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This essay examines four schools of thought about US strategy in Asia, particularly regarding China. These four viewpoints—here termed the responsible stakeholder, communist collapse, constructive cooperation, and managed competition schools—are determined largely by the answers to two questions. First, to what degree should US policies focus on integrating China into the international order, versus mitigating the consequences of China's rise? Second, should US policy makers seek a specified end state with China, or simply focus on achieving a stable steady state? Based on a detailed analysis of existing commentary, we assert that most debates about US objectives vis-à-vis China revolve around these questions. This essay concludes that US policies are likely to incorporate aspects of all four theories, which will make it difficult—if not impossible—for the United States to adopt any clear and sustained strategy across administrations. Barring a major breakthrough or breakdown in US–China relations, Washington is destined for a muddled debate on China that will make it difficult to achieve strategic consensus. And this strategic confusion on China will have substantial implications for US regional strategy more broadly. [ABSTRACT FROM AUTHOR]

The United States and South Korea are both shifting their engagement in the Indo‐Pacific, but in fundamentally different ways. In recent years, Washington has altered the format of its engagement in the region—shifting toward an increasingly minilateral approach seen in the Quad and AUKUS arrangements. On the other hand, Seoul has sought primarily to alter the focus of its engagement—shifting from a narrow focus on the Korean Peninsula toward a broader regional approach. In other words, American leaders have adjusted the format of their engagement while Korean leaders have adjusted the focus of their engagement. This has created a disconnect. As South Korea has aligned its focus to that of the United States, Seoul has expected Washington to integrate South Korea more deeply into American regional strategy. Yet, US efforts to build minilaterals have seldom included South Korea. Addressing this divide will require leaders in both capitals to adjust their approaches to both focus and format in the Indo‐Pacific. [ABSTRACT FROM AUTHOR]

In the article, the authors present their study showing a 37% increase in hospital lawsuits over unpaid medical bills in Wisconsin during 2001-2018. Also cited are the decision by the Wisconsin government not to participate in the Affordable Care Act Medicaid expansion program, and the use of data from the Wisconsin Circuit Court Access system in the study.

Applied micro-economists, health economists, and health service researchers, for the most part, want their research to have impact, to inform public policy, and, ideally, to improve the lives of the public. Particularly in health care, we believe that the changes that will lower health care costs for the public will be less "blue sky" masterpieces and more technocratic improvements that incrementally improve specific problems in the US health care system. WHAT THE BRIEFS SUGGEST ABOUT REDUCING HEALTH CARE SPENDING IN THE UNITED STATES The briefs we received from the 27 authors were also informative about which parts of the health care system seem to have the most potential to reduce US health care costs. [Extracted from the article]

In the United States, hospitals and physicians independently negotiate contracts with insurers. Therefore, a privately insured individual can be treated at an in-network hospital's emergency department but receive a large unexpected bill from an out-of-network emergency physician working at that facility. Because patients do not choose their emergency physician, emergency physicians can remain out of network and charge high prices without losing patient volume. We illustrate that this strong outside option improves physicians' bargaining power with insurers. We conclude by analyzing New York's efforts to address out-of-network billing through binding arbitration between physicians and insurers over out-of-network payments. This intervention reduced out-of-network billing by 12.8 percentage points (88%). [ABSTRACT FROM AUTHOR]

When physicians whom patients do not choose and cannot avoid can bill out of network for care delivered within in-network hospitals, it exposes patients to financial risk and undercuts the functioning of health care markets. Using data for 2015 from a large commercial insurer, we found that at in-network hospitals, 11.8 percent of anesthesiology care, 12.3 percent of care involving a pathologist, 5.6 percent of claims for radiologists, and 11.3 percent of cases involving an assistant surgeon were billed out of network. The ability to bill out of network allows these specialists to negotiate artificially high in-network rates. Out-of-network billing is more prevalent at hospitals in concentrated hospital and insurance markets and at for-profit hospitals. Our estimates show that if these specialists were not able to bill out of network, it would lower physician payments for privately insured patients by 13.4 percent and reduce health care spending for people with employer-sponsored insurance by 3.4 percent (approximately $40 billion annually). [ABSTRACT FROM AUTHOR]

Evidence suggests that growth in providers' prices drives growth in health care spending on the privately insured. However, existing work has not systematically differentiated between the growth rate of hospital prices and that of physician prices. We analyzed growth in both types of prices for inpatient and hospital-based outpatient services using actual negotiated prices paid by insurers. We found that in the period 2007-14 hospital prices grew substantially faster than physician prices. For inpatient care, hospital prices grew 42 percent, while physician prices grew 18 percent. Similarly, for hospital-based outpatient care, hospital prices grew 25 percent, while physician prices grew 6 percent. A majority of the growth in payments for inpatient and hospital-based outpatient care was driven by growth in hospital prices, not physician prices. Our work suggests that efforts to reduce health care spending should be primarily focused on addressing growth in hospital rather than physician prices. Policy makers should consider a range of options to address hospital price growth, including antitrust enforcement, administered pricing, the use of reference pricing, and incentivizing referring physicians to make more cost-efficient referrals. [ABSTRACT FROM AUTHOR]

We examined the growth in health spending on people with employer-sponsored private insurance in the period 2007-14. Our analysis relied on information from the Health Care Cost Institute data set, which includes insurance claims from Aetna, Humana, and UnitedHealthcare. In the study period private health spending per enrollee grew 16.9 percent, while growth in Medicare spending per fee-for-service beneficiary decreased 1.2 percent. There was substantial variation in private spending growth rates across hospital referral regions (HRRs): Spending in HRRs in the tenth percentile of private spending growth grew at 0.22 percent per year, while HRRs in the ninetieth percentile experienced 3.45 percent growth per year. The correlation between the growth in HRR-level private health spending and growth in fee-for-service Medicare spending in the study period was only 0.211. The low correlation across HRRs suggests that different factors may be driving the growth in spending on the two populations. [ABSTRACT FROM AUTHOR]

We use insurance claims data covering 28% of individuals with employer-sponsored health insurance in the United States to study the variation in health spending on the privately insured, examine the structure of insurer-hospital contracts, and analyze the variation in hospital prices across the nation. Health spending per privately insured beneficiary differs by a factor of three across geographic areas and has a very low correlation with Medicare spending. For the privately insured, half of the spending variation is driven by price variation across regions, and half is driven by quantity variation. Prices vary substantially across regions, across hospitals within regions, and even within hospitals. For example, even for a nearly homogeneous service such as lower-limb magnetic resonance imaging, about a fifth of the total case-level price variation occurs within a hospital in the cross section. Hospital market structure is strongly associated with price levels and contract structure. Prices at monopoly hospitals are 12% higher than those in markets with four or more rivals. Monopoly hospitals also have contracts that load more risk on insurers (e.g. they have more cases with prices set as a share of their charges). In concentrated insurer markets the opposite occurs—hospitals have lower prices and bear more financial risk. Examining the 366 mergers and acquisitions that occurred between 2007 and 2011, we find that prices increased by over 6% when the merging hospitals were geographically close (e.g. 5 miles or less apart), but not when the hospitals were geographically distant (e.g. over 25 miles apart). [ABSTRACT FROM AUTHOR]

The article present the survey on the estimated percentage of insured individuals who have difficulty in paying the medical bills in the U.S. The topics discussed include the surprise bills, from doctors who are not listed in their insurance network, as the leading cause of financial trouble for patients, two prime reasons why surprise out-of-network billing is considered problematic, and the competition among physicians to be include in the insurers' network.

It is widely claimed that secondary states across East Asia are not purely balancing or bandwagoning, but rather hedging between the United States and China by combining policies of economic and political engagement with risk management. We argue that hedging behavior should not include costless activities that do not require states to face trade-offs in their security choices. We redefine hedging as signaling that generates ambiguity over the extent of a secondary state's shared security interests with great powers. This definition returns the focus to security relationships and better accounts for the trade-off between autonomy and alignment. Based on this definition, we argue that hedging occurs in far narrower (but arguably more interesting) circumstances than is widely believed. Many Asian states have existing treaty alliances with the United States or major territorial conflicts with China, creating path dependencies that reinforce balancing behavior rather than hedging. We therefore clarify cross-national variation in state behavior and contribute to the larger research project on regional responses to China's rise. [ABSTRACT FROM AUTHOR]

Background: Older patients who undergo mitral valve surgery (MVS) have high 1-year survival rates, but little is known about the experience of survivors. Our objective was to determine trends in 1-year hospital readmission rates and length of stay (LOS) in these individuals. Methods: We included 100% of Medicare Fee-for-Service patients ≥65 years of age who underwent MVS between 1999–2010 and survived to 1 year (N = 146,877). We used proportional hazards regression to analyze the post-MVS 1-year readmission rate in each year, mean hospital LOS (after index admission), and readmission rates by subgroups (age, sex, race). Results: The 1-year survival rate among patients undergoing MVS was 81.3%. Among survivors, 49.1% experienced a hospital readmission within 1 year. The post-MVS 1-year readmission rate declined from 1999–2010 (49.5% to 46.9%, P<0.01), and mean hospital LOS decreased from 6.2 to 5.3 (P<0.01). Readmission rates were highest in oldest patients, but declined in all age subgroups (65–74: 47.4% to 44.4%; 75–84: 51.4% to 49.2%, ≥85: 56.4% to 50.0%, all P<0.01). There were declines in women and men (women: 51.7% to 50.8%, P<0.01; men: 46.9% to 43.0%, P<0.01), and in whites and patients of other race, but not in blacks (whites: 49.0% to 46.2%, P<0.01; other: 55.0% to 48.9%, P<0.01; blacks: 58.1% to 59.0%, P = 0.18). Conclusions: Among older adults surviving MVS to 1 year, slightly fewer than half experience a hospital readmission. There has been a modest decline in both the readmission rate and LOS over time, with worse outcomes in women and blacks. [ABSTRACT FROM AUTHOR]