How To Bend The Cost Curve In Health Care

Whatever money is saved through short-term restraint will be lost in panicked spending down the road. That's been the lesson of the past 20 years. The challenge is to bend the cost curve permanently while making the system perform better. What health value do we achieve for what we spend? Improving value for money will require governments, organizations and practitioners to leave their comfort zone of conventional practice.

Through Canadian and international perspectives, Bending the Cost Curve in Health Care explores the management of growing health costs in an extraordinarily complex arena. The book moves beyond previous debates, agreeing that while efficiencies and better value for money may yet be found, more fundamental reforms to the management and delivery of health services are essential prerequisites to bending the cost curve in the long run. While there is considerable controversy over direction and details of change, there also remains the challenge of getting agreement on the values or principles that would guide the reshaping of the policies, the structures, and the regulatory environment of health care in Canada. Leading experts from around the world representing a range of disciplines and professional backgrounds come together to organize and define the problems faced by policy-makers. Case studies from the United States, the United Kingdom, Australia, the Nordic countries, and industrialized Asian countries such as Taiwan offer useful reform experiences for provincial governments in Canada. Finally, common Canadian cost factors, such as pharmaceuticals and technology, and paying the health workforce, are explored. This book is the first volume in The Johnson-Shoyama Series on Public Policy, published by the University of Toronto Press in association with the Johnson-Shoyama Graduate School of Public Policy, an interdisciplinary centre for research, teaching, and executive training with campuses at the Universities of Regina and Saskatchewan.

Finance/Accounting/Economics

In this short book R.W. Murphy makes the argument that the US healthcare delivery system is irreparably broken as the result of a perfectly inelastic demand curve for healthcare goods and services. In essence, he indicates that Americans will buy the same number of units regardless of price and that is destroying the system. He points to all the retail level cost control initiatives to date as failing to address wholesale pricing pressures. His premise is that underlying wholesale cost increases have hardly been affected at all. Any cost reductions at the retail level resulting from tough utilization management have been no more than temporary "stair step" efforts that get quickly absorbed. He offers both historical perspective and going-forward options for structural change. He refers to the need to make the demand curve more price responsive as an "American Healthcare Imperative" because the inevitable alternative is serious damage to American society in its absence. He indicates that failing to act is no longer an option. R.W. Murphy has been involved in healthcare cost control since 1980. He started his career as a home office underwriter for a major US healthcare insurance company. In 1990 he became a consultant for an international firm and in 1995 formed his owned consulting company. He has been involved in virtually every cost control initiative in the last forty years - and by his own admission, has the scars to prove it. The book has been made deliberately short. It can be read in less than an hour. The author indicates that his intent has been to make Americans think about the necessity for structural change - not give them an actual road map for it. As such, he remains relatively nonpartisan regarding the options. He also is clear that he has spent less time in doing statistical research then using his professional experience to show relationships. He tells the reader to not be caught up in absolute numbers but to instead examine the historical and projected trends.The Introduction has been written under an alias by a professional healthcare administrator in West Palm Beach, Florida. By remaining anonymous, he offers candid opinions with which peer administrators might not agree. His comments come from perspective gained via vast experience on the provider side of the industry. In addition, his politics are significantly right of the author's. As such, his views provide germane counterpoint.As more a red-flag then a how-to book, at its price point it should be read by every person who believes that healthcare policy will be an important differentiating factor in the 2020 US election.

"Consumer-Directed" Health Plans (CDHPs) combine high deductibles with personal medical accounts and are intended to reduce health care spending through greater patient cost sharing. Prior research shows that CDHPs reduce spending in the first year. However, there is little research on the impact of CDHPs over the longer term. We add to this literature by using data from 13 million individuals in 54 large US firms to estimate the effects of a firm offering CDHPs on health care spending up to three years post offer. We use a difference-in-differences analysis and to further strengthen identification, we balance observables within firm, over time by developing weights through a machine learning algorithm. We find that spending is reduced for those in firms offering CDHPs in all three years post. The reductions are driven by spending decreases in outpatient care and pharmaceuticals, with no evidence of increases in emergency department or inpatient care.

The United States has the highest per capita spending on health care of any industrialized nation but continually lags behind other nations in health care outcomes including life expectancy and infant mortality. National health expenditures are projected to exceed $2.5 trillion in 2009. Given healthcare's direct impact on the economy, there is a critical need to control health care spending. According to The Health Imperative: Lowering Costs and Improving Outcomes, the costs of health care have strained the federal budget, and negatively affected state governments, the private sector and individuals. Healthcare expenditures have restricted the ability of state and local governments to fund other priorities and have contributed to slowing growth in wages and jobs in the private sector. Moreover, the number of uninsured has risen from 45.7 million in 2007 to 46.3 million in 2008. The Health Imperative: Lowering Costs and Improving Outcomes identifies a number of factors driving expenditure growth including scientific uncertainty, perverse economic and practice incentives, system fragmentation, lack of patient involvement, and under-investment in population health. Experts discussed key levers for catalyzing transformation of the delivery system. A few included streamlined health insurance regulation, administrative simplification and clarification and quality and consistency in treatment. The book is an excellent guide for policymakers at all levels of government, as well as private sector healthcare workers.

This issues-based reference work (available in both print and electronic formats) shines a spotlight on health care policy and practice in the United States. Impassioned debates about the best solutions to health care in America have perennially erupted among politicians, scholars of public policy, medical professionals, and the general public. The fight over the Health Care Reform Act of 2010 brought to light a multitude of fears, challenges, obstacles, and passions that often had the effect of complicating rather than clarifying the debate. The discourse has never been more heated. The complex issues that animate the health care debate have forced the American public to grapple with the exigencies of the present system with regard to economic, fiscal, and monetary policy, especially as they relate to philosophical, often ideologically driven approaches to the problem. Americans have also had to examine their ideas about the relationship of the individual to and interaction with the state and the varied social and cultural beliefs about what an American solution to the problem of health care looks like. In light of the need to keep students, researchers, and other interested readers informed and up-to-date on the issues surrounding health care in the U.S., this volume uses introductory essays followed by point/counterpoint articles to explore prominent and perennially important debates, providing readers with views on multiple sides of this complex issue. Features & Benefits: The volume is divided into three sections, each with its own Section Editor: Quality of Care Debates (Dr. Jennie Kronenfeld), Economic & Fiscal Debates (Dr. Mark Zezza), and Political, Philosophical, & Legal Debates (Prof. Wendy Parmet). Sections open with a Preface by the Section Editor to introduce the broad theme at hand and provide historical underpinnings. Each Section holds 12 chapters addressing varied aspects of the broad theme of the section. Chapters open with an objective, lead-in piece (or "headnote") followed by a point article and a counterpoint article. All pieces (headnote, point article, counterpoint article) are signed. For each chapter, students are referred to further readings, data sources, and other resources as a jumping-off spot for further research and more in-depth exploration. Finally, the volume concludes with a comprehensive index, and the electronic version of the book includes search-and-browse features, as well as the ability to link to further readings cited within chapters should they be available to the library in electronic format.

A startlingly insightful discussion of the problems facing American health care providers and consumers and their solutions In Transforming Health Care, expert physician Dr. Morey Menacker explains how the United States can contain the world’s leading collection of superlative health care practitioners, technologies, treatments, research, education, and hospitals while simultaneously failing to provide care to many of its citizens. The author walks you through the past, present, and future of American health care, showing you how the United States got to its present state and offering practical solutions to improving access and affordability for millions of people. In the book, you’ll find: Insightful commentary about how to maintain the stellar quality of care found in the United States while expanding health care affordability and access Discussions of how to reduce the cost and complexity of US health care Explorations of the latest research and data as seen through the eyes of a physician who has spent their entire career working in the American medical system A can’t-miss resource for US-based physicians and allied health care professionals, Transforming Health Care will also earn a place on the bookshelves of regulators, administrators, and lawmakers with an interest in the American health care establishment.