Well, I'm an unapologetic admirer of the Pacific Research Institute - but your comments on the Times article seem overly cautious.
In the first place, I think the magnitude of the cost shift is much greater than you state. I think it's your source that underestimates it. Milliman puts it at about $90 billion or 2 1/2 times greater than the study you allude to. Here is a link to the Milliman findings:
BTW, Michael Crichton estimated the cost shift at more than 14% of hospital revenues, as far back as 1970. Here is Chrichton's article (scroll to page 4):
I think the cost-shift problem has been with us in a significant way for more than 40 years. It only took Moses 40 years to find a way out of his wilderness. Yeah, maybe medical care is a harder problem. But still . . .
And secondly, the great majority of the cost shift is from the uninsured and from public programs such as Medicaid and Medicare, onto private insurance plans.
Last week came the news that public expenditures for American health care had exceeded 50% of total health expenditures for the first time in our history.
So your estimate of the cost shift is 1.44% of total spending, right away must be doubled to nearly 3% of private spending. And if Milliman's estimate is correct, then the impact of the cost-shift on private spending is in fact closer to 7% or 8%.
Thanks for taking the time to comment. I agree with your amplification. I discussed the Milliman research and other cost-shift issues in my recent study of Medicare Advantage (http://tinyurl.com/y8odq98). The Milliman folks address cost-shifting by the government, via Medicare and Medicaid, which is very significant and far greater than cost-shifting by the uninsured. The NY Times article alludes to the former as well, but its focus is on uncompensated care for the uninsured. For this short blog entry, I just wanted to focus on the uninsured, and the figure reported in the article.
3 comments:
Well, I'm an unapologetic admirer of the Pacific Research Institute - but your comments on the Times article seem overly cautious.
In the first place, I think the magnitude of the cost shift is much greater than you state. I think it's your source that underestimates it. Milliman puts it at about $90 billion or 2 1/2 times greater than the study you allude to. Here is a link to the Milliman findings:
http://www.milliman.com/expertise/healthcare/publications/rr/pdfs/hospital-physician-cost-shift-RR12-01-08.pdf
BTW, Michael Crichton estimated the cost shift at more than 14% of hospital revenues, as far back as 1970. Here is Chrichton's article (scroll to page 4):
http://www.theatlantic.com/doc/197003/crichton-hospital-bills
I think the cost-shift problem has been with us in a significant way for more than 40 years. It only took Moses 40 years to find a way out of his wilderness. Yeah, maybe medical care is a harder problem. But still . . .
And secondly, the great majority of the cost shift is from the uninsured and from public programs such as Medicaid and Medicare, onto private insurance plans.
Last week came the news that public expenditures for American health care had exceeded 50% of total health expenditures for the first time in our history.
So your estimate of the cost shift is 1.44% of total spending, right away must be doubled to nearly 3% of private spending. And if Milliman's estimate is correct, then the impact of the cost-shift on private spending is in fact closer to 7% or 8%.
And that's not trivial at all.
Thanks for taking the time to comment. I agree with your amplification. I discussed the Milliman research and other cost-shift issues in my recent study of Medicare Advantage (http://tinyurl.com/y8odq98). The Milliman folks address cost-shifting by the government, via Medicare and Medicaid, which is very significant and far greater than cost-shifting by the uninsured. The NY Times article alludes to the former as well, but its focus is on uncompensated care for the uninsured. For this short blog entry, I just wanted to focus on the uninsured, and the figure reported in the article.
And thank you - for the clarification and the link to your earlier article which I missed.
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