Over a year after federal hospital pricing transparency regulations went into effect, it is still hard to get hospitals to provide transparent pricing, according to a recent JAMA Internal Medicine report.
Over a third of top-ranked hospitals and almost four in five other hospitals could not say what they would bill for a facility fee for vaginal childbirth. Half of safety-net hospitals couldn’t provide telephonic or online reporting for the cost of brain MRIs.
Researchers reviewed websites and inquired by telephone for healthcare prices at a diverse group of 60 hospitals for two services: vaginal childbirth, and brain MRI scans. For each procedure, they asked for the price of a single medical billing code.
JAMA discovered a poor correlation between prices found on the web and those quoted by phone. The study found that many hospitals showed different prices online and when queried by telephone. The researchers cannot say whether either of these price quotes reflect what the hospital ultimately bills.
Implications for employers:
A recent report showed that women spend $15.3 billion more than men in out-of-pocket costs, largely because women use more health services. This difference persisted even after costs of childbirth were removed. Men are more likely to wait two years between medical visits, and almost half of men have under $1,000 in medical costs each year. The research also showed:
This analysis doesn’t include pharmacy data, which represents an increasing portion of medical and out-of-pocket expenses. Further, the researchers were not evaluating the appropriateness of care.
This adds to evidence of a healthcare cost gap for women.
Implications for employers:
Historically, we are reluctant to test any new medicines or vaccines on pregnant women, in part because adverse effects could impact both the mother and the fetus. However, there is growing evidence that a pregnant woman’s immune system can help protect her baby against severe diseases in infancy. This is especially important because we don’t administer vaccinations to babies until six months of age.
A study released by the Centers for Disease Control and Prevention (CDC) in September shows that:
There are additional vaccinations that pregnant women should strongly consider:
Prior research into influenza’s impact on pregnant women and newborns shows similar protective benefits as the CDC’s COVID-19 research. Women who are pregnant are two to three times more likely to be hospitalized and die of influenza compared to non-pregnant women. And women who get flu shots during pregnancy have fewer miscarriages, preterm births and children with low birth weight.
Implications for employers
During the pandemic, rates of Type 1 and Type 2 diabetes among people under 20 increased 20%, according to a report in JAMA Network Open from researchers at Kaiser Permanente of Southern California. Age standardized risk for diabetes over this period went up from 19.55 to 24.27 per 100,000 children – a 20% increase.
The researchers used the data warehouse from Kaiser Permanente's electronic health record, which has data on 4.8 million health plan members. Electronic health records are often clinically more accurate than health plan claims, but the data is more difficult to analyze as it is often unstructured.
It’s not a surprise that the pandemic led to an increase in cases of diabetes among children.
Diabetes is one of many inflammatory illnesses that are seen at a higher rate following a COVID-19 infection. Data also shows an increased risk of autoimmune diseases including rheumatoid arthritis, lupus and inflammatory bowel disease, and an increased risk of cardiovascular disease, including both heart attacks and strokes.
These are all associations and causality. For example, people might have had an underlying disease that was only diagnosed because they sought medical attention for their COVID-19.
It’s reassuring to see the rate of new cases of diabetes declining in the later years of this study. Nonetheless, the spike in 2020 of newly diagnosed people with diabetes will mean that the prevalence of diabetes will continue to be higher in this generation.
Implications for employers:
Jeff is an internal medicine physician and has led WTW’s clinical response to COVID-19 and other health-related topics. He has served in leadership roles in provider organizations and a health plan and is an Assistant Professor at Harvard Chan School of Public Health.