Vaccine Economics, Private Equity, And More

From the Editor-In-Chief Health AffairsVol. 44, No. 10: Vaccine Economics, Private Equity & More Vaccine Economics, Private Equity, And MoreDonald E. Metz and The Editorial Staff AffiliationsDonald E. Metz, executive editor and interim editor-in-chiefThe Editorial StaffPUBLISHED:October 2025Free Accesshttps://doi.org/10.1377/hlthaff.2025.01299AboutSectionsView PDFPermissions ShareShare onFacebookXLinked InRedditEmail ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsDownload Exhibits TOPICSVaccinesPrivate equityMedicare AdvantageMedicaidCosts and spendingHospicePaymentTraditional MedicareTreatmentPrescription drugs Our October 2025 issue features a range of topics, including vaccine economics, the role of private equity (PE) in health care, Medicare Advantage (MA), Medicaid, and more. The PE articles are part of our ongoing series, The Practice Of Medicine (Physicians Foundation) and Age-Friendly Health (John A. Hartford Foundation).Vaccine Economics Jamison Pike and coauthors analyze the medical expenditures of enrollees in Denver Health who were diagnosed with COVID-19 between April 2021 and July 2022, to determine the impact of vaccination on expenditures. The authors find that during the acute phase of hospitalization (within thirty days after diagnosis), average acute medical expenditures were $194 less for vaccinated children compared with unvaccinated children; for adults, expenditures were $1,743 less for vaccinated patients.Private Equity Alexander Philips and coauthors compare commercial prices for physicians offering cardiology and gastroenterology services in independent practice with the prices for physicians affiliated with hospitals and PE firms. The authors find higher prices among hospital- and PE-affiliated specialists and conclude that if such physicians charged prices "equivalent to those of independent practices, commercial health care spending would decrease by approximately $2.9 billion and $156 million, respectively." Alexander Soltoff and coauthors examine revenue and expense data across four models of hospice ownership: PE, publicly traded company, other for-profit, and not-for-profit. The authors find that not-for-profit hospices spend more on direct patient care, driven by differences in nursing salaries. PE-owned hospices report the highest profits and lowest spending on direct patient care and nonsalary administrative services. PE-owned hospices also report significantly greater revenues and expenses related to nursing facility room and board compared with all other ownership models.Medicare Advantage Bowen Garrett and John Holahan analyze trends in insurer concentration in the MA market during the period 2013–23. Although concentration remained high, the authors find a shift toward less concentration, which was in turn associated with lower Medicare payments and individual premiums, higher plan rebates, and less enrollee cost sharing. Grace Mackleby and coauthors explore variation in hospital prices negotiated by MA plans relative to traditional Medicare prices. Although MA prices are close to traditional Medicare prices (within 3 percent), only 39 percent of hospitals have average inpatient MA prices within 5 percent of traditional Medicare prices. Among payers, the authors find that MA prices vary from traditional Medicare prices far less than commercial or Medicaid prices do. Daria Pelech and coauthors investigate favorable selection into MA plans among Medicaid enrollees when they become eligible for Medicare. The authors find that every 1 percent increase in spending reduces the probability of enrolling in an MA plan by 2.3 percent. The effect is driven by the highest-spending people, who are 25 percent less likely to enroll in private plans than those with no medical spending.Medicaid Elizabeth Stone and coauthors evaluate the impact of Affordable Care Act (ACA) Medicaid expansion on state-level pre-exposure prophylaxis (PrEP) prescribing outcomes from the period 2012–23. They find that PrEP coverage increased over time but was not significantly associated with Medicaid expansion; there were, however, significant increases in the PrEP-to-need ratio (4.44 PrEP prescriptions per new HIV diagnosis) attributable to expansion, with the strength of effects increasing over time and across all subgroups. In an update to a 2020 Health Affairs article, Johanna Catherine Maclean and coauthors estimate the effect of ACA Medicaid expansion on specialty substance use disorder treatment episodes during the period 2010–22. They find that after expansion, treatment episodes increased 28 percent in expansion states compared with nonexpansion states.Other Topics Also in the issue, Matthew Maughan and coauthors look at differences in payments to hospital outpatient departments and ambulatory surgical centers among three major insurers; Aditi Vasan and coauthors examine the association between parents' receipt of monthly expanded Child Tax Credit payments during pregnancy and infant birth outcomes in Pennsylvania; Clara Barajas and coauthors explore how immigration-related concerns may affect decisions to apply for public benefits such as Medicaid and housing subsidies in California; Hannah Ratliff and coauthors examine registered nurse wages relative to wages for other health care occupations; Jennifer Kao and coauthors assess the impact of Food and Drug Administration risk evaluation and mitigation strategy (REMS) programs on generic drug approvals; and finally, a Narrative Matters essay by Kristine Shields explores the ethics of informed consent in Alzheimer's clinical trials. Loading Comments... Please enable JavaScript to view the comments powered by Disqus. DetailsExhibitsReferencesRelated Article Metrics History Published online 6 October 2025 Information© 2025 Project HOPE—The People-to-People Health Foundation, Inc.PDF download