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Hospitals, Big Pharma, Hmos & the Health Care War Economy

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Hospitals, Big Pharma, Hmos & the Health Care War Economy The Second Annual IHSP Hospital 200: Hospitals, Big Pharma, HMOs & the Health Care War Economy Version 1.1, Embargoed Until September 8, 2004 The Institute for Health & Socio-Economic Policy (IHSP) is a non-profit policy and research group. The IHSP focus is current political/economic policy analysis in health care and other industries and the constructive engagement of alternative policies with international, national, state and local bodies to enhance promote and defend the quality of life for all. The IHSP has a number of Advisory Boards comprised of analysts and policy activists with expertise in their respective industries of interest. Advisory Boards include Health Care, Alternative Technologies, Energy, Communications, etc. The Health Care Advisory Board is comprised of scholars from the Albert Einstein College of Medicine, Boston University, Harvard University, the Canadian National Federation of Nurses’ Unions, the New School in New York and the University of California. Institute for Health & Socio-Economic Policy 21 C Orinda Way #361 Orinda CA 94563 Tel: 510-267-0634 Fax: 510-267-0635 e-mail: [email protected] I. ABOUT THE INSTITUTE FOR HEALTH & SOCIO-ECONOMIC POLICY ............................ 4 II. PRINCIPAL FINDINGS.................................................................................................................. 5 III. DATA SOURCES.............................................................................................................................. 8 A. METHODOLOGY EMPLOYED IN THIS REPORT................................................................................... 8 IV. WHAT IS DRIVING HEALTH CARE COSTS? .......................................................................... 9 A. HIGH PRICE OF DRUGS AND HOSPITAL CHARGES............................................................................. 9 B. PHARMACEUTICAL MERGERS AND ACQUISITIONS ......................................................................... 10 1. Scope and Depth of Pharmaceutical Mergers and Acquisitions....................................................11 2. Pharma M & As: Research and Development (R&D) Mythology ................................................ 14 3. Prescription Drugs and the Elderly..............................................................................................20 4. Consequences of Increased Pharmaceutical Market Share.......................................................... 27 a) Hospital Drug Charge to Cost Ratios and Pharma Drug Prices................................................................. 28 C. HMOS, HOSPITALS, PHARMAS AND THE HEALTH CARE WAR ECONOMY ...................................... 29 V. MEDICARE FIXED RATE REIMBURSEMENT IS IMPACTED BY HOSPITAL GROSS CHARGES ................................................................................................................................................... 30 A. CALCULATING MEDICARE REIMBURSEMENT RATES ...................................................................... 31 B. HIGH CHARGES ARE A WARNING SIGN........................................................................................... 32 C. MEDICARE OUTLIERS, WORKER’S COMPENSATION & HMO STOP LOSS PAYMENTS ..................... 33 1. Worker’s Compensation and Outlier Payments ............................................................................ 37 VI. CHARGES MATTER: IMPLICATIONS OF GROSS HOSPITAL CHARGES – THE “STICKER PRICE”................................................................................................................................... 38 VII. IMPLICATIONS FOR HEALTH CARE REFORM: THE U.S. DOES NOT HAVE A HEALTH CARE SYSTEM........................................................................................................................ 39 A. FAILURE OF MARKET LED HEALTH CARE REFORM ....................................................................... 39 B. HOSPITALS AND THE “HEALTH CARE WAR ECONOMY” ................................................................. 40 VIII. STRIPPING AWAY THE MYTH OF A U.S. HEALTH CARE SYSTEM: A 12 STEP PROGRAM TO BEGIN RECOVERY..................................................................................................... 42 IX. TABLES........................................................................................................................................... 44 X. THE IHSP HOSPITAL 500: TOP TEN HOSPITALS BY STATE BY TOTAL CHARGE TO COST RATIO ............................................................................................................................................. 95 XI. ADDENDUM ................................................................................................................................ 129 A. BACKGROUND ON HOSPITAL CHARGES ....................................................................................... 129 B. STUDY HISTORY .......................................................................................................................... 132 C. GENERAL OBSERVATIONS ON SCIENTIFIC METHOD ..................................................................... 134 1. Replicability of findings.............................................................................................................. 135 2. Transparency of design............................................................................................................... 135 3. Open data architecture, format and structure ............................................................................ 135 4. Consistency of data format and structure across study period................................................... 135 5. Demonstrable mechanism of action, i.e., relevance between antecedent conditions and study object .................................................................................................................................................. 135 6. Integrity of data sets ................................................................................................................... 135 7. Design model must take into account both the possible confirmation and disconfirmation of principal findings/hypotheses............................................................................................................. 136 XII. REFERENCES ............................................................................................................................. 137 ©IHSP Hospital 200, 2004. Embargoed Until September 8, 2004 Page 2 TABLE 1 PHARMACEUTICAL MERGERS: 1993 THROUGH DECEMBER, 2003 ....................................................11 TABLE 2 WORLD’S TOP 50 DRUG CORPORATIONS – PROFITS, MARKET CAPITALIZATION AND SALES ........... 13 TABLE 3 LEADING 20 DRUG PRODUCTS BY U.S. SALES, MOVING ANNUAL TOTAL JUNE 2004...................... 24 TABLE 4 PERCENT OF TOTAL HEALTH CARE COSTS FOR PRESCRIPTION DRUGS SELECTED YEARS ............... 26 TABLE 5 HOSPITAL MEDICAL SUPPLY AND DRUG CHARGE TO COST RATIOS BY CONTROL TYPE – 2002/2003 (SORTED BY DRUG CHARGE TO COST RATIOS) ...................................................................................... 27 TABLE 6 TOP 50 HMO PROFITS INCREASE – 2000 TO 2003 ........................................................................... 29 TABLE 7 CMS OUTLIER THRESHOLDS, 1997 THROUGH 2005 (SOURCE: FEDERAL REGISTER, 2003)............. 35 TABLE 8 HEALTH CARE RELATED CORPORATIONS – SELECTED VALUES ....................................................... 39 TABLE 9 THE NATION’S HOSPITALS WITH THE HIGHEST CHARGES COMPARED TO COSTS: FISCAL YEAR 2002/2003............................................................................................................................................. 44 TABLE 10 THE NATION’S HOSPITALS WITH THE LOWEST CHARGES COMPARED TO COSTS: FISCAL YEAR 2002/2003............................................................................................................................................. 60 TABLE 11 STATE LOCATION OF THE TOP 100 HOSPITALS, 2002/2003............................................................. 64 TABLE 12 SYSTEM AFFILIATION OF THE TOP 100: 2002/2003........................................................................ 65 TABLE 13 SYSTEM AFFILIATION OF THE LOWEST 100: 2002/2003................................................................. 66 TABLE 14 HOSPITAL AVERAGE PROFITS BY DECILE OF TOTAL CHARGE TO COST RATIOS: 2002/2003........... 67 TABLE 15 AVERAGE HOSPITAL PROFITS BY AVERAGE CHARGE PER INDIVIDUAL INPATIENT DISCHARGE: 2002/2003............................................................................................................................................. 68 TABLE 16 AVERAGE TOTAL CHARGE TO COST RATIO OF THE TOP 100 HOSPITALS BY STATE: 2002/2003 ...... 69 TABLE 17 AVERAGE TOTAL CHARGE TO COST RATIOS BY HOSPITAL SYSTEM, SORTED BY AVERAGE CHARGE TO COST RATIO, FISCAL YEAR 2002/2003............................................................................................. 74 TABLE 18 AVERAGE CHARGE TO COST RATIO, BEDS, PROFITS AND CHARGE PER DISCHARGE BY HOSPITAL BED DECILES, 2002/2003...................................................................................................................... 85 TABLE 19 AVERAGE TOTAL CHARGE TO COST RATIO BY HOSPITAL CONTROL TYPE: 2002/2003................... 86 TABLE 20 AVERAGE TOTAL CHARGE TO COST RATIO BY STATE: 2002/2003.................................................. 87 TABLE 21 TOP 40 HOSPITALS: TOTAL OPERATING ROOM CHARGES AS A PERCENT OF TOTAL OPERATING
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