JAMA Health Forum最新文献

Importance: Health care spending in South Korea (hereafter Korea) nearly doubled from 2010 to 2019. However, little is known about the drivers and effectiveness of these spending increases in terms of changes in disability-adjusted life-years (DALYs).

Objectives: To evaluate the factors contributing to changes in health care spending and DALYs and estimate the value of health care spending from 2010 to 2019 in Korea.

Design, setting, and participants: This cross-sectional study of the population of Korea used 2010 and 2019 data from the National Health Insurance Service for health care spending, and from the Global Burden of Disease 2019 for DALYs. Changes from 2010 to 2019 were decomposed into changes in several factors, including population size, aging, and per-person measures of spending or DALYs. Data analyses were performed from April 2023 to June 2024.

Main outcomes and measures: Health care spending was calculated as the total expenditure on medical and long-term care, and health gains were measured as DALYs averted. The value of health care spending was estimated as the ratio of changes in spending per person to changes in DALYs per person.

Results: Total health care spending in Korea increased from $55.0 billion in 2010 to $92.0 billion in 2019. Increases in spending per person accounted for 52.9% of the increase, followed by population aging and population size (35.6% and 11.4%). Total DALYs increased from 11.4 million to 12.2 million. Population aging accounted for 269.4% of the increase, followed by population growth (64.0%). However, DALYs per person decreased (-233.4%), reflecting a lower per capita health burden given the country's age structure. Assuming 50% and 80% of these health improvements could be attributed to health care spending, the estimated spending per DALY averted was $20 678 and $12 924, respectively. The estimate was slightly larger when excluding DALYs not directly impacted by medical care ($23 687). Korea's spending per DALY averted is at the lower range of estimates and comparable to that of other high-income countries.

Conclusions and relevance: This cross-sectional study indicates that increased spending per person, which accounted for half of the total health care spending increase, was associated with improved overall health, evidenced by substantially fewer DALYs. These findings contribute to understanding and evaluating the value of health care spending in Korea.

Importance: Although Medicare Advantage plans frequently offer dental benefits, enrollees report lower rates of dental care use and higher rates of unmet dental need compared with individuals with employer-sponsored benefits. It is unknown which attributes of Medicare Advantage dental plans are associated with enhanced dental care access.

Objective: To determine attributes of Medicare Advantage dental plans associated with higher rates of dental care use and lower rates of unmet dental need.

Design, setting, and participants: This cross-sectional study included respondents from the 2019 Medicare Current Beneficiary Survey whose Medicare Advantage plan identifiers were linked to 2019 Medicare Advantage dental plan data from the Centers for Medicare & Medicaid Services. Respondents enrolled in a Medicare Advantage dental plan for all 12 months in 2019. Data analysis was performed between May and August 2024.

Exposures: Medicare Advantage plans offering dental benefits.

Main outcomes and measures: Main outcomes were unmet dental need in the past year, unmet dental need due to cost in the past year, and whether the respondent visited a dentist in the past year. Outcomes were measured in a survey of individuals ages 65 years and older.

Results: In a sample including up to 1789 enrollees (mean [SD] age, 74.7 [7.4] years; 58.4% female; and 13.2% lived in a rural county), enrollees in Medicare Advantage HMO plans were 7.0 percentage points (95% CI, 3.2 to 10.9 percentage points) more likely to report unmet dental need and 4.4 percentage points (95% CI, 0.9 to 7.8 percentage points) more likely to report an unmet dental need due to cost. Prior authorization was associated with an increase of 4.5 percentage points (95% CI, 0.3 to 8.7 percentage points) in unmet dental need. Relative to plans that imposed no out-of-pocket costs on comprehensive services, plans that covered only preventive services were associated with an increase of 12.1 percentage points (95% CI, 3.2 to 21.0 percentage points) in unmet dental need and an increase of 7.8 percentage points (95% CI, 0.6 to 15.0 percentage points) in unmet dental need due to cost. Relative to plans with up to a $500 annual plan maximum, benefits with no annual plan maximum were associated with a decrease of -12.4 percentage points (95% CI, -20.9 to -3.8 percentage points) in unmet dental need.

Conclusions and relevance: This study found that restrictive characteristics of Medicare Advantage dental plans are associated with greater unmet dental need and financial barriers to care. Results of this study suggest that increasing annual plan maximums or eliminating them entirely from benefit plans could decrease unmet dental need and increase dental care utilization.

Importance: Few studies have examined the extent to which employers emphasize financial over nonfinancial criteria in measurement, reporting, and decision-making about health care benefits.

Objective: To measure and identify factors associated with financial over nonfinancial emphasis in employer decision-making about health benefits.

Design, setting, and participants: A survey was administered to a nationally representative sample of US employers to assess the extent of employers' emphasis on benefits plans' costs over member experience, access to care, and equity, and on financial vs other considerations when choosing third-party benefits administrators. The sample included in-company human resources administrators from randomly selected nongovernmental organizations with at least 50 employees. The survey was administered in 2 waves: May 2022 to July 2022 and November 2022 to April 2023.

Exposure: The survey included 41 multipart questions capturing information about the respondent, company, company interactions with benefits consulting firms and benefits administrators, and company approach to managing employee health benefits.

Main outcomes and measures: Main outcomes were proportion of financially oriented measures that internal benefits administrators and external benefits consultants use and importance of financial vs other factors in companies' choice of third-party administrators.

Results: Of 1159 companies sampled, 251 (22%) responded; 30 with less than 50 employees were excluded. Of the 221 remaining companies, 147 (67%) used a benefits consulting firm. The companies and their benefits consultants focused on financial over nonfinancial performance dimensions in decision-making. While 125 companies (74%) tracked trends in health benefits costs and 109 (64%) tracked spending on the highest cost cases, only 14 (8%) tracked time employees spent having questions answered, and 12 (7%) tracked how often employees delayed receiving care because of an insurance company's actions. This financial focus was largely independent of organizational characteristics and other potential explanatory factors. Of 37 paired differences comparisons in the proportion of financial vs nonfinancial items, only 6 proportions (16%) differed significantly, with differences in proportions of 0.22 or less.

Conclusions and relevance: In this survey study, US employers emphasized financial over nonfinancial criteria in their measurement and decision-making about health benefits. To improve health plan performance, employer measurement and decision-making must emphasize both nonfinancial and financial criteria.