A blog covering the health/care ecosystem and people.

On June 11, Rohit Chopra, the Director of the Consumer Financial Protection Bureau (CFPB) announced the agency’s vision to ban Americans’ medical debt from credit reports. He called out that, “In recent years, however, medical bills became the most common collection item on credit reports. Research from the Consumer Financial Protection Bureau in 2022 showed that medical collections tradelines appeared on 43 million credit reports, and that 58 percent of bills that were in collections and on people’s credit records were medical bills.” Chopra further explained that medical debt on a consumer credit report was quite different than other kinds

How financially vulnerable are people with medical debt in the U.S.? Significantly more, statistically speaking, we learn from the latest survey data revealed by the National Financial Capabilities Study (NFCS) from the FINRA Foundation. The Kaiser Family Foundation and Peterson Center on Healthcare analyzed the NFCS data through a consumer health care financial lens with a focus on medical debt.          Financial distress takes many forms, the first chart inventories. People with medical debt were most likely lack saving for a “rainy day” fund, feel they’re “just getting by” financially, feel their finances control their life, and

Two-thirds of U.S. consumers say they can’t afford to pay their medical bills on-time, based on the 2023 Consumer Survey from Access One, a financial services company focused on healthcare payments.               The report’s title page asks the question, “What options do consumers really want for paying healthcare expenses?” The survey report responds to that question, finding out that nearly one-half of patients have taken some kind of action to reduce their medical expenses. Furthermore, one-third of consumers are not confident they could pay a medical bill of $500 or more. Access One fielded

The UK’s National Health Service (NHS) turns 75 today.             The NHS was the brainchild of Minister of Health Aneurin Bevan; he wrote in a statement to doctors and nurses in The Lancet on July 3, 1948,  “My job is to give you all the facilities, resources, apparatus and help I can, and then to leave you alone as professional men and women to use your skill and judgement without hindrance.” This week in The Lancet, the editors assert, “The founding principles of the NHS put into practice 75 years ago are at risk of

In health care, one of the “gifts” inspired by the coronavirus pandemic was the industry’s fast-pivot and adoption of digital health tools — especially telehealth and more generally the so-called “digital front doors” enabling patients to access medical services and personal work-flows for their care. Two years later, Experian provides a look into The State of Patient Access: 2023.                     You may know the name Experian as one of the largest credit rating agencies for consumer finance in the U.S. You may not know that the company has a significant footprint

On April 11, 2023, three of the largest U.S. consumer credit rating companies — Equifax, Experian and TransUnion — planned to remove medical bill collections that were under $500 from consumers’ credit reports. The Consumer Financial Protection Bureau (CFPB) calculated that these medical bill “erasures” under $500 impacted nearly 23 million consumers and eliminated medical collections totally for 15.6 million people in the U.S. according to CFPB’s recently-published Data Point report. For some context, it’s useful to know that the CFPB was created as part of the Dodd-Frank Wall Street Reform and Consumer Protection Act passed by Congress and signed

More people in the U.S. than ever have put off medical care due to cost, according to Gallup’s latest poll of patients in America.             Gallup conducted the annual Health and Healthcare poll U.S. adults in November and December 2022. This was the highest level of self-rationing care due to cost the pollster has found since its inaugural study on the topic in 2001. This was also the most dramatic year-on-year increase of postponing treatment due to cost in the study’s history.             Note the substantial difference in women avoiding

Three in four people in America grade health care costs a #fail, at grade “D” or lower. This is true across all income categories, from those earning under $24,000 a year to the well-off raking in $180K or more, we learn in Gallup’s poll conducted with West Health, finding that Majorities of people rank cost and equity of U.S. healthcare negatively. Entering the fourth quarter of 2022, several studies were published in the past week which reinforce the reality that Americans are facing high health care costs, preventing many from seeking necessary medical services, and hitting under-served health citizens even harder

There is a direct association between a person’s health status and patient outcomes and their financial health, quantified in original research published this week in JAMA Internal Medicine.                 Researchers from the University of Michigan (my alma mater) Medical School and Institute for Healthcare Policy and Innovation analyzed two years of commercial insurance claims data generated between January 2019 and January 2021, linking to commercial credit data from January 2021 for patients enrolled in a preferred providers organization in Michigan. The first chart illustrates the predicted probability of credit outcomes based on the

When high-deductible health plans became part of health insurance design in America, they were lauded as giving patients “more skin in the game” of health care payments. The theory behind consumer-directed care was that patients-as-consumers would shop around for care, morph into rational consumers of medical services just as they would do purchasing autos or washing machines, and shift the cost-curve of American health care ever downward. That skin-in-the-game has been a risk factor for .some patients to postpone care as well as take on medical debt — the strongest predictor of which is dealing with multiple chronic conditions. “The

Inflation and rising prices are the biggest problem facing America, most people told the Kaiser Family Foundation March 2022 Health Tracking Poll. Underpinning that household budget concern are gas and health care costs. Overall, 55% of people in the U.S. pointed to inflation as the top challenge the nation faces (ranging from 46% of Democrats to 70% of Republicans). Second most challenging problem facing the U.S. was Russia’s invasion into Ukraine, noted by 18% of people — from 14% of Republicans up to 23% of Democrats. The COVID-19 pandemic has fallen far down Americans’ concerns list tied third place with

“Social distancing is great. Medical distancing? Not so much,” I observe in Medical Distancing in America: A Lingering Pandemic Side Effect., my essay published this week in Medecision’s Liberate Health blog. Since we learned to spell “coronavirus,” we also learned the meaning and risk-managing importance of physical distance early in the COVID-19 pandemic. But medical distancing became a corollary life-flow of the physical version, and for our collective health and well-being, it hasn’t been good for our health in ways beyond keeping our exposure to the virus at bay. For health care providers — physicians, hospitals, ambulatory clinics, diagnostic centers —

In the U.S., being covered by health insurance is one of the social determinants of health. Without a health plan, an uninsured person in America is far more likely to file for bankruptcy due to medical costs, and lack access to needed health care (and especially primary care). But even with health insurance coverage, most health-insured people are concerned about medical costs in America, found in a MITRE-Harris Poll on U.S. consumers’ health insurance perspectives published today. “Even those fortunate to have insurance struggle with bills that result from misunderstanding or underestimating costs of treatments and procedures,” Juliette Espinosa of

Simply put, is the equation, “Spend more, get less” a sustainable business model? Of course not. But that’s the simple math on U.S. health care spending and what comes from it, according to Mirror, Mirror 2021: Reflecting Poorly, a perennial report from The Commonwealth Fund that compares health system performance across eleven developed countries. The first table details the metrics that the Fund compares across the eleven peer nations, which included Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States. The metrics compared were access to care, care process, administrative efficiency, equity,

The level of medical debt in America exceeded debt of other types in 2020. Furthermore, the flow of medical debt was greater among health citizens living in states that did not expand Medicaid as part of the Affordable Care Act, compared with patients who reside in Medicaid expansion states, according to an original research essay, Medical Debt in the US, 2009-2020 published in JAMA on 20 July 2021. The first line chart illustrates the trends in medical debt in collections by state expansion of Medicaid, with the bottom darkest line representing debt in collections in Medicaid expansion states from the

“Compare digital health to airlines, cruise lines, and other industries” and the sector looks quite privileged, opined Matthew Holt in a discussion on a study diving deeply into the State of Digital Health, conducted by Catalyst @ Health 2.0 and sponsored by WIPFLI.. The research was conducted among 335 respondents, which included 182 digital health companies polled between November 2020 and March 2021. Digital health companies represented 60% of the sample, the other 40% of which were consulting firms, subsidiaries of providers/payers/life science companies and tech corporations, and investors. As Matthew called out, the digital health sector has a relatively

U.S. hospitals’ operating margins went negative in January 2021 after turning north for the first time in December 2020 since the start of the coronavirus pandemic, according to the February 2021 Hospital Flash Report from Kaufman Hall, commissioned by AHA, the American Hospitals Association. The first chart illustrates the importance of CARES Act funding to keep hospitals financially afloat during the public health crisis through most of last year. The start of 2021 was difficult for hospitals and health systems, Kaufman Hall explains, with falling outpatient revenues and increasing expenses resulting in that below-the-line blue bar for January 2021’s operating

The coronavirus pandemic has exposed major weaknesses in the U.S. health care system, especially laying bare inequities and inertia in American health care, explained in The Progress We Need: Ten Health Care Imperatives for the Decade Ahead from Manatt Health. The report details the ten objectives that are central to Manatt’s health care practice, a sort of team manifesto call-to-action and North Star for the next decade. Their ten must-do’s for bending the cost curve while driving constructive change for a better health care system are to: Ensure access Achieve health equity Stability the safety net and rebuild public health

Before the coronavirus pandemic, patients had been transforming into health care payors, bearing high deductibles, greater out of pocket costs, and financial risk shifting to them for medical spending. In the wake of COVID-19, we see health consumers-as-payors impacted by the pandemic, as well as for existing diagnoses and chronic care management. There is weakening in U.S. consumers’ overall household finances, the latest report from the U.S. Bureau of Economic Analysis (BEA) asserted (published 25 November 2020). In John Leer’s look into the BEA report in Morning Consult, he wrote, “Decreases in income, the expiration of unemployment benefits and increased

2020 marked the centennial anniversary of the 19th Amendment to the U.S. Constitution, giving women the right to vote. In this auspicious year for women’s voting rights, as COVID-19 emerged in the U.S. in February, women’s labor force participation rate was 58%. Ironic timing indeed: the coronavirus pandemic has been especially harmful to working women’s lives, the Brookings Institution asserted last week in their report in 19A: The Brookings Gender Equality Series. A new study from Tia, the women’s health services platform, looks deeply into COVID-19’s negative impacts on working-age women and how they would advise the next occupant of

In terms of income, U.S. households entered 2020 in the best financial shape they’d been in years, based on new Census data released earlier this week. However, the U.S. Census Bureau found that the level of health insurance enrollment fell by 1 million people in 2019, with about 30 million Americans not covered by health insurance. In fact, the number of uninsured Americans rose by 2 million people in 2018, and by 1.9 million people in 2017. The coronavirus pandemic has only exacerbated the erosion of the health insured population. What havoc a pandemic can do to minds, bodies, souls, and wallets. By September 2020,

One in two people in the U.S. say their financial health has been negatively impacted by the COVID-19 pandemic, through job loss, income disruption, or reduced work hours. The 2020 Financial Wellness Census, from Prudential found that one-half of U.S. adults are anxious about their financial future as of May 2020, an increase from 38% in late 2019. Prudential surveyed 3,000 U.S. adults across three generational cohorts: Millennials, Gen X, and Baby Boomers. The economic hit from the pandemic has disproportionately impacted people of color, younger people, women, small business owners, gig workers, and people working in retailer harder than

The pace of digital health investments quickened in the first half of 2020, based on Rock Health’s look at health-tech financing in mid-year. Digital health companies garnered $5.4 billion in the first half of the year, record-setting according to Rock Health. Underneath this number were very big deals, shown by the size of the blue bubbles in the first graphic from the report. Note that in H1 2020, the average deal size exceeded $25 mm. Among the largest deals valued at over $100 mm were ClassPass (raising $285 mm), in the business of virtual fitness classes;  Alto Pharmacy, a digital

Patients in the U.S. are self-rationing care in the era of COVID-19 by cutting spending on health care visits and prescription drugs. The coronavirus pandemic’s impact on health consumers’ spending varies depending on whether the household is generally a healthy family unit, healthy “enthusiasts,” dealing with a simple or more complex chronic conditions, or managing mental health issues. PwC explored how COVID-19 is influencing consumers’ health care behaviors in survey research conducted in early April by the Health Research Institute. The findings were published in a May 2020 report, detailing study findings among 2,533 U.S. adults polled in early April

The Coronavirus has impacted every aspect of human life: first, the direct biological impact of COVID-19 on people, as of today the cause of over 63,000 deaths in the U.S. along with unquantifiable morbidity among millions of Americans who are surviving the virus and the toll on family caregivers. Beyond the direct physical impact of the virus, social and emotional health impacts are emerging now due to physical distancing, mandates to #StayHome, and telecommuting to jobs when possible. Mental health impacts will persist as a pandemic after the Coronavirus pandemic, I’ve previously detailed here in Health Populi. On a global

One in three working age people in the U.S. lost their job as a response to the COVID-19 pandemic, some of whom lost health insurance and others anxious their health coverage will be threatened, revealed in a survey from The Commonwealth Fund published on April 21, 2020. 2 in 5 people in America who are dealing with job insecurity are also health insurance insecure, the study found, as shown in the pie chart. The Commonwealth Fund commissioned the poll among 1,001 U.S. adults 18 to 64 years of age between 8-13 April 2020. Nearly all Americans believe the dots of

In the midst of growing inpatient admissions and test results for COVID-19, Congress is working as I write this post to finalize a round of legislation to help Americans with the costs-of-living and (hopefully) health care in a national, mandated, clarifying way. Right now in the real world, real patients are already being treated for COVID-19 in American hospitals. Patients are facing health care costs that may result in multi-thousand dollar bills at discharge (or death) that will decimate households’ financial health, particularly among people who don’t have health insurance coverage, covered by skinny or under-benefited plans, and/or lack banked

Four in five U.S. adults say lowering the cost of health care in America should be high priority for the next American president, according to a poll from The Commonwealth Fund and NBC News. Health care costs continue to be a top issue on American voters’ minds in this 2020 Presidential election year, this survey confirms. The first chart illustrates that lowering health care costs is a priority that crosses political parties. This is true for all flavors of health care costs, including health insurance deductibles and premiums, out-of-pocket costs for prescription drugs, and the cost of long-term care. While

There’s a gap between the supply of digital health tools that hospitals and health systems offer patients, and what patients-as-consumers need for overall health and wellbeing. This chasm is illustrated in The future of the digital patient experience, the latest report from HIMSS and the Center for Connected Medicine (CCM). The big gap in supply to patients vs. demand by health consumers is highlighted by what the arrow in the chart below points to: managing payments and paying bills. Nowhere in the top 10 most commonly provided digital tools is one for price transparency, cost comparing or cost estimating.  In the

On February 12, 2020, the Chairman of the Federal Reserve Bank of the U.S. submitted the Semiannual Monetary Policy Report to Congress and testified to the Senate Banking Committee. Chairman Jerome Powell detailed the current state of the economy, discussing the state of the macroeconomy, GDP growth, unemployment, inflation, and projections for 2022 and beyond. The top line data points are shown in the first chart. After his prepared remarks, Chairman Powell responded to questions from members of the Senate Banking Committee. Senator Ben Sasse (R-Neb.) asked him about health care costs’ impact on the national U.S. economy. The Chairman

The digital health presence at CES 2020 is the fastest-growing segment of consumer technologies at the Show this year, increasing by 25% over 2019. Heart-focused technologies are a big part of that growth story. In fact, in our search for devices and tools underpinned with clinical proof, evidence is growing for consumer-facing technology for heart-health, demonstrated by this year’s CES. Wrist-worn devices, digital therapeutics, patient engagement platforms, pharma and health plans converged at this year’s CES, with the professional association “blessing” of the American College of Cardiology who granted a continuing medical education credit for physicians attending a one-day “disruptive

While customer satisfaction with health insurance plans slightly increased between 2018 and 2019, patient satisfaction with hospitals fell in all three settings where care is delivered — inpatient, outpatient, and the emergency room, according to the 2018-2019 ACSI Finance, Insurance and Health Care Report. ACSI polls about 300,000 U.S. consumers each year to gauge satisfaction with over 400 companies in 46 industries. For historic trends, you can check out my coverage of the 2014 version of this study here in Health Populi. The 2019 ACSI report bundles finance/banks, insurance (property/casualty, life and health) and hospitals together in one document. Health

ABBA sang the song “Money Money Money” back in 1976. The lyrics feel, sadly, spot-on when thinking about health care costs, job-lock and Americans’ home economics in 2019. “Work all night, I work all day, to pay the bills I have to pay Ain’t it sad And still there never seems to be a single penny left for me That’s too bad… Money, money, money must be funny In the rich man’s world.” That year, ’76, wasn’t just the U.S. bicentennial — it was a year when the U.S. allocated 8.6% of the nation’s Gross Domestic Product for health care.

As patients have taken on more financial responsibility for first-dollar costs in high-deductible health plans and medical bills, hospitals and health care providers face growing fiscal pressures for late payments and bad debt. Those financial pressures are on both sides of the health care payment transaction, stressing patients-as-payors and health care financial managers alike. I’m speaking to health industry stakeholders on patients-as-payors at Cerner’s Now/Next conference today about the patient-as-payor, a person primed for engagement. That’s as in “Amazon-Primed,” which patients in their consumer lives now use as their retail experience benchmark. But consumers-as-patients don’t feel like health care today

Among stresses facing people at least 50 years of age, health care costs rank top of mind compared with other issues like long-term care, health insurance, Social Security, taxes, and being read to retire. Worries about health care costs are particularly stressful among future retirees, 8 of 10 of whom share this top concern along with 7 in 10 recent retirees and 6 in 10 people retired for at least a decade. Health care stress cuts in two ways: most people are worried about paying for health care, as well as experienced an unanticipated decline in their health, according to

If you heed the mass media headlines and President Trump’s tweets, the U.S. has achieved “the best economy” ever in mid-July 2019. But if you’re working full time in that economy, you tend to feel much less positive about your personal prospects and fiscal fitness. Nearly nine in 10 working Americans believe that medical costs will rise in the next few years as they pondering potential changes to the Affordable Care Act. The bottom line is that one-half of working people are more concerned about how they will save for future health care expenses. That’s the over-arching theme in PwC’s

“It’s the prices stupid,” Uwe Reinhardt and Gerard Anderson and colleagues asserted in the title their seminal Health Affairs manifesto on U.S. healthcare spending. Sixteen years later, yesterday on 8th July 2019, a Federal U.S. judge blocked, in the literal last-minute, a DHHS order mandating prescription drug companies to publish “retail prices” of medicines in direct-to-consumer TV ads. I was getting this post on transparency together just before that announcement hit the press, so this post would have had a different nuance yesterday compared with today. And that’s how health care politics and economics in America roll these days. Welcome to

Pharmaceutical company executives are testifying in the U.S. Congress this week on the topic of prescription drug costs. One of those medicines, insulin, cost a patient $5,705 for a year’s supply in 2016, double what it cost in 2012, according to the Health Care Cost Institute. Know that one of these insulin products, Lilly’s Humalog,  came onto the market in 1996. In typical markets, as products mature and get mass adoption, prices fall. Not so insulin, one of the many cost components in caring for diabetes. But then prescription drug pricing doesn’t conform with how typical markets work in theory.

Patients in the U.S. assume the role of payor when they are enrolled in high-deductible health plans. People are also the payor when dealing with paying greater co-payments for prescription drugs, especially as new therapeutic innovations come out of pipelines into commercial markets bearing six-digit prices for oncology and other categories. For mainstream Americans, “the math doesn’t add up” for paying medical bills out of median household budgets, based on the calculations in the 2019 VisitPay Report.  Given a $60K median U.S. income and average monthly mortgage and auto payments, there’s not much consumer margin to cover food, utilities, petrol,

Nearly one-half of Americans are quite concerned they won’t have enough money to pay for medical care, according to the latest Gallup poll. Health insurance in-security is mainstream as of November 2018, when Gallup polled U.S. adults about views on healthcare costs. It’s a major concern among six in ten people that their health plan would require they pay higher premiums or a bigger portion of their healthcare expenses. It’s also a big concern for four in ten people that someone in their family would be denied health insurance covering for a pre-existing condition, or that they might have to

The saving rate in the U.S. ranks among the lowest in the world, in a country that rates among the richest nations. So imagine how well Americans save for healthcare? “Consumers are not disciplined about saving in general,” with saving for healthcare lagging behind other types of savings, Alegeus observes in the 2018 Alegeus Consumer Health & Financial Fluency Report. Alegeus surveyed 1,400 U.S. healthcare consumers in September 2017 to gauge peoples’ views on healthcare finances, insurance, and levels of fluency. As patients continue to take on more financial responsibility for healthcare spending in the U.S., they are struggling with finances and

Most Americans have been surprised by a medical bill, a NORC AmeriSpeak survey found. Who’s responsible? Nearly all Americans (86% net responsible) first blame health insurance companies, followed by hospitals (82%). Fewer U.S. patients blamed doctors and pharmacies, although a majority of consumers still put responsibility for surprise healthcare bills on them (71% and 64% net). Most of the surprise bills were for charges associated with a physician’s service or lab test. Most surprise charges were not due to the service being excluded from a health plans provider network. The poll was conducted among 1,002 U.S. adults 18 and over

It will cost about $275,000 for a couple retiring in the U.S. this year to cover their healthcare costs for the rest of their life in retirement, Fidelity estimated. But Americans are notoriously pretty undisciplined about saving money, compared with peers living in other developed countries. How to address this challenge? Show people what improving their personal health can do to boost their 401(k) plans. This tactic is discussed in Health & Retirement Savings: Leveraging Healthcare Costs to Drive 401(k) Contributions & Improve Health, from HealthyCapital, a joint venture of Mercy health systems and HealthView Services.   The chart illustrates three

          The U.S. gets relatively low ROI for its relatively exorbitant spending on healthcare, noted once again in the latest Health at a Glance, the annual OECD report on member nations’ healthcare systems. The report includes U.S. country data asking, “How does the United States compare?” with its sister OECD countries. The answer is, “not well across most population health, access, and mortality measures.” For the Cliff’s Notes/Where’s Waldo top-line of the research, find the two long bars in this chart heading “south” of the OECD average, and one long blue bar going “north.” The northern climbing bar

Two in 3 Americans haven’t heard the phrases “personalized medicine” or “precision medicine.” When the concept of therapies tailored to individual patients is explained, most people like the idea of diagnostic tools that can identify biological markers and marry to personal medical records data to help determine medical treatments that best fit them. This picture of U.S. consumers’ views on personalized medicine comes from a survey conducted for PMC, the Personalized Medicine Coalition, and GenomeWeb, published in May 2018. The poll results are published in Public Perspectives on Personalized Medicine, with the top-line finding that life science industry innovators must

What could $28,166 buy you in 2018? A new car? A year of your child’s college education? A plot of land for your retirement home? Or a year of healthcare for a family of four? Welcome to this year’s edition of the Milliman Medical Index (MMI), one of the most important forecasts of the year in the world of the Health Populi blog and THINK-Health universe. That’s because we’re in the business of thinking about the future of health and health care through the health economics lens; the MMI is a key component of our ongoing environmental analysis of the

Two weeks in a row, The Economist, the news magazine headquartered in London, included two special reports stapled into the middle of the magazines. Universal health care was covered in a section on 28 April 2018, and coverage on financial inclusion was bundled into the 5th May edition. While The Economist’s editors may not have intended for these two reports to reinforce each other, my lens on health and healthcare immediately, and appreciatively, connected the dots between healthcare coverage and financial wellness. The Economist, not known for left-leaning political tendencies whatsoever, lays its bias down on the cover of the section here: universal healthcare

In healthcare, we use the word “toxicity” when it comes to taking a new medicine, especially a strong therapy to cure cancer. That prescription may be toxic as a harmful side effect on our journey to getting well. The concept of “financial toxicity” for cancer patients was raised by concerned clinicians at Sloane-Kettering Medical Center, who discussed the topic on 60 Minutes in 2014 and have published papers on the issue. Beyond strong medicines, a new financial toxicity has emerged for patients due to hospital inpatient admissions. A new article in the New England Journal of Medicine studies Myth and

Over four in 10 U.S. workers were enrolled in a high-deductible health plan in the first 9 months of 2017, according to the latest research published by the National Center for Health Statistics, part of the Centers for Disease Control in the U.S. Department of Health and Human Services. The report details Health Insurance Coverage: Early Release of Estimates From the National Health Interview Survey, January-September 2017. About 28 million people were uninsured in the U.S. in 2017, about the same proportion as in 2016 — but nearly 20 million fewer than in 2010, as the line chart illustrates. The