Healthcare Costs
Understand the drivers of hospital costs and explore strategies to improve efficiency and affordability.
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What Is Medicaid? A Guide to Qualifications, What It Covers, & Costs
Key Takeaways: Medicaid covers 74M+ Americans, 41% of U.S. births, and 5 in 8 nursing home residents, making it the largest health insurer in the U.S. Eligibility combines federal rules with state variation; expansion states cover adults up to 138% of the federal poverty level. Mandatory benefits include hospital care, physician services, and nursing facility care; dental, vision, and prescription...
Prescription Drug Costs: Plans, Coverage, & Other Price-Driving Factors
Key Takeaways: U.S. prescription drug spending hit $805.9 billion in 2024, with prices averaging 2.78x higher than 33 other OECD nations. High costs stem from manufacturer pricing power, patent thickets, opaque PBM rebates, and insurance cost-sharing tied to list prices. The IRA capped Medicare Part D out-of-pocket costs at $2,100 in 2026 and enabled the first round of Medicare drug price negotiat...
How Much Can Pharma Lose?
IntroductionWhenever policymakers consider approaches to reduce drug spending, the pharmaceutical industry sings a familiar refrain — any reduction in drug manufacturer revenues will cause investment to wither, depriving manufacturers of the resources needed to research and develop future treatments. The empirical validity of this argument has not, to our knowledge, been analyzed. In this analysis...
Protecting Patients from Unexpected Outpatient Facility Fees
In recent years, health care consumers, payers, and policymakers have brought attention to the growing prevalence of hospital outpatient facility fees in the United States. As hospitals and health systems expand their ownership and control of ambulatory care practices, they are typically charging new facility fees for services delivered in these outpatient settings. Consumers, too, are facing grea...
Healthcare Service Delivery for Older Adults: A Landscape of Programs and Funding
IntroductionAs the population of older adults in the United States grows, so will the challenges associated with ensuring older adults can access healthcare services. Policymakers and stakeholders must work together to ensure the nation’s healthcare service delivery system supports the evolving and complex needs of older adults and promotes healthy aging.Healthcare for older adults has historicall...
Key Challenges Women Face that Impact Their Financial Security
Planning for retirement is difficult at any age, but it can be especially challenging for women ages 50 to 64, who are often juggling work, caregiving responsibilities, and rising health expenses associated with an increase in health care needs. These years are also often women’s peak earning years, making this period a critical window to build savings and strengthen financial security. Elder Inde...
How Do Older Adults Experience the U.S. Healthcare System?
Gallup and West Health have unveiled a new, first-of-its-kind state-by-state ranking measuring how Americans experience the healthcare system, not through claims or spending totals, but through their lived experience. The new West Health-Gallup Center on Healthcare in America offers an unprecedented look at healthcare cost, access and quality across all 50 states and Washington, DC. It brings clar...
Industrial Evolution
Over the last decade, pharmacy benefit managers (PBMs) have become highly consolidated and vertically integrated, playing a central role in negotiating drug rebates on behalf of health plans. In recent years, however, PBMs have increasingly shifted this function to newly created entities known as rebate aggregators. Launched by the three largest PBMs, these aggregators now negotiate billions of do...
FAQ - Employer-Based Health Plans
More than 150 million people—close to half of all Americans—get health insurance coverage through work, either through their own employer or as a dependent. Per person, health care spending in this population rose over 20% between 2017 and 2021, driven by increasing prices for health care services. Recent HCCI data show that price growth accounted for over 50% of the change in health care spending...
Price Markups for Clinical Labs: Employer‑based Insurance Pays Hospital Outpatient Departments 3X Than Physician Offices and Independent Labs for Identical Tests
West Health in collaboration with the Health Care Cost Institute (HCCI) conducted an analysis of the high prices that employer-based insurance pays hospital outpatient departments for clinical lab tests. We found that insurers are paying 3 times more for identical tests (such as simple blood and urine tests) when billed by hospital outpatient departments compared to physician offices and independe...