The EAM conducts research concerning different factors surrounding the economy, particularly in the health care arena.
Privately insured consumers expect that by paying premiums and using in-network providers, their insurer will cover the cost of medical care beyond their cost-sharing. However, problems arise when consumers seek care in emergency departments or in-network facilities and are treated by an out-of-network provider working in that institution. For emergency services, there is often not enough time to find an in-network provider or properly inform a patient of their payment responsibilities. For non-emergencies, patients may be unaware that their provider or lab that their in-network facility uses is out-of-network, and insurers and providers may not properly inform patients of the risks of receiving out-of-network care.
Patients in these circumstances may receive a surprise “balance bill” for an amount beyond what their insurer is willing to pay the providers. This practice can be exceedingly costly for consumers, who received unexpected bills for hundreds, or even thousands, of dollars when they believed that they were making a responsible choice by choosing an in-network hospital or emergency department. In 2014, up to 14% of emergency department visits and 9% of hospital stays were likely to produce balance bills, indicating that this is a significant problem in the United States (Garmon & Chartock, 2017). With no explicit federal protections against balance billing, some states have stepped in to protect consumers from this expensive and confusing practice. Protections in other states can be models for how states lacking in consumer protections can begin to address the issue of surprise balance billing. CLICK HERE TO READ MORE
RISING HEALTH CARE COSTS & THE ECONOMY
In 2015, EAM published a study demonstrating the effects of rising health care on Michigan’s economy. Key findings include:
An estimated 53 percent of Michigan residents have employer-sponsored health insurance, and employers are struggling to meet rising premium costs by reducing the number of new hires and limiting wage increases – most businesses are shifting premium costs to employees.
The cost-shift of health care premiums contributed to average family income to remain stagnant. The median average family income in Michigan grew just 0.4 percent between 2008 and 2013, while the cost of the average family insurance premium rose nearly 35 percent and the employee’s share increased 57 percent, according to the federal Agency for Healthcare Research and Quality.
For employers, rising health care costs mean that for every four employees making $45,000 annually, the employer pays more than $46,000 in health care premiums, federal Agency for Healthcare Research and Quality data show.
Read the study more in depth: EAM Study Rising Health Care Costs and the Economy.
SOCIOECONOMICS AND HOSPITAL QUALITY OF CARE
MICHIGAN’S CERTIFICATE OF NEED PROCESS
- Benefits of Michigan’s Certificate of Need
- Michigan’s CON Process One of the Best! Health Care Certificate-of-Need (CON) Laws: Policy or Politics?
- EAM CON Study Cost and Discharge Analysis
RESEARCH PERTAINING TO HEALTH CARE INSURANCE
PRIMARY PHYSICIAN SHORTAGE
Currently in Michigan, Nurse Practitioners (NP) do not have full practicing authority. The EAM believes NP’s are the solution to Michigan’s primary care physician shortage.
- For information regarding NP’s and cost savings to a state’s economy: APRN Cost Effectiveness Studies Summary
- For information regarding NP’s and effect on the primary care supply: APRN Quality Studies Summary
Nurse practice laws and regulations are specific to each state. For details go to: http://www.aanp.org/legislation-regulation/state-legislation-regulation/state-practice-environment.
- The Challenges of Health System Capacity Growth: http://www.nihcm.org/pdf/CapacityBrief-FINAL.pdf
- New Cardiac Surgery Programs Established From 1993 To 2004 Led To Little Increased Access, Substantial Duplication Of Services: https://www.ncbi.nlm.nih.gov/pubmed/21700599
- Hospital Geographic Expansion: The New Medical Arms Race?: http://nihcr.org/analysis/improving-care-delivery/prevention-improving-health/hospital-geographic-expansion/
- Medical building boom increasing Americans’ health care costs: http://triblive.com/x/pittsburghtrib/news/s_772584.html#axzz3CHR4eKhP
- How much hospital growth is too much?: http://articles.orlandosentinel.com/2012-05-05/health/os-hospital-growth-20120505_1_hospital-growth-hospital-expansion-critical-care
- U.S. Auto Big Three Health Care Costs Study: http://friendsofcon.com/studies-research/autos-big-three-health-care-costs-study/
- Do More Hospital Beds Lead to Higher Hospitalization Rates?: http://friendsofcon.com/studies-research/do-more-hospital-beds-lead-to-higher-hospitalization-rates/
- Understanding Healthcare Economics: http://friendsofcon.com/page-3/
- Risks Are High at Low-Volume Hospitals: http://www.usnews.com/news/articles/2015/05/18/risks-are-high-at-low-volume-hospitals.