health expenditure growth. We find that in addition to its reputation for having high health price levels compared to other high-income countries, the United States also faces health price growth for goods and services paid for by government and households in excess of general price growth. Furthermore, US households are exposed to greater health price growth than households in comparator countries.
Medical crowdfunding is a key source of finance for individuals facing high out of pocket costs, including organ transplant candidates. However, little is known about racial disparities in campaigning activity and outcomes, or how these relate to access to care. In this exploratory nationwide cross-sectional study, we examined racial disparities in campaigning activity across states and the association between U.S. campaigners’ race and ethnicity and crowdfunding outcomes using a novel database of organ-transplant related campaigns, and an algorithm to identify race and ethnicity based on name and geographic location. This analysis suggests that there are racial disparities in individuals’ ability to successfully raise requested funds, with Black and Hispanic campaigners fundraising lower amounts and less likely to achieve their monetary goals. We also find that crowdfunding among White, Black, and Hispanic populations exhibit different patterns of activity at the state level, and in relation to race specific uninsurance and wait list additions, highlighting potential differences in fundraising need across the three groups. Policy efforts should consider not only how inequalities in fundraising ability for associated costs influences accessibility to care, but also how to identify clinical need among minorities.
Most high-income countries except the US rely on health technology assessment (HTA) to ensure that prices paid for new medicines reflect the value they provide.1,2 Health technology assessment bodies assess the relative clinical or economic impact of new drugs to guide pricing and coverage decisions. These assessments usually occur after marketing authorization by a medicines regulatory body (eg, European Medicines Agency), and patients may have little or no access to therapies not assessed favorably by HTA bodies. As Medicare considers using comparative effectiveness data to negotiate drug prices, examining HTA decisions abroad can inform US policymakers about how HTA affects the availability and coverage of new medicines.3 We analyzed HTA outcomes and review times in 6 countries (Australia, Canada, England, France, Germany, and Switzerland) for novel therapeutic agents approved by the US Food and Drug Administration (FDA).
In low- and middle-income countries, many believe that telehealth services could significantly expand access to doctors by offering remote access at low cost. Yet, despite its convenience, telehealth care is limited by the absence of physical examination, point-of-care testing, or immediate treatment. Hence it is unclear how individuals value such options compared to standard face-to-face care. We study this issue in South Africa with general practitioners who today mostly practice in the private sector and are geographically located in wealthier areas with higher health insurance coverage. We use an incentive-compatible method to elicit robust measures of willingness-to-pay (WTP) for telehealth and face-to-face consultations with general practitioners in a sample of uninsured individuals. We find that only 36% of respondents are willing to pay the prevailing market price for a telehealth consultation. We find average WTP for in-person consultations is only 10% higher than that of telehealth. Additionally, individuals with higher health needs are willing to pay a premium for face-to-face consultations, while others are indifferent. Our findings suggest that private telehealth services are better suited for more minor health needs, but are unlikely to expand access to a majority unless cheaper models are introduced.
The COVID-19 pandemic was associated with increased mental health visits for parents of young children. This raises concerns about mental health impacts and highlights the need to address these concerns.
Study results raise concerns over prolonged high rates of mental health use during the pandemic, particularly in female adolescents and young women, and highlights the need to better monitor and identify mental health outcomes associated with COVID-19 containment measures and to develop policies to address these concerns.
Jonathan Cylus and colleagues argue that inflationary pressures mean the NHS may have reached the limit on its ability to contain costs for goods and staff without affecting care.
The need for cardiac transplantation (CT) in eligible patients with advanced heart failure has continued to grow, with a substantial mismatch between organ availability and demand. As the demand for transplantable organs has risen in the United States,1 so has the prevalence of major cardiometabolic risk factors, including diabetes mellitus (DM), among the current and emerging pool of potential donors.2 Although the cardiovascular complications of DM are well recognized, donor DM status has not been shown to adversely impact post-CT outcomes in older analyses.3 However, this has not been evaluated in the contemporary era or over longer-term follow-up.
One of the most pressing challenges facing most health care systems is rising costs. As the population ages and the demand for health care services grows, there is a growing need to understand the drivers of these costs across systems. This paper attempts to address this gap by examining utilization and spending of the course of a year for two specific high-need high-cost patient types: a frail older person with a hip fracture and an older person with congestive heart failure and diabetes. Data on utilization and expenditure is collected across five health care settings (hospital, post-acute rehabilitation, primary care, outpatient specialty and drugs), in six countries (Canada (Ontario), France, Germany, Spain (Aragon), Sweden and the United States (fee for service Medicare) and used to construct treatment episode Purchasing Power Parities (PPPs) that compare prices using baskets of goods from the different care settings. The treatment episode PPPs suggest other countries have more similar volumes of care to the US as compared to other standardization approaches, suggesting that US prices account for more of the differential in US health care expenditures. The US also differs with regards to the share of expenditures across care settings, with post-acute rehab and outpatient speciality expenditures accounting for a larger share of the total relative to comparators.
Although there are cross-country differences in the availability and structure of data sources, countries had the ability to effectively identify comparable HNHC personas for international study. This work serves as the methodological paper for six accompanying papers examining differences in spending, utilization, and outcomes for these personas across countries.
Across seven countries, we find important variations in end-of-life care for patients who sustained a hip fracture, with some differences explained by sex and age. Our work sheds important insights that may help ongoing health policy discussions on equity, efficiency, and reimbursement in health care systems.
Sara Machado Ph.D. uses the HSPA framework to examine the health policy propositions being debated by parties in the 2024 Portuguese legislative elections.
Irene Papanicolas: Every health care model involves people doing their best to balance competing priorities in the face of limited resources. In other words, every system involves tradeoffs.