A Health Podyssey

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 are more than two and a half times those in 32 other nations studied. The disparities are even wider when we focus just on brand name drugs.

Drug pricing is the subject of seemingly perennial debates. One side focuses on access barriers due to high prices while the other side argues that lower prices threaten future innovation.

Stacie Dusetzina from Vanderbilt University Medical Center joins A Health Podyssey to talk about the complex world of drug pricing.

She and colleagues published a paper in the April 2022 issue of Health Affairs examining the degree to which people with Medicare prescription drug benefits use the drugs that are prescribed to them.

In the paper, the authors found non-initiation rates among some beneficiaries of greater than 50 percent for certain treatments.

If you enjoy this interview, order the April 2022 Health Affairs issue to get research on access to care, hospitals and more.

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The availability of pharmacist-administered vaccination has grown in recent decades. Proximity to a pharmacy has found to be predictive of vaccine use.

In Florida, Publix grocery stores were the first retail pharmacies to provide COVID-19 vaccinations to eligible members of the public. For more than a month after the initial rollout, Publix remained the sole retail pharmacy authorized to administer COVID-19 vaccines.

Grocery stores seem like a natural place to reach a large share of the population, but grocery stores are not located evenly throughout communities.

Jennifer Attonito, an instructor of health administration from Florida Atlantic University, joins A Health Podyssey to discuss disparities in access to COVID-19 vaccines during the initial vaccine rollout in Florida.

Attonito and co-authors published a paper in the December 2021 issue of Health Affairs that analyzed the locations of Publix stores in Florida. They found that the Publix locations don't always line up with where the needs are greatest.

Listen to Health Affairs Editor-in-Chief Alan Weil interview Jennifer Attonito on her research, its implications in the context of broader vaccine disparities, and health equity.

If you enjoyed this interview, order the December 2021 Health Affairs issue.

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When we launched A Health Podyssey in 2020, our goal was to take listeners beyond the research published in Health Affairs.

For A Health Podyssey's one-year anniversary, we wanted to take listeners on an Excursion and speak with someone who epitomizes so much of what brings professionals into the fields of health policy and health services.
Ashish Jha from the Brown University School of Public Health is a widely published researcher whose public voice arises from a combination of deep expertise and a unique ability to explain complex concepts in an accessible language. Over the course of the COVID-19 pandemic, Jha's insights on the virus have helped many navigate thorny, complicated public health issues.

Jha's most recent publication in Health Affairs was a commentary article where he and coauthors discussed adding a climate lens to health policy discussion in the U.S. Before joining Brown University, he was at the Harvard T. H. Chan School of Public Health.
Today, Ashish Jha joins Health Affairs' Editor-in-Chief Alan Weil to discuss what he's learned from the COVID-19 pandemic, the bright spots he sees for health care payment reform, and how he uses social media.

This episode is sponsored by the University of Pennsylvania's Master of Health Care Innovation.

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The US government reports that the total spending on hospital care in 2019 was almost $1.2 trillion. High and highly variable hospital prices have been in the news recently in part due to new information made available under the price transparency rules implemented by the Trump administration.

Competitive markets are supposed to constrain prices, but in much of the US, there's little competition among hospitals and consolidation throughout the healthcare sector has contributed to that consolidation. The result is a number of proposals to regulate health care prices in general and for hospital prices in particular.

Leemore Dafny from the Harvard Business School and Harvard Kennedy School joins Health Affairs Editor-in-Chief Alan Weil to discuss her latest research on hospital prices and market concentration.
Dafny and colleagues published a paper in the September 2021 issue of Health Affairs analyzing hospital prices and relating them to market concentration. The authors found the relationship isn't as straightforward as one might expect — but the findings still have major implications for any consideration of regulating hospital prices.
If you like this interview, order the September issue of Health Affairs.

Pre-order the October Perinatal Mental Health Theme Issue.

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Almost all commercial insurance plans have cost-sharing provisions where patients help pay for their health care services.

Annual deductibles — which patients have to meet before insurance pays anything at all — and co-payments — where the patient pays either a fixed amount for or a share of the cost of each service received — are common examples.

Cost-sharing generally reduces the health insurance premium by simply shifting a share of the costs to enrollees. But it also affects utilization because having to pay for a share of the care can deter people from getting it.

How cost-sharing actually works in practice is the subject of this episode's A Health Podyssey.

Stacie Dusetzina from Vanderbilt University School of Medicine and Michal Horný from Emory University published a paper in the February 2021 edition of Health Affairs that analyzes the out-of-pocket spending patterns for commercially-insured individuals. They focused on the timing for when expenses are incurred.
The unique analysis points to some distorting of the provisions of a typical health insurance plan. In particular, they found that although most commercially-insured people had several health care encounters throughout the year, their out-of-pocket spending was mostly concentrated within short time intervals.

Listen to Health Affairs Editor-in-Chief Alan Weil interview Stacie Dusetzina and Michal Horný on out-of-pocket health care spending.

This episode is sponsored by the Rural Health Research Gateway at the University of North Dakota.

Order your copy of the July 2021 issue of Health Affairs.

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