During a recent U.S. Senate Finance Committee hearing, Sen. Ron Wyden asked Yale University health economist Zach Cooper for insight into how hospital mergers will affect the nation’s workforce. rice field.
“For workers, one wonders if consolidation means more layoffs and lower wages,” said Wyden, a Democrat from Oregon and chair of the committee. “Does that match some of what you know in your research?”
Cooper, who is currently investigating how the U.S. health care system affects the broader economy and the economic opportunities for U.S. families, said hospital mergers will affect workers inside and outside the health sector. I told Mr. Wyden. He said hospitals could raise prices and allow higher premiums, which would increase costs for employers responsible for providing health insurance to their employees.
“Employer-sponsored health insurance just makes it more costly for companies to retain workers,” Yale testified as part of a five-member panel of policy researchers. Cooper, associate dean of the university’s Tobin Center for Economic Policy, said. healthcare executive. “And what happens when the cost of hiring workers outside the medical sector increases? [is] They are laying off workers. ”
Citing a study that found that 1 in 400 people who lose their jobs die within a year, he said studies show that layoffs have a negative impact on people’s health.
“What really scares me, and what has been eye-opening to me over the last few years looking into this issue, is the health impact of job turnover,” said a doctoral student in health policy and economics at the Yale School of Public Health. Cooper, an associate professor, said. He received his doctorate from Yale University’s Faculty of Arts and Sciences. “[Layoffs] It can have a fundamentally negative impact on your health. ”
throughout Public hearing on June 8Cooper briefed senators from both parties on the latest and greatest academic research on the impact of hospital mergers and other consolidations in the health care sector and rising health care spending. The opportunity to share these findings with legislators will not only produce world-class, data-driven research on policy-relevant issues, but also extend the impact of that research through regular engagement with local government policymakers. It embodies the mission of the Tobin Center. , and federal level.
And this is evidence that the Center’s efforts to engage directly with legislators are paying off.
last year, Center recruited Elizabeth (Liz) Julinkais a health policy expert and former Special Assistant to President Biden who has helped shape and drive engagement with policymakers on health-related issues. To this end, the center is currently working with Connecticut’s Medicaid program administrators to use data-driven research to strengthen the state’s public health care system.
The center has previously supported research by Cooper and Fiona Scott-Morton, the Theodore Nirenberg economics professor at Yale School of Business, and others, which showed the number of patients nationwide treated at hospitals within the insurance network. It was shown that about 20% of patients had an unexpected event. They were often being billed exorbitant medical bills because they were unknowingly being treated by out-of-network doctors. As a direct result of their work and subsequent engagement with policymakers, Congress passed legislation in December 2020 to protect people from unexpected health care costs.
Cooper and Morton launched in February 2021 “Medical reform 1% step” projectleverages research on the U.S. healthcare system by academics from Yale University and others to provide policy makers with a roadmap for reducing healthcare costs.
Cooper said in congressional testimony that about 20% of the 1,000 hospital mergers over the past 20 years made them less competitive and caused higher prices. Because the United States relies on employer-provided health insurance to cover at least 150 million people, rising health insurance premiums have economic implications far outside the healthcare system, he said. rice field.
He pointed to recent research suggesting that the impact of increased healthcare spending on private payers contributes to economic inequality on a par with the impacts of outsourcing, trade and automation. He said consolidation would not be limited to hospitals, but across the healthcare sector, including among insurance and physician markets, commercial insurance and pharmacy benefits managers (PMBs), who are third-party administrators of prescription drug programs in commercial insurance and public health plans. emphasized what was happening in
Cooper suggested several potential solutions to mitigate the impact of consolidation, including strengthening antitrust enforcement and improving the quantity and quality of data available in the health sector.
“I think what we fundamentally need is an all-payers claims database that provides detailed information on admissions and discharges, information on provider ownership and, importantly, the ability to measure quality. ‘” he told lawmakers. “It can’t be stressed enough. What really underpins the functioning of the U.S. healthcare market is the ability to measure the quality of healthcare providers.”
Senator Mike Crapo, a Republican from Idaho and an influential member of the committee, asked about a third potential solution Mr. Cooper proposed. That would enact site-neutral billing in the Medicare program, which would require Medicare to pay the same amount for identical outpatient services. Whether performed in a hospital, clinic, or other facility.
Cooper said Medicare lacks practice-neutral billing, so if a hospital owns the practice, it will pay more for certain services performed in the clinic, but this is not the case. He said it was inefficient and provided an inadvertent incentive for hospitals to acquire the practice of doctors.
And he had the evidence to back it up. He cited a recent study by the Medicare Payments Advisory Board that identified that many services most frequently performed in clinics should not result in higher reimbursement rates when performed in hospitals. Stated.
“It doesn’t have to be,” he told the commission.
