Why is US health care so expensive? Some of the reasons you’ve heard turn out to be myths.

There were two areas where the United States really was quite different: We pay substantially higher prices for medical services, including hospitalization, doctors’ visits and prescription drugs. And our complex payment system causes us to spend far more on administrative costs. The United States also has a higher rate of poverty and more obesity than any of the other countries, possible contributors to lower life expectancy that may not be explained by differences in health care delivery systems.

Just because other countries use the hospital more doesn’t mean that every hospitalization in the United States is appropriate. Jonathan Skinner, a professor at Dartmouth, who has studied patterns in health care use in the United States, noted that there probably is money to be saved by eliminating some of the extra scans and operations that are much more common in the United States than elsewhere.

Alex Azar ’88 confirmed as HHS secretary

According to economics professor and professor at The Dartmouth Institute for Health Policy and Clinical Practice Jonathan Skinner, lowering the prices of drugs is necessary.

“It’s certainly true that when you give drug companies a monopoly through the patent system on particular drugs that they’ve developed and there’s a general policy that Medicare and private health insurance have to pay whatever it is that the drug companies charge,” Skinner said. “It’s not surprising that the prices they charge are very high.”

Skinner added that he believes Azar to have a firm understanding of drug pricing from his experience in the private sector and said that it will be interesting to see whether the secretary is able to bring a “stronger set of tools” to cut back on prices based on his time at Eli Lilly.

The Integrity of MACRA May Be Undermined by “Incident to Billing” Coding.

The Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 ended the Sustainable Growth Rate formula that for years had resulted in an eleventh-hour intervention by Congress to avoid drastic reductions in Medicare physician payments. MACRA also established incentives for clinician payments to become increasingly based on value with the intent of rewarding clinicians who produce better outcomes at lower costs. Efforts are underway to establish the outcomes and quality measures that will be included in the new payment systems.

How Much Should You Save for Retirement?

It's hard to plan for retirement, and one of the trickiest questions is: How much should I save?

The honest answer is: It depends. "The best-laid plans can be undone by a messy divorce, a disabling disease, or a stock market crash," Jonathan Skinner, a professor of economics at Dartmouth College, wrote in a study on the topic. Your future health-care expenses are almost impossible to predict, for example, especially as Congress considers big changes to the system.

The Puzzling Popularity of Back Surgery in Certain Regions

You might think that once drugs, devices and medical procedures are shown to be effective, they quickly become available. You might also think that those shown not to work as well as alternatives are immediately discarded.

Reasonable assumptions both, but you’d be wrong.

Instead, innovations in health care diffuse unevenly across geographic regions — not unlike the spread of a contagious disease. And even when studies show a new technology is overused, retrenchment is very slow and seemingly haphazard.

Managing new health technologies

Countries around the world are struggling with rising healthcare bills. Every introduction of pricey new biologics, surgical procedures, and exotic “precision” treatments causes ever-increasing fiscal stress, leading to deficit spending, cutbacks in other government services, and insurance costs shouldered by firms and employees alike. Yet, freezing budgetary allocations is clearly not an option, as citizens in our ageing societies are likely to demand more and better access to new health innovations, and essential healthcare services. What can be done?

Life expectancy is down for a second year. Drug overdoses are a big reason why.

The difference between the U.S. and most of the rest of the world “is very stark,” said Jonathan Skinner, a professor of economics at Dartmouth College.

Newborns in 29 countries, including Japan, Australia and Spain, had life expectancies above 80 years in 2015, according to the World Health Organization. The average global life expectancy was 71.4 and rising, according to that agency’s most recent report.  

Study finds more spending doesn’t improve heart attack patients’ outcomes

More Medicare dollars spent on treatment of a heart attack patient doesn't lead to better health outcomes, according to a new study.

A JAMA study published Wednesday found that mortality rates stayed constant for heart attack patients up to 180 days after discharge even as spending on cardiac procedures and post-acute care rose. But the study did find mortality dropped among patients who received early percutaneous coronary intervention, also known as angioplasty with a stent.

These Maps Show How Americans Are Dying Younger. It’s Not Just the Opioid Epidemic.

"Every once in a while, you get these spikes and mortality jumps up — but there’s usually something you can point to to explain why it happened," said one of the authors of that commentary, Dartmouth health economist Jonathan Skinner. "You can point to the fact that millions of Russian men lost their secure jobs in the Soviet Union."

The same isn’t true for the mortality trends in the US today, he added. "The attribution here is just much more difficult because we think we have some idea — we are pointing to opioids — but we don’t really know yet."

Dying Younger: U.S. Life Expectancy ‘a Real Problem’

If only the good die young, Americans are unfortunately getting better.

U.S. life expectancy dipped by a little more than a month last year from 2014, to 78.8 years, according to a report from the National Center for Health Statistics. It's the first decline in more than two decades. And after years of gains, U.S. life expectancy has been essentially flat for a few years, which means an inauspicious trend could be in the works.

The decline "could be a blip, but even if it’s flat, we have a real problem," said Jonathan Skinner, a professor at the Dartmouth Institute for Health Policy & Clinical Practice.