National Health Expenditures In 2023: Faster Growth As Insurance Coverage And Utilization Increased A must- read from Health Affairs: “Health care spending in the US reached $4.9 trillion and increased 7.5 percent in 2023, growing from a rate of 4.6 percent in 2022. In 2023, the insured share of the population reached 92.5 percent, as enrollment in private health insurance increased at a strong rate for the second year in a row, and both private health insurance and Medicare spending grew faster than in 2022. For Medicaid, spending and enrollment growth slowed as the COVID-19 public health emergency ended. The health sector’s share of the economy in 2023 was 17.6 percent, which was similar to its share of 17.4 percent in 2022 but lower than in 2020 and 2021, during the height of the COVID-19 pandemic. State and local governments accounted for a higher share of spending in 2023 than in 2022, while the federal government share was lower as COVID-19-related funding declined and federal Medicaid spending growth slowed.”
Congress' end-of-year health deal may be falling apart “The bill text for the deal to extend expiring healthcare programs like Medicare telehealth flexibilities was finally finished Wednesday evening. By Thursday morning, there was blowback from Elon Musk, an incoming watchdog on federal spending, about the cost of the bill and the rush to pass it in the days before the government runs out of funding.
Elon Musk, who president-elect Donald Trump wants to advise the White House on federal spending through the Department of Government Efficiency, opposed the bill on his social media platform X on Thursday morning. He wrote that any lawmaker that votes to pass the C.R. ‘should not be reelected in 2 years.’”
About health insurance/insurers
CMS sunsets Medicare Advantage value-based model, citing billions in costs “The Centers for Medicare & Medicaid Services (CMS) is discontinuing the Medicare Advantage (MA) Value-Based Insurance Design model at the end of 2025.
The CMS said the model was too costly because of ‘increased risk score growth and Part D expenditures’ among participating plans.
In calendar years 2021 and 2022, the model cost the Medicare Trust Fund a combined $4.5 billion. That level of costs was ‘unprecedented,”’ and there were no ‘viable policy modifications’ to make the model more sustainable.”
Mandatory Medicare Bundled Payment and the Future of Hospital Reimbursement A great review of this program, which starts next month. A report from the Institute for Accountable Care highlights that hospitals participating in the Transforming Episode Accountability Model (TEAM) could face an average financial loss of $500 per episode of care.
About hospitals and healthcare systems
Hospitals tried to cut labor expenses this year. Did it work? “Four things to know:
1. Labor expenses are still above pre-pandemic levels, signaling a new normal. But hourly earnings growth has slowed to below 4% monthly from January through October of this year. It's unfeasible to reduce staff because patient volumes are growing, even in areas where the population is stagnant, according to the report.
2. Hospital employee average hourly earnings growth dropped 3.2% in 2024, compared to 4.2% the year prior. However, hospital payrolls have increased every month for the past 35 months, while health system payrolls have risen consistently for the past 46 months.
3. Over the last 12 months, the average hospital job additions hit 17,780, up from 15,800 over the previous year. Health systems added an average of 29,630 jobs per month in the last 12 months, compared with 28,760 the year prior.
4. Quit rates for the healthcare and social assistance sector hit 2.3% in October, compared to 2.9% in May 2023, according to the report. While quit rates have decreased, they are still above the 1.6% average in the 10 years before the pandemic.”
About pharma
Giant Companies Took Secret Payments to Allow Free Flow of Opioids Excellent investigative journalism shows how PBMs encouraged and profited from expanded opioid use. For example: “Even as the epidemic worsened, the P.B.M.s collected ever-growing sums. The largest of the middlemen bought competitors and used their increasing leverage not to insist on safeguards but to extract more rebates and fees. From 2003 to 2012, for example, the amount Purdue was paying P.B.M.s in rebates roughly doubled to about $400 million a year, almost all of it for OxyContin.”
About the public’s health
CDC confirms first known severe case of H5N1 bird flu in the U.S. “The United States has confirmed its first known severe human infection of H5N1 bird flu, in a person in Louisiana believed to have contracted the virus through contact with sick or dead birds in a backyard flock.”
REVIEW OF EVIDENCE ON ALCOHOL AND HEALTH [Click on Download Free PDF]
Much controversy has arisen in recent years about beneficial and deleterious effects of alcohol. This excellent review provides some answers. For example, “For those who do consume alcohol, the DGA [Dietary Guidelines for Americans] recommend drinking in moderation by limiting intake to two drinks or fewer in a day for men and one drink or fewer in a day for women on days alcohol is consumed…
On the basis of a meta-analysis of eight eligible studies, there was a 16 percent lower risk of all-cause mortality among those who consumed moderate levels of alcohol compared with those who never consumed alcohol (RR 0.84, 95% CI 0.81–0.87).”
Subset recommendations warrant caution, for example, the association of higher incidence of breast cancer with alcohol consumption.
Vitamin D, Calcium, or Combined Supplementation for the Primary Prevention of Falls and Fractures in Community-Dwelling Adults: Preventive Medication “The USPSTF recommends against supplementation with vitamin D with or without calcium for the primary prevention of fractures in community-dwelling postmenopausal women and men age 60 years or older.” [Grade D recommendation]
Effects of Microplastic Exposure on Human Digestive, Reproductive, and Respiratory Health: A Rapid Systematic Review “We concluded that microplastics are “suspected” to harm human reproductive, digestive, and respiratory health, with a suggested link to colon and lung cancer.”