Aaron E. Carroll's Blog

We Need Congress to Get Serious About Lowering Drug Costs

This article accompanies a primer on pharmacy benefit managers from June 2025. You can read more here .  There is widespread, bipartisan belief across the country that prescription drug costs are too high . So, why won’t Congress get serious about lowering costs and reforming one of the most influential players in the drug supply chain, pharmacy benefit managers (PBMs)? PBMs, the middlemen of the drug supply chain, were originally created to streamline things for their customers (health insurers) and negotiate to save them money. In turn, insurers could ideally pass on those savings to patients in the form of lower premiums and cost-sharing. However, PBMs have increasingly put their own profits over patients. In recent years, Congress (and numerous presidents) have floated policies that would limit PBMs’ influence over the supply chain and overall costs. Yet, they have failed to pass significant legislation that reins them in. I wrote about this problem this week for Public Health Post, summarizing how PBMs siphon savings away from American patients while Congress sits back and watches. I go on to suggest a few national reforms that Congress should pass this session, many of which have already been successful at the state-level.You can read the full piece here.The post We Need Congress to Get Serious About Lowering Drug Costs first appeared on The Incidental Economist.

Dual-Covered and Underserved: Can the “OpenTable of Health Care” Change That?

Dual-eligible enrollees — those covered by both Medicare and Medicaid — often face barriers to getting timely, high-quality care. Digital platforms like Zocdoc and Solv, or what some call the “OpenTable for urgent care”, could help by making it easier for patients to find providers and schedule appointments quickly.

The United States’ (US) health care system often falls short in delivering coordinated, accessible care for the 12.5 million dual-eligible Americans, who are typically older (65+), living with chronic health conditions or disabilities, and have limited income or resources. This is largely due to the combination of fragmented networks, unmet social needs, and provider shortages.

While only one solution, digital health care marketplaces can address many of these barriers to care.

Fragmented Networks
Despite ongoing reform efforts, dual-eligible enrollees still struggle to navigate a fragmented system. Medicare and Medicaid weren’t designed to work together and differ in benefits, provider networks, and eligibility — with state-by-state variation adding to the confusion. Integrated care models aim to streamline services, but currently reach few enrollees, and evidence of their impact remains limited.

Digital health marketplaces, like Zocdoc and Solv, help make it easier for patients to find care by allowing them to search for and book appointments with providers who accept both insurances. Zocdoc, founded in 2007, covers over 250 specialties and includes providers at federally qualified health centers. Alternately, Solv, a younger start-up, focuses on urgent care. Though, both platforms offer real-time appointment availability — often within 24 to 72 hours — shortening the long wait times many patients typically face. They also include features tailored to dual-eligible users: Zocdoc lets patients enter secondary insurance via intake forms, and Solv allows users to upload both insurance cards to their account.

Unmet Social Needs
Unmet social needs are widespread among dual-eligible enrollees and are another reason access to care is tricky. Factors like poverty, housing instability, limited digital literacy, language barriers, and lack of transportation frequently have led to delays or missed appointments.

While digital tools can’t eliminate all barriers, platforms like Zocdoc and Solv offer features that help some. Both platforms offer artificial intelligence assistants to support users with limited digital literacy and provide telehealth services that help reduce transportation barriers. Zocdoc further integrates with Google and Apple Maps to assist patients in navigating to in-person appointments. Zocdoc also provides multilingual support, provider filters for language and gender, and reviews to guide patients toward culturally responsive care.

Provider Shortages
Finding providers who accept both Medicare and Medicaid is especially difficult in areas experiencing provider shortages. One study found that a third of counties with the largest dual-eligible populations face significant primary care shortages—particularly in Southeastern states, where restrictive laws limit the roles of nurse practitioners and physician assistants. These gaps make timely care harder to access and leave patients with few alternatives.

While platforms like Zocdoc and Solv can’t directly fix this systemic issue, they do help patients navigate the options that are already out there. For example, in 2022, around 15% of Zocdoc bookings were made by federally funded patients, including dual-eligible enrollees, and over 85% of its providers (excluding mental health) accept Medicare or Medicaid. However, it remains unclear what percentage of these bookings were exclusive to dual-eligible enrollees. This data is not publicly available from Solv either.

Limitations
There are notable limitations to consider with these marketplaces.

First, there are few alternatives in the market, and limited evidence on how well these platforms perform. While one study suggests that booking through Zocdoc is associated with lower no-show rates, another study indicates Medicaid patients have fewer nearby appointment options than Medicare and private patients despite overall availability.

Second, because Zocdoc and Solv are primarily appointment-booking platforms, they do not provide ongoing care coordination and cannot address structural access or coverage issues. This requires legislative action from policymakers to strengthen existing programs.

Third, these platforms only seem to work if enough providers participate, but provider fees may continue to discourage involvement. Zocdoc now charges doctors between $40-140 per new appointment, a shift from their previous, controversial annual subscription fee of $3,600. While Solv does not publicly disclose its pricing, they report that fees are charged by location (rather than per user), with annual, quarterly, or monthly payment options available.

Lastly, there are still some usability issues with the platforms. For example, Zocdoc and Solv do not currently allow users to select multiple insurance providers simultaneously when filtering search results. Adding this functionality would significantly streamline the process.

Next Steps
With the dual-eligible population projected to grow by 6% annually—reaching over 15 million Americans by 2028—addressing these limitations is becoming increasingly urgent. Zocdoc appears to be moving in this direction by enhancing provider engagement through partnerships with the Department of Veterans Affairs, electronic health record systems, and practice management software companies. Solv, likewise, is broadening its reach, having partnered with the Urgent Care Association on a consumer awareness campaign.

Digital tools won’t fix a broken system—but they can make it easier to navigate. For dual-eligible enrollees, platforms like Zocdoc and Solv are helping bridge the gap between intention and access. With the right support, they could become more than just the “OpenTable for urgent care”—they could be the front door to a fairer, more connected health care system.

Research for this piece was supported by Arnold Ventures.

The post Dual-Covered and Underserved: Can the “OpenTable of Health Care” Change That? first appeared on The Incidental Economist.

Libraries are health hubs: why eliminate them?

Millions of Americans, myself included, love visiting their local public library to check out books, attend community programs, or study. Libraries are so much more than free book repositories, though. They are also some of the most important community health hubs in big cities and rural towns alike.Public libraries – particularly those in rural and small towns – have relied on federal funding since 1956 to maintain staffing and deliver health programs to communities. For the first time in nearly 70 years, the Trump administration is moving to eliminate that funding altogether. The result would be catastrophic for public libraries and the millions of Americans who rely on them to access health information, find links to health care, and take refuge during hard times.I wrote about federal funding for public libraries and the consequences of eliminating it for WBUR’s Cognoscenti earlier this week. You can read more here. The post Libraries are health hubs: why eliminate them? first appeared on The Incidental Economist.

Measuring Biopharmaceutical Innovation in the Modern Era

As the Inflation Reduction Act empowers Medicare to negotiate drug prices based in part on clinical benefit, and as the FDA more closely scrutinizes accelerated approvals, a fundamental question has become increasingly important: what exactly constitutes “innovation” in biopharma?

To date, our answers have largely focused on counting—company R&D investment, drug approvals, and patents. But such metrics can favor quantity over quality, making it harder to distinguish between transformative and incremental advances. Relying on them alone risks misallocating resources, weakening patient outcomes and healthcare sustainability, and overlooking high-value therapies.

Complementary measures of innovation aim to capture dimensions traditional metrics overlook, such as clinical effectiveness, societal benefit, and equitable access. Some emphasize broader value—including scientific spillovers, greater access, and long-term public health gains—while others highlight the gap between discovery and usable therapies.

Still, there is no unified, broadly applicable framework that integrates the full spectrum of biopharma innovation—from traditional volume-based indicators to value-oriented measures such as therapeutic effectiveness, real-world impact, and policy relevance.

To address this gap, we systematically reviewed interdisciplinary literature on innovation metrics to identify a comprehensive set that captures clinical, economic, and societal value. The resulting rubric is designed to be both rigorous and practical—providing strategic guidance for those who develop, evaluate, fund, and benefit from biopharma innovation.

A Multidimensional Innovation Rubric

Our systematic literature review identified innovation metrics in 2,350 articles across medicine, public health, economics, strategy, finance, and operations, of which 617 were relevant to biopharmaceuticals. From them, we constructed a six-dimensional rubric to comprehensively evaluate biopharmaceutical innovation from early discovery to real-world implementation:

Scientific and Technological Advances: Captures innovation and productivity using metrics such as NMEs, IND applications, and patents. Emerging indicators such as AI-enabled R&D and digital biomarkers offer forward-looking insights.Clinical Outcomes: Highlights therapeutic impact through metrics such as safety, efficacy, and patient-reported outcomes, emphasizing real-world patient benefits and delays in disease progression.Operational Efficiency: Measures efficiency in development and production using trial success rates, R&D timelines, supply chain resilience, and adaptive trial designs.Economic and Societal Impact: Evaluates economic returns and societal benefits through cost-effectiveness analyses, budget impacts, and productivity improvements.Policy and Regulatory Effectiveness: Assesses how regulatory frameworks support innovation through approval speed, breakthrough designations, and surrogate endpoint integration.Public Health and Accessibility: Examines broader health impacts, including reduced disease incidence, healthcare access improvements, and equitable geographic distribution, ensuring innovations meet widespread public health needs.

Stakeholder Perspectives: Making the Rubric Actionable

Our rubric specifically addresses five critical stakeholders in the biopharmaceutical ecosystem—pharmaceutical companies, investors, payers (including insurers and healthcare providers), patients, and policymakers. Each group shapes and benefits from innovation, requiring tailored metrics aligned with their strategic objectives and operational contexts.

Fig. 1 Adoption of Innovation Metrics by Stakeholder Groups.

Innovation Dimension and MetricsCompaniesInvestorsPayersPolicymakersPatientsScientific & Technological Advances– Scientific productivity (NMEs, patents)🔵🔵◯◯◯– Platform & delivery innovations🔵🔵◯◯Clinical Outcomes– Efficacy, safety, quality of life🔵◯🔵🔵🔵– Patient-reported outcomes◯◯🔵◯🔵Operational Efficiency– R&D efficiency (cycle time, success rates)🔵🔵◯◯– Manufacturing scalability & reliability🔵◯◯Economic & Societal Impact– Financial metrics (revenue, profits, costs)🔵🔵🔵◯– Societal productivity & healthcare savings◯◯🔵🔵Policy & Regulatory Effectiveness– Approval speed & regulatory incentives🔵◯◯🔵– Compliance & reimbursement success🔵🔵🔵🔵Public Health & Accessibility– Health impact & disease incidence◯🔵🔵🔵– Healthcare equity & geographic reach◯🔵🔵🔵

Notes: This figure illustrates current practices and opportunities across six dimensions of biopharmaceutical innovation metrics. Solid circles (🔵) indicate commonly used metrics, while open circles (◯) highlight potential metrics currently underutilized.

Figure 1 illustrates how stakeholders currently measure innovation and where gaps exist that emerging metrics could fill. Today, they strongly rely on traditional metrics like NMEs, patents, and financial indicators, which are straightforward, easily quantifiable, and historically established. However, they have lagged in adopting emerging metrics that offer nuanced insights into patient-centered outcomes, long-term societal benefits, and healthcare access. Metrics identified as “potential” emerged consistently from recent literature and stakeholder discussions, reflecting their growing recognition and practical feasibility. Key findings include:

Pharmaceutical companies primarily use scientific and operational metrics—such as NMEs, patents, and R&D efficiency—to guide investments and manage portfolios. Expanding focus to patient-reported outcomes could improve market forecasts and strategic choices. For example, a biotech firm developing an mRNA platform might seem undervalued by NME counts, but recognizing the platform’s flexibility and future potential reveals significant strategic value.Investors typically assess innovation through financial metrics (projected revenues, profitability) and technological indicators (patents, platforms). Incorporating societal productivity gains, regulatory compliance, and geographic reach can better align investments with long-term impact and reduce risk. This could lead an apparently risky investment in a potential Alzheimer’s therapy to become more attractive when considering long-term productivity gains and reduced caregiving burdens.Payers focus on clinical effectiveness and economic value (cost-effectiveness, pricing alignment) in reimbursement decisions. Including metrics like adherence rates, healthcare utilization, and operational reliability could further support coverage. The proposed rubric would formalize analyses already applied to one-time gene therapies that, despite high upfront costs, may show superior long-term value when accounting for lifetime savings, improved adherence, and fewer hospitalizations.Patients prioritize clinical outcomes—safety, efficacy, quality of life—and access. Real-world evidence, geographic availability, and timely market access help them advocate for improvements. For example, a biologic for autoimmune conditions may modestly extend life but substantially improve daily functioning. Patient-reported outcomes and adherence data capture this added value.Policymakers use public health and economic outcomes to guide resource allocation. Metrics like supply chain resilience and regulatory responsiveness improve preparedness. Incorporating these metrics into an innovation framework would formally capture the strategic and public health value of an otherwise commercially unviable antimicrobial drug.

Adopting a multidimensional framework introduces trade-offs, including added complexity, resource competition, and potential conflicts among metrics. Stakeholders must prioritize dimensions aligned with their strategic goals and regulatory contexts. For example, payers might emphasize clinical and cost-effectiveness, while pharmaceutical companies may prioritize operational efficiency and scientific productivity.

Redefining Biopharmaceutical Innovation

Next steps include piloting the framework in health technology assessment (HTA) case studies, aligning metrics to each dimension, and incorporating stakeholder input to refine usability. The goal is not to replace existing evaluation systems, but to enhance them with a multidimensional structure grounded in cross-sector evidence.

The rubric broadens how we define innovation—incorporating clinical effectiveness, patient-centered outcomes, and broader societal impact alongside traditional volume-based indicators. If policymakers and payers adopt these complementary metrics in evaluation and reimbursement frameworks, they can better align investment and R&D incentives with high-value, transformative innovation. Emphasizing long-term health outcomes, real-world effectiveness, and broader economic value would bring innovation policy closer to patient needs and societal priorities. These shifts would help ensure that innovative therapies are recognized for both their scientific and real-world impact.

The post Measuring Biopharmaceutical Innovation in the Modern Era first appeared on The Incidental Economist.

Older Americans Backing Trump Now Face Cuts to Medicaid, Services

People aged 65 and older make up a big chunk of the United States population ( 18% ) and use the most health care of any age group. Just over half of these aging Americans will need some sort of long-term services or supports in their lifetime.  Americans aged 65 and older also have the highest voter turnout amongst any age group. About 30 percent of all votes for President Trump in the 2024 presidential election came from this group. It is perplexing then, given these facts, that the Trump administration and Republicans are slashing the health care coverage, programs and services, and health care infrastructure that support this growing group.I wrote about these cuts and the expected, negative health outcomes for aging Americans in the Worcester Telegram & Gazette last weekend. You can read more here .  The post Older Americans Backing Trump Now Face Cuts to Medicaid, Services first appeared on The Incidental Economist.

A Primer on Pharmacy Benefit Managers

President Trump signed an executive order last month to lower prescription drug costs, partly taking aim at the considerable influence of pharmacy benefit managers (PBMs). Few Americans know what PBMs are.

In short, PBMs have great influence over the logistics and cashflow of the prescription drug industry, setting prices for patients and controlling their access to medicines. But what exactly do they do?

Federal law first mandated prescriptions for certain medicines in the 1950s. In response, health insurance companies added prescription drug benefits to their policies. PBMs arose to help insurers implement these new benefits.

Today, PBMs manage all components of health plans’ (payers’) prescription drug benefit. The “Big Three” – CVS Caremark, OptumRx, and Express Scripts – control 60 percent of the US market, managing about 80 percent of all prescriptions and serving nearly 300 million Americans.

To understand how PBMs operate, we can trace the flow of both prescription drugs and funds in the supply chain.

The flow of the drug is relatively straightforward: Wholesalers purchase drugs from manufacturers, who in turn sell them to pharmacies, who in turn distribute them to patients.

The flow of funds is much more convoluted. While manufacturers are selling their drugs to wholesalers, they are also negotiating with PBMs to include those drugs in health plans’ pharmacy benefits. PBMs secure rebates or discounts from drug makers in exchange for preferred placement on a health plan’s formulary, its list of preferred drugs. The more preferred the placement on the formulary (e.g., with lower cost sharing), the more likely the drug will be chosen for or by patients over other options, leading to greater use and greater profit. In exchange for managing this process, health plans pay PBMs.

Lastly, PBMs reimburse pharmacies for dispensing drugs to patients, and PBMs then bill health plans for the cost of the prescription.

There are two concerns in this process though: vertical integration and spread pricing.

Vertical integration occurs when a PBM’s parent company owns multiple parts of the drug supply chain, such as the insurer, the PBM itself, the pharmacy, etc. Some even manufacture drugs overseas.

Take CVS Health, for example. CVS Health owns Aetna (health insurer), Caremark (PBM), and CVS pharmacy (as well as specialty and mail-order pharmacies). CVS Health has, therefore, vertically integrated its entire operation.

This vertical integration contributes to the “Big Three” PBMs having less competition and more power to steer patients to their own pharmacies and insurers, leading to more profits.

In fact, the Federal Trade Commission (FTC) found that the “Big Three” reimbursed unaffiliated pharmacies at lower rates than their own pharmacies. They also marked up drugs at their own pharmacies by hundreds and thousands of percent, resulting in over $7 billion in revenue from 2017 to 2022.

Spread pricing is another challenge.

Spread pricing is a practice by which PBMs charge the health plan a certain amount for a drug but then turn around and pay the pharmacy less for the same drug. The difference is the spread, often retained (in part or in full) by the PBM as profit.

Spread pricing means that PBMs reimburse independent pharmacies less than what those pharmacies paid for the drugs from the wholesaler, resulting in a loss. Over 25,000 independent pharmacies in the US closed between 2010 and 2020 because of these losses. According to a 2024 FTC report, the top three PBMs generated about $1.5 billion in profits from spread pricing from just 51 specialty drugs from 2017 to 2022.

Ultimately, for patients, vertical integration and spread pricing mean less pharmacy access and choice for patients, alongside higher out-of-pocket costs and premiums.

In response to these concerns, both state and federal governments are increasing their regulatory authority over PBMs.

All 50 states have passed legislation to regulate PBMs. Some laws focus on protecting small pharmacies by ensuring unaffiliated pharmacies are reimbursed at the same rates as PBM-affiliated ones. Others limit patient cost-sharing or require PBMs to be licensed to operate. Additionally, 27 states require PBMs to comply with reporting and transparency requirements.

One state has gone even further: Arkansas now prohibits PBMs from operating their own retail pharmacies in the state, disrupting vertical integration.

Federally, seven PBM-focused, bipartisan, bicameral bills have been introduced this congressional cycle. They focus largely on prohibiting spread pricing, increasing transparency and reporting requirements, and changing how drug manufacturers and PBMs negotiate. Some bills also define penalties for PBMs that don’t play by the rules and give the federal government more enforcement power.

The influence of PBMs in the prescription drug supply chain has grown in recent decades, as have their profits. In response, states and the federal government have proposed or enacted laws to regulate PBMs and lower prescription drug costs for patients. What legislative approaches will regulate PBMs in a way that actually lowers costs for patients, though, is yet to be determined.

Research for this article was supported by Arnold Ventures.

The post A Primer on Pharmacy Benefit Managers first appeared on The Incidental Economist.

Making Life Easier for Patients with Alzheimer’s Disease and Their Caregivers

Oscar-winning actor Gene Hackman and his wife, Betsy, were found deceased in their New Mexico home earlier this year under seemingly suspicious circumstances. But after some investigation, we learned that their passing was simple, but tragic. Betsy died of Hantavirus and Hackman, who had advanced Alzheimer’s disease, wandered around their home for a week, unable to care for himself or call for help. Their story is harrowing, but components of their final days are not uncommon for millions of Americans with dementia and their caregivers. The Hackmans could’ve benefited from coordinated dementia care, a model of care that improves outcomes for patients and caregivers alike. Many Americans could benefit, too. Fortunately, interest in and implementation of this type of care is growing. I wrote about this last week for BU Today. You can read more here.The post Making Life Easier for Patients with Alzheimer’s Disease and Their Caregivers first appeared on The Incidental Economist.

Health Care Subscriptions: Who Benefits and Who Gets Left Behind?

With smartphones at hand, what were once considered chores have become everyday conveniences. From streaming the next HBO hit show to ordering bespoke food for your dog, nearly every facet of modern life can be customized and automated.

Why should going to the doctor be any different?

Health care subscriptions seek to answer this question – and disrupt the marketplace in the process.

By eliminating insurance hurdles and encouraging preventive care, health care subscriptions can make care more accessible for some. Yet, they often require upfront payments, digital access, or employer sponsorship, potentially excluding low-income, uninsured, or rural patients.

What Are Health Care Subscriptions?

A health care subscription can be a lot like signing up for YouTube Premium or Spotify. You pay a monthly or yearly fee for access to services like checkups, virtual visits, and discounted prescriptions. Unlike traditional insurance, health care subscriptions are offered more directly by providers, giving patients greater flexibility, fewer hidden costs, and more control over their health care decisions. These models often provide direct access to doctors without copays, deductibles, or claims paperwork.

For providers, subscriptions ensure steady revenue and reduce administrative burdens. Clinically, they allow providers more time with patients, focusing on care rather than claims billing associated with fee-for-service payment models. Patients benefit from predictable costs and streamlined access to their provider, which encourage better quality care, preventative care, and chronic disease management, while removing financial barriers for some.

More specifically, Direct Primary Care (DPC) enhances accessibility, with some providers sharing personal phone numbers for quicker responses, faster appointment scheduling, and shorter wait times. It’s especially helpful for elderly patients or those who struggle to visit the doctor regularly.

Subscription models generally operate independently of traditional insurance. While most health care subscribers in the U.S. keep their insurance to cover specialist care, hospitalizations, or emergency services, uninsured individuals may rely on subscriptions as their primary form of health care, despite the coverage gaps.

These models have gained traction in urban and suburban areas, particularly among affluent and insured individuals frustrated with long wait times in the traditional system. Marketing often targets middle- and upper-income patients, emphasizing quick access, longer appointments, and 24/7 communication.

In low- and middle-income countries, health care subscription could expand access to essential medicines by spreading pharmaceutical costs over time, pooling resources to lower drug prices, and improving distribution. While not a universal solution, they offer a scalable way to improve affordability and consistency in resource-limited settings.

What Aren’t Health Care Subscriptions?

Health care subscriptions themselves are not a replacement for traditional health plans, but rather a supplement designed to address specific needs or populations. For example, the DPC model may be most beneficial for middle-income individuals, while the Amazon One Medical subscription caters for urban professionals who prioritize convenience.

However, these models often exclude uninsured, rural, or lower-income patients due to financial and digital access barriers. These include unreliable or non-existent internet access, limited tech fluency, language barriers, and the cost of internet services. Inadequate infrastructure and a lack of affordable, culturally sensitive content further restricts access for underserved communities.

As corporations like Amazon expand into subscription-based health care, market consolidation raises concerns about pricing power, reduced competition, and long-term affordability. Because these models operate outside of insurance regulations, they may lack accountability in quality measures. Without transparency, they risk recreating the same access gaps as traditional health care, shifting control from insurers to corporations without ensuring equitable care.

Recommendations for a More Equitable Model

To ensure health care subscriptions expand access rather than reinforce disparities, companies must prioritize affordability and inclusivity. Sliding-scale pricing, income-based subsidies, or pay-as-you-go models could make memberships more accessible to low-income patients. Expanding services beyond urban centers (e.g., through mobile clinics, telehealth infrastructure in rural areas, and partnerships with community health organizations) would help ensure underserved groups aren’t left behind.

Transparency is also critical. Companies should disclose pricing structures, patient outcomes, and enrollment demographics to assess whether their models equitably improve access. Public-private collaborations, such as integrating subscription models with Medicaid or public clinics, could incorporate them into existing systems rather than creating parallel, exclusionary options.

The clear upfront pricing of health care subscriptions can empower consumers to make more informed decisions. However, without these efforts to improve accountability, transparency, and integration with public health systems, subscriptions risk reinforcing disparities rather than advancing health equity.

Health care subscriptions arose as a response to many of the challenges faced by the health care sector. They make big promises, and their surging popularity suggests that some may be able to deliver. As these models grow, we should all take care that this innovation benefits everyone and doesn’t become another pay-to-play scheme.

The post Health Care Subscriptions: Who Benefits and Who Gets Left Behind? first appeared on The Incidental Economist.

Provider Supply and Access to Primary Care

Waiting weeks or months to see a health care provider isn’t just an inconvenience; long wait times can lead to poorer health outcomes, higher mortality rates, and inefficiencies like cancellations and wasted provider time. These challenges are particularly evident in resource-constrained public health care systems like the Veterans Health Administration (VHA), where timely access to care has been a long-standing challenge.

In response, policies such as the Choice Act of 2014 and the MISSION Act of 2018 have aimed to expand care options for Veterans. Despite these efforts, access issues persist, raising critical questions about whether increasing provider supply can help reduce wait times and improve care delivery. Given the complex nature of health care access, understanding how provider availability interacts with factors like patient demand, scheduling practices, and clinician productivity is crucial for designing effective policy interventions.

New Research

Published in Health Economics, researchers at the Partnered Evidence-based Policy Resource Center (PEPReC) investigated the relationship between provider supply and access to primary care in VHA. Their investigation sheds light on how the number of available health care providers impact patients’ ability to receive timely care. By analyzing access trends across different regions, the researchers provide valuable insights into how variations in provider supply affect the overall efficiency of the health care system.

Methods

Using multiple administrative datasets (e.g., VA Corporate Data Warehouse and Area Health Resource File), PEPReC researchers combined provider data with patient access metrics across different regions. They developed a model of wait times for new patients seeking primary care at VHA medical centers.

Based on a supply and demand framework, the model was used to help assess factors that influence wait times and estimate by how much an increase in the number of providers can reduce the wait time to seeing a primary care provider.

Findings

PEPReC researchers’ findings suggest that increasing provider supply may lower wait times and improve overall patient outcomes. Specifically, they found that a 10 percent increase in the number of full-time clinical providers at a facility (i.e., clinician capacity) is associated with a 0.48-day reduction in wait times (2.1 percent of the 22.9 day average wait time for a new patient primary care appointment).

Researchers also found that increases in the number of visits that clinicians can perform per day, which may be influenced by scheduling protocols, is associated with lower wait times. Moreover, patient access to alternative health insurance options is associated with lower VHA wait times.

Conclusion

Addressing the adequacy of provider supply remains a critical step toward improving health care access. As policy efforts continue to focus on expanding health care access, strategies that bolster the primary care workforce will be essential in ensuring equitable access to care for all populations.

This investigation highlights the significant impact of provider supply on wait times, offering insights from a clinic operations perspective. Keeping wait times low and improving timely access can improve patient outcomes. Targeted policy interventions, such as incentivizing providers to practice in underserved areas and implementing evidence-based scheduling improvements, could help bridge gaps in access to care and improve health outcomes for Veterans nationwide.

The post Provider Supply and Access to Primary Care first appeared on The Incidental Economist.

Trump’s attack on public lands is an attack on public health

U.S. national parks have long been called “America’s best idea,” but the Trump administration seems to disagree, firing nearly 1,000 National Park Service (NPS) employees and planning to terminate over 34 NPS leases. Budget cuts and privatization are also back on the table.

In my recent piece for The Portland Press Herald, I explore how nature supports our health and well-being—and how these attacks on our parks threaten both.

Read the full article here.

The post Trump’s attack on public lands is an attack on public health first appeared on The Incidental Economist.