Academic researchers in collaboration with data scientists at the Internal Revenue Service (IRS) published a pre-print this spring exploring the impact of allowable charge increases on labor force and the economy. This is an ingenious study; the researchers evaluated the impact of hospital mergers from 2010–15, which caused an average price increase of 1.2% in these communities. They used medical claims from the Health Care Cost Institute, Department of Labor filings for healthcare costs and individual tax filings from the IRS. About a fifth of mergers led to a 5% increase in prices.
The researchers found that a 1% increase in prices was associated with:
The labor impact of rising healthcare costs from hospital mergers was borne by those making between $20,000 and $100,000. Those earning under $20,000 were likely not on employer-sponsored health insurance, and higher-wage workers weren’t affected since health insurance costs make up a smaller portion of their total compensation.
The researchers also found that a 1% increase in healthcare prices led to a 2.7% increase in deaths from suicides and overdoses (one additional death per 100,000.) This is one extra death for every 140 individuals who lost their jobs due to healthcare price increases.
A hospital merger that led to a 5% increase in hospital costs would lead to 203 job losses, $32 million in foregone wages, $6.8 million in lower federal income tax payments and 1-2 additional deaths from suicide or overdose, with an aggregate harm of $42 million.
There were over 1,000 hospital mergers from 2000–20, and the researchers found that over 99% of commuting zones in the U.S. that had a hospital were exposed to a merger within or adjacent to that commuting zone.
Implications for employers:
Many of us have questions we want to ask our doctors. And most doctors are deeply fatigued by responding to the onslaught of messages in their in-boxes. Doctors complain of “pajama time,” answering patient portal questions in bed late at night. What if we could ask AI to answer these questions?
Researchers at New York University asked 16 primary care physicians to rate the quality of healthcare provider and AI responses to patient queries. They were given blinded responses (they didn’t know if they were written by physicians or AI), and the AI used to create the responses was software from Epic, the large electronic health record company. The provider responses were from a range of providers, including physicians, nurses and medical assistants.
The reviewers were more likely to find the AI responses personalized (52% vs. 38%) and empathetic (37% vs. 17%). The AI responses were longer and more likely to require a wider vocabulary for full understanding. The AI performed poorly on a few categories, especially interpretation of lab values.
Another study compared readability and information quality in cancer information from a free chatbot with answers from a chatbot that was behind a paywall. (Both were ChatGPT; the free version was 3.5, and the paid version was 4o.) The researchers evaluated 100 chatbot responses. They found that the paid chatbot produced more readable answers, although prompting the free chatbot to reword responses at a sixth-grade level eliminated this difference.
Implications for employers:
The American Cancer Society has updated its estimates of the portion of cancers in the U.S. related to modifiable risks. Researchers used cancer incidence and mortality and risk factor prevalence from 2019 to create these estimates through multiple simulations. The analysis includes 30 types of cancer but excludes non-melanoma skin cancers. The authors avoided using 2020 data due to fewer overall diagnoses during the pandemic.
Tobacco remains the number one risk factor for preventable cancer, contributing to 344,000 cases each year. Excess body weight contributes to 136,000 cases of cancer, and alcohol consumption is associated with about 97,000 potentially preventable cases of cancer. Ultraviolet light (mostly from the sun) contributes to 83,000 cancers (not including non-melanoma skin cancers), and physical inactivity contributes to 55,000 cases of cancer a year. Second-hand smoke contributes to over 6,000 cases of lung cancer annually.
Modifiable risk factors contributed to a substantial portion of many types of cancer in this analysis, including:
Other notable findings:
Implications for employers:
Although deaths from drug overdoses declined slightly in 2023, few people with opioid use disorder (OUD) are treated with effective medications to treat their addiction. Treatment with buprenorphine (such as Suboxone) or methadone decreases the urge to use illicit drugs and decreases the likelihood of death by as much as 59%.
Nonetheless, only a quarter of those who’d benefit from such treatment received Medication Assisted Treatment (MAT). Those who are seen in an emergency department after treatment with naloxone for a narcotic overdose are at an especially high risk of death if they aren’t treated medically.
Data from the Centers for Disease Control and Prevention shows that Black and Hispanic people, who face larger risks of death from overdose, were less likely to receive MAT.
In a separate study, researchers reviewed data from Massachusetts from 2021–23 on 8,679 individuals who were treated for serious injection-related infections from illegal drugs. Less than half (49%) received MAT within 12 months. Another study from Massachusetts showed that 28% of those on commercial health insurance in 2014 who were newly diagnosed with an opioid use disorder had changed insurance within the year after a diagnosis. Insurance instability can lead to disruptions in medication-assisted therapy.
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.
