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Management: - hold Medicare physician fees at current levels - increase them only for particpating in innovations in how care is delivered - implement bundled reimbursement approaches - single payment for all services provided during a hospital stay - encourage Medicare & Medicaid beneficiaries to seek care from integrated-care systems (patient-centered medical homes) - reward primary care clinicians for coordinating care & using team-based approaches - accelerate "meaningful use" of information technology - make available comparative data on outcomes - advise patients on marginal benefits of healthcare intervention when appropriate [8] - consider number needed to treat, number needed to harm & the financial implications of the health care intervention - principles for the future of medicine [18] - empower patients - expand access - centralization, eliminate state boundaries - no cherry-picking of patients to insure - optimize technology [18] Notes: - healthcare spending in 2011 18% of gross domestic product GDP) or about $8680 per person [1] - low back pain & neck pain accounted for the 2 greatest health care expenditures in 2016 [21] - $3 trillion spent on health care in U.S. in 2014, an increase of 5.3% over 2013, primarily due to major coverage expansions under the Affordable Care Act & a 12-percentage-point increase in prescription drug spending [11] - $3.2 trillion spent on health care in U.S. in 2015, almost $10,000 per capita & nearly 18% of the gross domestic product [12] - the federal government paid 29% of the bill, households (28%), private businesses (20%), state & local governments (17%) [12] - costs for hospital care $1 trillion, - costs for professional services (clinicians, dentists ..) $840 billion. - prescription drug spending $325 billion - % of population with health insurance ~91% [12] - affordability index is a ratio created by dividing the mean cost of an employer-sponsored family health insurance policy by median household income: 31% in 2016, much unchanged from 2012 but much higher then 14% in 1999. [15] - health insurance coverage expansion in Massachusetts was associated with a 2.9% reduction in mortality [6] - patient access to pricing information leads to lower absolute costs per service, especially for complex imaging studies [7] - failure to incorporate clinical guidelines into medical decisions due to lack of awareness is a major driver of healthcare costs [9] - attempts for patient satisfaction along with fear of litigation also drive up healthcare costs [9] - little evidence of benefits of consolidation of health care (mergers etc) to patients or society [13] - 2013-2016 U.S. health care statistics vs 11-high-income countries [16] - U.S. annual health spending per capita ($9400) nearly double that of other countries average ($5400) - U.S. generalist physicians' pay ($218,000) higher than other country average ($134,000) - drug spending per capita ($1440) higher than other country average ($750). - U.S. life expectancy was lowest (78.8 vs. 81.7 years) vs other countries [16] - 25% of the $3.8 trillion spent on healthcare in the U.S. is wasted each year [20] - self-appointed saviors of medicine who do not care for patients leaves physicians on the sidelines in health care reform [17]

Related

health health care worker (HCW) health insurance health literacy health maintenance (preventive medicine) healthcare-associated infection

Specific

culturally-competent care integrated healthcare long-term health care low-value care obstetric care; maternity care planned parenthood; preconception planning; preconception risk assessment

General

clinical process

References

  1. Hartman M et al National Health Spending In 2011: Overall Growth Remains Low, But Some Payers And Services Show Signs Of Acceleration Health Affairs, Jan 2013 PMID: 23297275 http://content.healthaffairs.org/content/32/1/87.full.html
  2. The Commonwealth Fund Commission on a High Performance Health System. Confronting Costs: Stabilizing U.S. Health Spending While Moving Toward a High Performance Health Care System. January 10, 2013 http://www.commonwealthfund.org/Publications/Fund-Reports/2013/Jan/Confronting-Costs.aspx
  3. Porter ME. What is value in health care? N Engl J Med. 2010 Dec 23;363(26):2477-81 PMID: 21142528
  4. Swensen SJ, Meyer GS, Nelson EC et al Cottage industry to postindustrial care--the revolution in health care delivery. N Engl J Med. 2010 Feb 4;362(5):e12 PMID: 20089956
  5. Owens DK, Qaseem A, Chou R, Shekelle P et al High-value, cost-conscious health care: concepts for clinicians to evaluate the benefits, harms, and costs of medical interventions. Ann Intern Med. 2011 Feb 1;154(3):174-80. PMID: 21282697
  6. Sommers BD et al. Changes in mortality after Massachusetts health care reform: A quasi-experimental study. Ann Intern Med 2014 May 6; 160:585 PMID: 24798521 http://annals.org/article.aspx?articleid=1867050
  7. Whaley C et al. Association between availability of health service prices and payments for these services. JAMA 2014 Oct 22/29; 312:1670 PMID: 25335149
  8. Roman BR On Marginal Health Care - Probability Inflation and the Tragedy of the Commons. N Engl J Med 2015; 372:572-575. February 5, 2015 PMID: 25651255 http://www.nejm.org/doi/full/10.1056/NEJMms1407446
  9. Winawer NH What Are the Drivers of Higher Healthcare Costs? NEJM Journal Watch. May 28, 2015 Massachusetts Medical Society (subscription needed) http://www.jwatch.org - Kachalia A et al. Overuse of testing in preoperative evaluation and syncope: A survey of hospitalists. Ann Intern Med 2015 Jan 20; 162:100 PMID: 25599349
  10. Martin AB et al National Health Spending In 2014: Faster Growth Driven By Coverage Expansion And Prescription Drug Spending. Health Affairs. Dec 2015 PMID: 26631494 http://content.healthaffairs.org/content/early/2015/11/25/hlthaff.2015.1194
  11. Hallsworth M, MPhil & David Halpern Applying Behavioral Insights to Improve Health and Health Care. NEJM Catalyst. Oct 12, 2016 http://catalyst.nejm.org/applying-behavioral-insights-improve-health-care/
  12. Martin AB, Hartman M, Washington B, Catlin A and the National Health Expenditure Accounts Team. National Health Spending: Faster Growth In 2015 As Coverage Expands And Utilization Increases. Health Affairs. published online December 2, 2016 http://content.healthaffairs.org/content/early/2016/11/22/hlthaff.2016.1330.full.pdf+html
  13. Gaynor M, Mostashari F, Ginsburg PB. Making Health Care Markets WorkCompetition Policy for Health Care. JAMA. Published online March 2, 2017. PMID: 28253376 http://jamanetwork.com/journals/jama/article-abstract/2607819
  14. Cresswell KM, Bates DW, Sheikh A Why Every Health Care Organization Needs a Data Science Strategy. NEJM Catalyst. March 22, 2017 http://catalyst.nejm.org/healthcare-needs-data-science-strategy/
  15. Emanuel EJ, Glickman A, Johnson D. Measuring the Burden of Health Care Costs on US Families. The Affordability Index. JAMA. 2017;318(19):1863-1864 PMID: 29098292 https://jamanetwork.com/journals/jama/fullarticle/2661699 - Reinhardt U What Level of Health Spending Is Affordable"? JAMA. 2017;318(19):1869-1870 PMID: 29098277 https://jamanetwork.com/journals/jama/article-abstract/2661697 - Antos J, Capretta JC Challenges in Measuring the Affordability of US Health Care. JAMA. 2017;318(19):1871-1872 PMID: 29098273 https://jamanetwork.com/journals/jama/article-abstract/2661698
  16. Papanicolas I, Woskie LR, Jha AK Health Care Spending in the United States and Other High- Income Countries. JAMA. 2018;319(10):1024-1039 PMID: 29536101 https://jamanetwork.com/journals/jama/fullarticle/2674671 - Emanuel EJ The Real Cost of the US Health Care System. JAMA. 2018;319(10):983-985 PMID: 29536081 https://jamanetwork.com/journals/jama/article-abstract/2674647 - Baicker K, Chandra A. Challenges in Understanding Differences in Health Care Spending Between the United States and Other High-Income Countries. JAMA. 2018;319(10):986-987 PMID: 29536082 https://jamanetwork.com/journals/jama/article-abstract/2674648 - Parente ST Factors Contributing to Higher Health Care Spending in the United States Compared With Other High-Income Countries. JAMA. 2018;319(10):988-990 PMID: 29536080 https://jamanetwork.com/journals/jama/article-abstract/2674646 - Bauchner H, Fontanarosa PB. Health Care Spending in the United States Compared With 10 Other High-Income Countries. What Uwe Reinhardt Might Have Said. JAMA. 2018;319(10):990-992 PMID: 29536083 https://jamanetwork.com/journals/jama/article-abstract/2674650
  17. West HJ Physicians on the Sidelines: How Can Healthcare Be Reinvented Without the People Who Actually Care for Patients? Medscape - Mar 14, 2018. https://www.medscape.com/viewarticle/893790
  18. Mandelbaum BR Five Principles for the Future of Healthcare. Medscape - May 03, 2017. https://www.medscape.com/viewarticle/879203
  19. Blendon RJ, Benson JM, McMurtry CL et al Health Care in the 2018 Election. N Engl J Med 2018; 379:e32. Nov 1, 2018 PMID: 30380387 Free full text https://www.nejm.org/doi/full/10.1056/NEJMsr1813425
  20. Shrank WH, MD, Rogstad TL, Parekh] N. Waste in the US Health Care SystemEstimated Costs and Potential for Savings. JAMA. Published online October 7, 2019, PMID: 31589283 https://jamanetwork.com/journals/jama/fullarticle/2752664 - Bauchner H, Fontanarosa PB. Waste in the US Health Care System. JAMA. Published online October 7, 2019. PMID: 31589277 https://jamanetwork.com/journals/jama/fullarticle/2752663 - Joynt Maddox KE, McClellan MB. Toward Evidence-Based Policy Making to Reduce Wasteful Health Care Spending. JAMA. Published online October 7, 2019. PMID: 31589271 https://jamanetwork.com/journals/jama/fullarticle/2752661 - Berwick DM Elusive Waste. The Fermi Paradox in US Health Care. JAMA. Published online October 7, 2019. PMID: 31589275 https://jamanetwork.com/journals/jama/fullarticle/2752662
  21. Dieleman JL, Cao J, Chapin A et al US Health Care Spending by Payer and Health Condition, 1996-2016. JAMA. 2020;323(9):863-884 PMID: 32125402 https://jamanetwork.com/journals/jama/fullarticle/2762309 - Ayanian JZ The Complex Mosaic of Health Care Spending in the United States. JAMA Network. March 3, 2020 Not indexed in PubMed https://jamanetwork.com/channels/health-forum/fullarticle/2762676
  22. The White House. April 18, 2023. FACT SHEET: Biden-Harris Administration Announces Most Sweeping Set of Executive Actions to Improve Care in History. https://www.whitehouse.gov/briefing-room/statements-releases/2023/04/18/fact-sheet-biden-harris-administration-announces-most-sweeping-set-of-executive-actions-to-improve-care-in-history/