Experts Pick this Year's Scariest Health Policy Studies

Research Corner
October 31, 2023

Soleil Shah, MD, MSc, Research Reporter

Soleil Shah writes Tradeoffs’ Research Corner, a weekly newsletter bringing you original analysis, interviews with leading researchers and more to help you stay on top of the latest health policy research.

Happy Halloween! In this season of zombies and ghosts on every doorstep, it seems like a good time to take a look at some of the issues keeping health policy researchers up at night. So, for this week’s Research Corner we asked our Advisory Board members to pick the research findings that gave them the biggest fright this year. I learned a lot from the articles they shared, and I hope you will too.

Experts Pick this Year’s Scariest Health Policy Studies

Stacie Dusetzina
Professor of Health Policy, Vanderbilt University School of Medicine

One of the most disconcerting studies I’ve seen focused on the spread of health misinformation and disinformation on social media. This statistic from the abstract says it all: “More than two-thirds of participants reported that they were unable to assess social media information as true or false.” Many of us rely on the internet for health information and the presence of so much misinformation or disinformation could result in people not getting needed care or getting unnecessary or harmful care. 

The study underscores the importance of finding effective solutions for reducing the amount of bad information out there — or at least better equipping people to spot and disregard it. Reviews in PNAS and in Health Affairs of some of the solutions being tested offer at least a ray of hope in this otherwise dark and scary social media landscape.

Ateev Mehrotra
Professor of Health Care Policy, Harvard Medical School

I was both surprised and concerned by this Health Affairs article authored by Chris Whaley, Sebahattin Demirkan and Ge Bai. It showed that the financial health of many large nonprofit health systems is driven not by the money they make delivering patient care but rather the performance of their investment portfolios. 

The authors examined the financial data of 10 large nonprofit health systems and found their average overall profit margin fell from 9% in 2021 to -6% in 2022. During that time, the systems’ revenues from patient care actually bumped up a tick, but their revenues from financial investments tanked by 185%.

Hospitals, in theory, could end up raising prices to offset these investment losses. That prospect, the authors note, raises an important question: Should patients, employers and insurers be forced to pay the price for the financial risks that these nonprofit hospitals take?

Dan Polsky
Bloomberg Distinguished Professor of Health Economics, Johns Hopkins University

This NBER working paper by Eilidh Geddes and Molly Schnell should frighten anyone who cares about improving access to health care in the U.S. It shows that one of the most tried and true methods for getting more people connected to care — giving them affordable health insurance — can actually worsen disparities in access.

The authors looked at how growth in new retail clinics, like those located in grocery and drug stores, and urgent care centers changed after the passage of the Affordable Care Act. The ACA increased the share of people covered by public insurance (through Medicaid expansion) as well as by private insurance (through the marketplaces). Basic principles of economics would have predicted that in areas where more patients gain insurance and can newly afford access to care, we should also see more clinics enter those markets to meet that increased demand for services.

This paper shows that relationship holds true, but only for people with private insurance. Areas that saw big growth in private coverage rates following the ACA also saw a major influx in new retail clinics. But areas with big bumps in Medicaid coverage actually saw the opposite effect — a significant share of clinics left the area. The authors attribute these results to Medicaid’s lower payments to providers, finding that the areas where those payments are lowest, lost the most clinics.

As long as there is more money to be made by caring for those with private insurance (compared to Medicaid), even the most ambitious health equity initiatives will struggle to gain ground.

Three Other Studies You Might Have Missed…

  • In San Francisco from 2011 to 2018, the rate of sudden death from heart arrhythmias was over seven times higher for people who were homeless compared to those who had a place to live. (JAMA Internal Medicine)

  • People who were pregnant in the Washington D.C. metro area during the “Beltway sniper” attacks of 2002 — a series of random shootings in the area — were 25% more likely to have babies born very premature or with low birthweight, compared to similar people who weren’t exposed to that threat. (National Bureau of Economic Research)

  • A randomized trial highlights the limits of tax credits as a tool for improving people’s financial, physical and mental health. Giving single childless adults more generous tax credits over 3 years had small but positive effects on the well-being of women in particular in one city (New York) but had no positive impact on people in the other trial site (Atlanta) — and even seemed to worsen people’s mental health there. (Milbank Quarterly)