When is the last time you took a good, hard look at your health insurance options? Do you know what changes were made to your plan last year?

If the answer is “no,” you are not alone.

According to a new study by Maria Polyakova, assistant professor of health research and policy and Stanford Health Policy core faculty member, most Medicare Part D enrollees do not change their plans from year to year — even though plans can change drastically.

The study, recently published in the American Economic Journal: Applied, asserts that nudging consumers to re-evaluate their coverage could save them around $500 per year in out of pocket spending and premiums.

What is Medicare Part D?

Implemented in 2006, Part D allows Medicare users to purchase prescription drug coverage. Plans are administered by private insurance companies, but are heavily subsidized and regulated by the federal government. Consumers choose from more than 30 plans in their home state and are able to switch during a yearly open-enrollment period.

About 40 million people in the United States are enrolled in a Part D plan.

But Polyakova finds that “people do not seem to be switching contracts very often. At the same time, the contracts are changing quite dramatically every year.”

Though the study does not examine why consumers failed to switch, the data suggests that changing plans can be costly. Not necessarily a financial cost, but likely one of time or energy.

Thoroughly examining more than 30 plans on a yearly basis can be a burden, and changes are not always easy to detect.

“There are many other features of Part D plans that may change, so even if premiums appear the same, insurers may have changed other parts of coverage, such as deductible levels, co-pays and co-insurance, as well as which drugs are included,” said Polyakova.

Because the Part D market as a whole is dynamic, consumers can lose money even when their plan is stable.

“Even if your specific plan doesn’t change much, it is possible that it is not the best plan anymore because other plans change.”

Consumers tend to stick with the plan they picked when they first signed up. As a result, the study observes that individuals with similar needs may find themselves enrolled in very different plans if they made their first enrollment choices in different years.

This suggests that while most people likely try to pick the best coverage initially, they do not tend to re-evaluate their coverage each year in a way that fits their needs.

How can we improve coverage choices?

Polyakova believes that if the U.S. government were to more actively remind people to re-examine their plans during open enrollment, they could save consumers 20 to 30 percent.

Some researchers worry that improving individual choices and encouraging consumers to update their coverage could negatively affect the insurance market through “adverse selection.”

For example, individuals who are fairly healthy might tend to choose less generous plans than those who are relatively sick. If all those in poorer health end up in one plan, and there are no relatively low-spending enrollees to counteract the risk, the generous plan can become unsustainable.

However, the study finds evidence suggesting that for Part D, reminders to re-examine plans are unlikely to cause issues from adverse selection.

The federal government has implemented risk adjustment policies, or ways to combat the negative effects of adverse selection, that work to keep the market from unraveling. The government provides higher subsidies for sicker patients, pays the majority of patient costs and caps insurers’ profits and losses.

“From the point of view of the government, it seems that it is worthwhile to remind people who are already enrolled to reconsider their choices and potentially explain the differences across plans,” said Polyakova.

As the Affordable Care Act (ACA) changes coverage for Part D plans, reminding enrollees to re-examine their choices will become even more important. The ACA will substantially increase coverage, and plans could change considerably as a result.

What does this mean for the health insurance market?

While the study focuses specifically on Medicare Part D, Polyakova believes these findings likely translate to other areas of health insurance, particularly coverage under the ACA, which has many similar policies.

“The idea that we should remind consumers to re-evaluate plans has already been quite influential in the ACA policy debate,” said Polyakova. “Policymakers are tracking whether consumers are switching plans from one year to the next.”

She argues that in a consumer-driven economy, people must be able to easily make choices between products, in this case health insurance plans, for the market to function. But because choosing takes so much time and plan features are not always transparent, the forces driving the market may become weak.

Educating people about the financial benefits of switching plans could help the insurance market get back on track.

“People should try to reconsider their health risk and their insurance choices during every enrollment period,” Polyakova said. “Because if they don’t, it could have serious financial implications.”

It’s always great to see the work of one of our researchers shouted out in the New York Times. It’s even better when it becomes the scientific basis of an argument thrown into the mix of a presidential campaign.

Nicholas Kristof asserted in his column on Sunday that when women are involved in the political process and given the capacity to shape public policy, everyone benefits, particularly when it comes to health.

Kristof, who covers human rights, women’s rights, health and global affairs for the Times, wrote in his column:

Put aside your feelings about Hillary Clinton: I understand that many Americans distrust her and would welcome a woman in the White House if it were someone else. But whatever one thinks of Clinton, her nomination is a milestone, and a lesson of history is that when women advance, humanity advances.

Grant Miller of Stanford University found that when states, one by one, gave women the right to vote at the local level in the 19th and early 20th centuries, politicians scrambled to find favor with female voters and allocated more funds to public health and child health. The upshot was that child mortality rates dropped sharply and 20,000 children’s lives were saved each year.

Many of those whose lives were saved were boys. Today, some are still alive, elderly men perhaps disgruntled by the cavalcade of women at the podium in Philadelphia. But they should remember that when women gained power at the voting booth, they used it to benefit boys as well as girls.

Miller, an associate professor of medicine and core faculty member of Stanford Health Policy, first wrote about this issue in the Quarterly Journal of Economics in 2008, arguing that women’s choices appear to emphasize child welfare more than those of men.

He presented evidence on how state-to-state suffrage rights for U.S. women from 1869 to the adoption of the 19th Amendment in 1920, which gave all women the right to vote, helped children benefit from scientific breakthroughs.

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Simple hygienic practices — including hand and food washing, boiling water and milk, refrigerating meat and the renewed emphasis on breastfeeding — were among the most important innovations in the 19th and early 20th centuries to help protect children from often-fatal diseases such typhoid fever, smallpox, measles and scarlet fever.

“Communicating their importance to the American public required large-scale door-to-door hygiene campaigns, which women championed at first through voluntary organizations and then through government,” explained Miller, who is also a senior fellow at the Freeman Spogli Institute for International Studies and the Stanford Institute for Economic Policy Research.

As women became more and more involved in state and federal politics, Miller found, child mortality declined by 8 to 15 percent, or 20,000 fewer child deaths each year.

“Public health historians clearly link the success of hygiene campaigns to the rising influence of women,” Miller wrote, citing examples with data and graphs.

That women have been — and can be — so influential seems like a no-brainer, but it’s nice to have the science to back it up.

A key concern weighing heavily on those attending this week’s global conference on AIDS is the diminishing donor support to fight the communicable disease, which has claimed an estimated 35 million lives since the beginning of the epidemic.

“That’s on everybody’s mind now — how to continue facing the epidemic with the shrinking resources,” said Eran Bendavid, a core faculty member at Stanford Health Policy and assistant professor at Stanford Medicine attending the conference in Durban, South Africa.

Donor government funding to support HIV efforts in low- and middle-income countries fell for the first time in 2015, decreasing from $8.6 billion in 2014 to $7.5 billion last year, according to a new report by the Kaiser Family Foundation and UNAIDS.

Funding for HIV treatment declined for 13 of 14 major donor governments, with the U.S. continuing to provide more donor funding for HIV than any other country or organization.

“There’s a sense of panic about how we’re going to fill the shortfall in funding,” Bendavid said. “All the major donors are here, PEPFAR, the Global Fund, and everyone is saying `We need more to continue the fight.’

“But, in my mind,” Bendavid continued, “the conversation that is mostly missing is the one between the organizations on the front lines and the national ministries of health and finance. See what they can do to get domestic resources to fill the gap.”

PEPFAR — the President’s Emergency Plan for AIDS Release — is the U.S. government initiative to help those suffering from HIV/AIDS.

Bendavid, an infectious disease physician, joins 18,000 global leaders, researchers, activists and front-line health workers attending the conference July 18-22.

The U.N. General Assembly last month pledged to end the AIDS epidemic by 2030. But more than half of the nearly 37 million people around the world infected with HIV still have no access to the antiretroviral therapy that is saving so many lives.

U.S. Secretary-General Ban Ki-moon said on the opening day of AIDS2016 that when the conference was last held in Durban 16 years ago, less than 1 percent of all people living with HIV in developing countries had access to treatment.

“Today, the world has proven that when we come together, we can transform lives,” Ban said, noting that of the 36.7 million people living with HIV today, about 46 percent of infected adults have access to antiretroviral treatment.

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“In addition, medicines are more effective and less toxic, technology allows diagnosis in 20 minutes or less, generic medicines reduced the cost of treatment to just a dollar a day and great international finance has been made available,” Ban said.

Still, the secretary-general warned, “the gains are inadequate — and fragile,” when you consider that more than half of all people living with HIV still lack access to treatment.

Bendavid, who spoke by telephone from Durban, gave a symposium at the conference on Tuesday that summarizes his research and provides his conclusions on the most effective approaches to use donor resources.

He said the while the global burden of noncommunicable diseases, such as heart disease and cancer, is greater than HIV, malaria, or TB, the interventions available to combat infectious diseases are more cost-effective. 

“Basically, the resource constraints are forcing us to think carefully about what to invest in, and we want to invest in what works,” Bendavid said, adding that donor funding typically goes straight to the disease rather than the local health system infrastructure.

“The scarce donor resources should not be directed towards interventions that are either inefficacious or costly,” he argued. “The opportunity cost of investing in costly or ineffective interventions is very high when you consider the millions who could benefit from inexpensive, simple interventions such as bed nets and drugs for TB.”

He conceded that he typically gets push back on this line of reasoning.

“But when you’re talking about what you can do with very limited resources, investing in noncommunicable diseases, in my mind, jeopardizes the premise of donor funding: There are many people who would be happy to shut down PEPFAR and the Global Fund if they were shown to be ineffective.”

He published a paper earlier this year that found the U.S. government has invested $1.4 billion in HIV prevention programs that promote sexual abstinence and marital fidelity. But there is no evidence that the programs have been effective at changing sexual behavior and reducing HIV Risk.

Bendavid said his presentation at the symposium was received with a mix of understanding and concern.

“People mentioned that funding health systems could have averted Ebola, and that the fight against HIV needs to address health systems,” he said. “I agree, but also think governments should step up and help fill some of those gaps.”

The Asia Health Policy Program at Stanford’s Shorenstein Asia-Pacific Research Center, in collaboration with scholars from Stanford Health Policy's Center on Demography and Economics of Health and Aging, the Stanford Institute for Economic Policy Research, and the Next World Program, is soliciting papers for the third annual workshop on the economics of ageing titled Financing Longevity: The Economics of Pensions, Health Insurance, Long-term Care and Disability Insurance held at Stanford from April 24-25, 2017, and for a related special issue of the Journal of the Economics of Ageing.

The triumph of longevity can pose a challenge to the fiscal integrity of public and private pension systems and other social support programs disproportionately used by older adults. High-income countries offer lessons – frequently cautionary tales – for low- and middle-income countries about how to design social protection programs to be sustainable in the face of population ageing. Technological change and income inequality interact with population ageing to threaten the sustainability and perceived fairness of conventional financing for many social programs. Promoting longer working lives and savings for retirement are obvious policy priorities; but in many cases the fiscal challenges are even more acute for other social programs, such as insurance systems for medical care, long-term care, and disability. Reform of entitlement programs is also often politically difficult, further highlighting how important it is for developing countries putting in place comprehensive social security systems to take account of the macroeconomic implications of population ageing.

The objective of the workshop is to explore the economics of ageing from the perspective of sustainable financing for longer lives. The workshop will bring together researchers to present recent empirical and theoretical research on the economics of ageing with special (yet not exclusive) foci on the following topics:

• Public and private roles in savings and retirement security
• Living and working in an Age of Longevity: Lessons for Finance
• Defined benefit, defined contribution, and innovations in design of pension programs
• Intergenerational and equity implications of different financing mechanisms for pensions and social insurance
• The impact of population aging on health insurance financing
• Economic incentives of long-term care insurance and disability insurance systems
• Precautionary savings and social protection system generosity
• Elderly cognitive function and financial planning
• Evaluation of policies aimed at increasing health and productivity of older adults
• Population ageing and financing economic growth
• Tax policies’ implications for capital deepening and investment in human capital
• The relationship between population age structure and capital market returns
• Evidence on policies designed to address disparities – gender, ethnic/racial, inter-regional, urban/rural – in old-age support
• The political economy of reforming pension systems as well as health, long-term care and disability insurance programs

Submission for the workshop

Interested authors are invited to submit a 1-page abstract by Sept. 30, 2016, to Karen Eggleston at karene@stanford.edu. The authors of accepted abstracts will be notified by Oct. 15, 2016, and completed draft papers will be expected by April 1, 2017.

Economy-class travel and accommodation costs for one author of each accepted paper will be covered by the organizers.

Invited authors are expected to submit their paper to the Journal of the Economics of Ageing. A selection of these papers will (assuming successful completion of the review process) be published in a special issue.

Submission to the special issue

Authors (also those interested who are not attending the workshop) are invited to submit papers for the special issue in the Journal of the Economics of Ageing by Aug. 1, 2017. Submissions should be made online. Please select article type “SI Financing Longevity.”

About the Next World Program

The Next World Program is a joint initiative of Harvard University’s Program on the Global Demography of Aging, the WDA Forum, Stanford’s Asia Health Policy Program, and Fudan University’s Working Group on Comparative Ageing Societies. These institutions organize an annual workshop and a special issue in the Journal of the Economics of Ageing on an important economic theme related to ageing societies.

More information can be found in the PDF below.

Studying the microorganisms that live in our gut is a relatively new field, one that has only really taken off in the last decade. In fact, it is estimated that half of the microbes that live in and around our GI track have yet to be discovered.

“This means there is a huge amount of this dark matter within us,” said Ami S. Bhatt, an assistant professor of medicine and genetics who runs the Bhatt Lab at the Stanford School of Medicine. The lab is devoted to exploiting disease vulnerabilities by cataloguing the human microbiome, the trillions of microbes living in and on our bodies.

“I think if we fast-forward to the impact of some these findings in 10 years, we’re going to learn that modifying the microbiota is a potent way to modulate health,” Bhatt said. “Humans are not only made up of human cells, but are a complex mixture of human cells and the microbes that live within us and among us — and these microorganisms are as critical to our well-being as we are to theirs.”

Bhatt, along with key collaborators at the University of Witwatersrand in Johannesburg, and the INDEPTH research consortium, now intends to take this research to Africa.

She is this year’s winner of the of the Rosenkranz Prize for Health Care Research in Developing Countries, awarded by Stanford Health Policy to promising young Stanford researchers who are investigating ways to improve health care in developing countries.

The $100,000 prize is targeted at Stanford’s emerging researchers who are dedicated to improving health care in poorer parts of the world, but may lack the financial resources.

Bhatt, MD, PhD, intends to take the prize money to execute the first multi-country microbiome research project focused on non-communicable disease risk in Africa. The project intends to explore the relationship between the gut microbiome composition and body mass index (BMI) in patients who are either severely malnourished or obese.

“As a rapidly developing continent with extremes of resource access, Africa is simultaneously faced with challenges relating to the extremes of metabolic status,” Bhatt wrote in her Rosenkranz project proposal. The Bay Area native, who is also the director of global oncology at Stanford, came to the School of Medicine in 2014 to focus on how changes in the microbiome are associated with cancer.

In this new project, Bhatt and members of her lab will team up with colleagues in Africa, first in South Africa, and then in Ghana, Burkina Faso, and Kenya. They will leverage the infrastructure already in place at the INDEPTH Network of researchers, using an existing cohort of 12,000 patients at within those four countries. The patients have already consented to be involved in DNA testing and have given blood and urine specimens.

Identifying alterations of the microbiome that are associated with severe malnutrition or obesity could pave the way for interventions that may mitigate the severity or prevalence of these disorders, Bhatt said.

“These organisms are critical to our health in that they are in a delicate balance with one another and their human hosts,” she said. “Alterations in the microbiome are associated with various diseases — but have mostly been studied in Western populations. Unfortunately, little is known about the generalizability of these findings to low- and middle-income countries – where most of the world’s population lives.”

Bhatt said that as Africa rapidly continues to develop, the continent is simultaneous faced with challenges relating to extreme weight gain and loss. While the wealthy are facing obesity and its associated disease such as stroke, heart failure and diabetes, many people are still faced with issues related to food insecurity, hunger and malnutrition.

The research, she hopes, could lead to aggressive behavioral, dietary and lifestyle modifications targeted at maintaining healthy BMI in at-risk individuals.

Video by Ankur Bhatt

Grant Miller, an associate professor of medicine and core faculty member at Stanford Health Policy who chaired the Rosenkranz Prize committee this year, believes Bhatt’s research could eventually break new ground.

“The entire Rosenkranz Prize selection committee was highly impressed with Ami and the innovation of her project,” Miller said. “Ami’s work on the human microbiome in the extremes of nutritional status in developing countries — including its potential link to obesity, an emerging challenge in low income countries — is potentially path-breaking.”

The award’s namesake, George Rosenkranz, first synthesized cortisone in 1951, and later progestin, the active ingredient in oral birth control pills. He went on to establish the Mexican National Institute for Genomic Medicine, and his family created the Rosenkranz Prize in 2009.

The award embodies Dr. Rosenkranz’s belief that young scientists hold the curiosity and drive necessary to find alternative solutions to longstanding health-care dilemmas.