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Worstpills Independent source for prescription drug information.
Partnership for Prescription Assistance Through this site, the Partnership for Prescription Assistance offers a single point of access to more than 275 public and private patient assistance programs for prescriptions, including more than 150 programs offered by pharmaceutical companies.
Healthcare Coverage Options Database An on-line tool to help make American health care consumers aware of all of the coverage options available to them. The Database contains information about private health insurance coverage, as well as the many public and private programs available to Americans to help them obtain the medical care they need.
StateHealthFacts.org Source of information provided by the Kaiser Family Foundation about state-level health services.
healthinsuranceinfo.net Georgetown University has written a consumer guide about your medical insurance rights for each state and the District of Columbia, each of which is available on this site.
Nieman Watchdog - "Health" Put out by the Nieman Foundation for Journalism at Harvard University. Its aim is to encourage more and better watchdog reporting, and it is targeted at reporters, editors and concerned citizens.
Hospital Compare This tool provides you with information on how well the hospitals in your area care for all their adult patients with certain medical conditions.
Association of Health Care JournalistsAn independent, non-profit organization dedicated to advancing public understanding of health care issues. Its mission is to improve the quality, accuracy and visibility of health care reporting, writing and editing.
patientINFORMA free online service that provides patients and their caregivers access to some of the most up-to-date, reliable and important research available about the diagnosis and treatment of specific diseases.
Health HippoHealth Hippo is a collection of policy and regulatory materials related to health care, with some graphics sprinkled in. It would be wise to confirm anything you intend to rely on with a hardcopy of the reference.
Boston University Health Reform ProgramThe Health Reform Program designs practical solutions to health care problems�solutions that address the needs of all parties.


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Fri Nov 04, 2005

The Best Health System In the World? US Patients Pay More But Get Less

One-third of patients with health problems in the United States report experiencing medical, medication, or test errors, the highest rate of any nation in a new Commonwealth Fund international survey. Assessing health care access, safety, and care coordination in Australia, Canada, Germany, New Zealand, the United Kingdom, and the United States, the survey found that while no one nation was best or worst overall, the United States stood out for high error rates, inefficient coordination of care, and high out-of-pocket costs leading to barriers to access to care.

The findings are published today in a Health Affairs article, �Taking the Pulse of Health Care Systems: Experiences of Patients with Health Problems in Six Countries,� whose lead author is Commonwealth Fund senior vice president Cathy Schoen.

You can read the article here.

�While the consistently high error rates and lack of coordination are disturbing, the findings also highlight the potential for each country to improve,� said Commonwealth Fund president Karen Davis. �Some countries have been able to achieve timely access to needed care while reducing financial barriers. Each country could also gain through strategies to improve the quality and efficiency of care, such as implementing modern information technology systems, supporting patient engagement in care, and improving management of chronic conditions.�

The 2005 survey of adults with health problems is the eighth in an annual series of cross-national surveys conducted by Harris Interactive for the Commonwealth Fund.

One-third (34 percent) of U.S. survey participants reported at least one of four types of errors: They believed that they experienced a medical mistake in treatment or care, were given the wrong medication or dose, were given incorrect results for a test, or experienced delays in being notified about abnormal test results. Three of ten Canadian respondents reported at least one of these errors, as did one-fifth or more of patients in Australia (27 percent), New Zealand (25 percent), Germany (23 percent), and the United Kingdom (22 percent).

U.S. patients who saw four or more doctors in the past two years were especially vulnerable, with about half reporting at least one of these errors; this points toward lapses in communication during care transitions.

Although attention to patient safety has focused chiefly on care in hospitals, a majority of patients (60 percent or more) in each country who reported medical mistakes or medical errors said that these errors occurred outside the hospital, which highlights the need for policies to improve patient safety in ambulatory care settings.

�There were many symptoms of poorly coordinated care in every country, regardless of the type of delivery or financing system,� said Schoen. �Shortfalls were particularly evident for people when discharged from the hospital, and for patients seeing multiple physicians. Improved care coordination during transitions across sites of care and providers offer opportunities for significant improvement. These patients are the �canary in the coal mine� of any health system.�

In all six countries, one-third or more of recently hospitalized patients reported failures to coordinate care during hospital discharge. Germany had the highest rate of patients reporting lack of follow-up care, with three-fifths (60 percent) saying that the hospital did not make arrangements for follow-up visits with a doctor or other health professional or otherwise give instructions about posthospital care, such as symptoms to watch for and when to seek further care.

The United States had the highest rate of patients reporting coordination-of-care problems that reflected inefficient care during doctor visits. One-third of U.S. respondents said that within the past two years, either their test results or records were not available at the time of a doctor�s appointment, or that a doctor had ordered a test that had already been done. Rates of care-coordination problems in the United States were higher than those in the other five countries, which ranged between about one-fifth to one-quarter reporting coordination problems.

Patients with chronic diseases in all of the countries often did not receive the care recommended to manage their condition. At best, about half of diabetics reported receiving all four recommended screening exams to manage their condition. Patients who had supports such as a self-management plan or a nurse included as part of their care management team were more likely than others to have received recommended care.

The United States was an outlier for its financial burdens on patients:
� Half of U.S. adults reported that they had gone without care because of costs in the past year
� In contrast, just thirteen percent of U.K. adults reported not getting needed care because of cost
� One-third of U.S. patients reported out-of-pocket expenses greater than $1,000 in the past year
� U.K. patients were the most protected from high cost burdens, with two-thirds having no out-of-pocket expenses. The variations were notable given the study�s design focus on sicker adults with recent intensive use of medical care.

Access�including after-hours access�and waiting times to see a doctor when sick differed markedly across the countries:
� Canadian and U.S. adults who needed medical care were the least likely to report fast access (same day) to doctors (30 percent or fewer of U.S. or Canadian patients)
� In contrast, majorities of patients in New Zealand (58 percent) and Germany (56 percent) reported that they were able to get same-day appointments, as did nearly half of patients in Australia (49 percent) and the United Kingdom (45 percent)
� Majorities of patients in Germany (72 percent), New Zealand (70 percent), and the United Kingdom (57 percent) also reported easy after-hours (nights, weekends, or holidays) access to a doctor
� In contrast, majorities of patients in the United States (60 percent), Australia (58 percent), and Canada (53 percent) said that it was very or somewhat difficult to get after-hours care
� The four countries with comparatively more rapid access to physicians�Australia, Germany, New Zealand, and the United Kingdom�also had lower rates of emergency room use, with Germany having the lowest rates
� One-fifth of Canadians and one-fourth of U.S. patients who reported going to the ER said that it was for a condition that could have been treated by their regular doctor if available

The findings highlight the need for improved access as well as coordination of care. The authors conclude that �these findings suggest that many of the problems with which policy leaders are grappling transcend specific payment or delivery systems and will require more fundamental transformation.�

The Commonwealth Fund is a private foundation supporting independent research on health care issues and making grants to improve health care practice and policy.

Health Affairs , published by Project HOPE, is the leading journal of health policy. The peer-reviewed journal appears bimonthly in print with additional online-only papers published weekly as Health Affairs Web Exclusives at www.healthaffairs.org The full text of each Health Affairs Web Exclusive is available free of charge to all Web site visitors for a two-week period following posting, after which it will switch to pay-per-view for nonsubscribers. The abstracts of all articles are free in perpetuity. Web Exclusives are supported in part by a grant from the Commonwealth Fund.

Posted by: Duncan Kinder on Nov 04, 05 | 10:13 am

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Thu Oct 13, 2005

Physician-Owned Hospitals Skim Patients With Better Insurance

Physicians who self-refer patients to their own specialty hospitals are reaping financial benefits by "cherry-picking" less severe patients and "cream-skimming& patients with better insurance, a Georgetown University economist said Wednesday at a Wichita health care seminar, according to the Wichita Eagle.

Posted by: Duncan Kinder on Oct 13, 05 | 7:33 pm

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Tue Oct 11, 2005

JAMA: Physician Pay-for-Performance Programs May Produce Little Gain in Quality

Paying clinicians to reach a common, fixed performance target may produce little gain in overall quality, and may largely reward those with higher performance at baseline, according to a study in the October 12 issue of JAMA.

The number of health plans and purchasers in the United States that have adopted pay-for-performance mechanisms for quality improvement is growing rapidly, according to background information in the article. However, most of these programs are in the early stages of trial, evaluation, and adjustment. Although there is intense interest in and optimism about pay-for-performance programs among many policy makers and payers, there is little published research on pay-for-performance in health care. There have been a few studies demonstrating that pay-for-performance leads to improved quality of care.

Meredith B. Rosenthal, Ph.D., of the Harvard School of Public Health, Boston, and colleagues conducted a study on the impact of a prototypical physician pay-for-performance on quality of care within one of the nation's largest health plans, PacifiCare Health Systems. In 2003, PacifiCare began paying its California medical groups bonuses according to meeting or exceeding 10 clinical and service quality targets. The researchers examined the performance of California medical groups that were subject to pay-for-performance, and a comparison group in the Pacific Northwest (Oregon and Washington). Quality improvement reports were included from October 2001 through April 2004 issued to approximately 300 large physician organizations. There were three process measures of clinical quality: cervical cancer screening, mammography, and hemoglobin A1c testing.

The researchers found that clinical quality scores improved as follows: for cervical cancer screening, 5.3 percent for California vs. 1.7 percent for Pacific Northwest; for mammography, 1.9 percent vs. 0.2 percent; and for hemoglobin A1c testing, 2.1 percent vs. 2.1 percent. Compared with physician groups in the Pacific Northwest, the California network demonstrated greater quality improvement after the pay-for-performance intervention only in cervical cancer screening (a 3.6 percent difference in improvement). For all 3 measures, physician groups with baseline performance at or above the performance threshold for receipt of a bonus improved the least but garnered the largest share of the bonus payments.

"In the first year of its quality incentive program (QIP), the plan paid $3.4 million of a potential bonus pool of $12.9 million. Three quarters of the 172 physician groups eligible at some point during the year for the program received some funds from the bonus pool. We also observed that few groups reached a majority of targets, consistent with the low correlation in performance across clinical areas that has been observed in other studies. Physician groups whose performance was initially lowest improved the most, whereas physician groups that had previously achieved the targeted level of performance improved the least. Unlike quality improvement, which followed an inverse relationship to baseline performance, bonus dollars were garnered in direct proportion to baseline performance. Physician groups whose performance was above the bonus threshold at baseline captured 75 percent of bonus payments on average across the 3 quality domains we examined, despite their limited improvement," the authors write.

"Our findings give rise to a number of speculations about the effects of pay-for-performance. First, groups with baseline performance already above the targeted threshold appeared to understand that they needed only to maintain the status quo to receive the bonus payments. More surprising, perhaps, is that low-performing groups improved as much as they did, given that their short-run chances of receiving a bonus were likely to be low. One possibility is that the groups viewed the QIP as a larger signal of a changing environment in which they would face increasing pressure to improve their care systems and decided to begin moving in that direction. Paying explicitly for quality improvement might alter the incentives for high-performing and low-performing groups, distribute bonus dollars more toward the latter group, and possibly increase the overall impact of pay-for-performance."

The authors add that one possible reason that the QIP failed to yield a greater response is that the financial rewards for quality were too low to motivate substantial departures from the underlying trend in quality improvement. Per enrollee, the maximum annual bonus was a relatively modest $27, or about 5 percent of the professional capitation amount. Moreover, PacifiCare accounts for only about 15 percent of the average group's revenue.

"PacifiCare's QIP, like most current pay-for-performance programs, should be viewed as a first step in the direction of aligning payment incentives with health system quality goals. Realization of the full potential of pay-for-performance to reduce the persistent gap between evidence-based and actual practice will require that payers adapt their incentive strategies as evidence to support best practices accumulates. The principal lesson we derive from this experience is that incentive design matters. The accumulating evidence from the continuing experimentation with pay-for-performance in the market will highlight these initial findings and other potential design lessons," the researchers conclude.

Posted by: Duncan Kinder on Oct 11, 05 | 11:51 pm

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Tue Oct 04, 2005

Commonwealth Fund: U.S. Health System Fraught With Waste and Inefficiency

Despite spending more per capita on health care than any other country, the U.S. health system is fraught with waste and inefficiency, according to a new chartbook released today by the Commonwealth Fund Commission on a High Performance Health System. The chartbook, discussed at a Capitol Hill briefing sponsored by the Fund and the Alliance for Health Reform, paints a stark picture of a fragmented system beset by widespread disparities in access to and quality of care.

A Need to Transform the U.S. Health Care System: Improving Access, Quality, and Efficiency also points to promising opportunities for reforming the health system. These include management of high-cost care, enhancements in care coordination, disease management, and developing networks of high performing providers under Medicare, Medicaid, and private insurance. The Commission on a High Performance Health System will be exploring such opportunities as part of its mission to move the nation toward a health care system providing better access, quality, and efficiency.

Commission chair James J. Mongan, M.D., president and CEO of Partners HealthCare, in his remarks at the Alliance briefing, noted that "the disconnect between people wanting the new things that medical science can produce, yet not being sure that they are willing or able to pay for them." In his presentation, A Tale of Two Health Systems Mongan said this disconnect "will lead to more of a focus on the value equation in health care, and to more of a focus on a high-performing health system."

The commission's goals are outlined in an essay by Fund president Karen Davis, Ph.D., Toward a High Performance Health System: New Commonwealth Fund Commission, which was published last month in Health Affairs.

A webcast of the commission event, provided by kaisernetwork.org, will be available Tuesday, October 4, on the Alliance for Health Reform Web site.

Posted by: Duncan Kinder on Oct 04, 05 | 10:51 am

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Mon Sep 26, 2005

Health Affairs: Curing any one disease will make the elderly live longer and in better health but it also means they accumulate more health care spending over a lifetime. That offsets the savings of being healthier. Exception: Eliminating Obesity

What impact will advances in biomedicine and technology have on health and spending for the elderly in the future? New data, released today by the journal Health Affairs, reveal that many of the most promising medical innovations will result in better health and longer life, but they will increase, not decrease, Medicare spending. Researchers also predict that curing any one particular disease won�t save Medicare much money, with one important exception: Eliminating obesity could potentially lower costs.

�Curing any one disease will make the elderly live longer and in better health�and this has great value to society�but it also means they accumulate more health care spending over a lifetime. That offsets the savings of being healthier,� said Dana P. Goldman, PhD, corporate chair and director of health economics at RAND in Santa Monica, California.

Under current projections, Medicare spending will rise from 2.6 percent of gross domestic product (GDP) today to 9.2 percent in 2050. Demographics will have a large impact as the first wave of baby boomers turns 65 in 2010. Goldman led a team of economists and physicians from RAND, Stanford University, and the VA [Department of Veterans Affairs] Greater Los Angeles Healthcare System to explore beyond the established, current projections, and to see how changes in medical technology, disease, and disability would affect future health spending for the elderly. The researchers developed the Future Elderly Model (FEM), a demographic and economic simulation model, to help them predict future costs and health status for the elderly. The data were published today in a series of six articles and seven accompanying Perspectives in a Health Affairs Web Exclusive.

�The challenge for policymakers is to understand and manage future Medicare spending. This in-depth analysis will help them chart direction for the future,� said John K. Iglehart, founding editor of Health Affairs.

In the lead article, �Consequences of Health Trends and Medical Innovation for the Future Elderly,� Goldman and colleagues looked at advances in cardiovascular disease, cancer and the biology of aging, and neurological disease to assess how innovations affected spending and life years saved over the period 2002�2030. Some technologies would be extremely expensive. For example, expanding the use of implantable cardioverter defibrillators (ICDs) to half of elderly patients with new cases of heart failure or heart attack would result in approximately 550,000 procedures annually in 2030, with total treatment costs of $27 billion measured in 2005 dollars.

Other technologies could have modest costs per additional life year, but could increase health care spending substantially. For example, the biomedical research community is actively seeking anti-aging compounds. Such a compound would increase health care spending by 14 percent in 2030 because, if the compound had been taken by healthy beneficiaries starting in 2002, there would be 13 million more Medicare beneficiaries in 2030.

However, researchers argue, the cost per additional year of life is well worth it�only $11,000 in 2005 dollars. And if the compound keeps people alive in very poor states of health, total health care spending in 2030 would be 70 percent higher, because there would be more elderly people in poor health, according to Goldman and colleagues. Yet even in this case, the cost per additional life year of $38,000 is still relatively modest.

In an accompanying Perspective, Harvard University�s David M. Cutler takes a more optimistic view for Medicare�s future. Taking into account information technology and other health improvement advances not included in the researchers� analysis, Cutler writes: �My forecast about medical spending is rosier than the FEM model suggests. The technological changes that the RAND authors consider will likely come to pass, and they will drive up Medicare spending (often with good value). But there is enormous potential for cost savings as well, which we have the capacity to realize. One can be an optimist even when the storm clouds are gathering.�

In the article �The Lifetime Burden of Chronic Disease among the Elderly,� economist Geoffrey F. Joyce and colleagues studied seven chronic conditions: stroke, chronic obstructive pulmonary disease (COPD), hypertension, coronary heart disease, cancer, diabetes, and acute myocardial infarction. Cumulative health care spending is only modestly higher for those with chronic diseases at age 65, ranging from about $5,000 to $18,000 (2005 dollars), because the chronically ill live fewer years. Annual Medicare expenses increase by about $750 to $2,000 for people with a serious chronic illness at age 65, while cumulative Medicare expenses increase by $2,500 to $15,000 across the seven chronic conditions studied.

Curing Obesity Could Translate Into Significant Savings For Medicare

Obesity could prove to play a large role in Medicare spending in the future, according to economist Darius N. Lakdawalla and colleagues in the article �The Health and Cost Consequences of Obesity among the Future Elderly.� Using the FEM, the authors contend that if obesity is shown to be responsible for the health differences between those who are obese and those who are not, preventing or curing obesity in any one person would return that person�s health care spending level to that of a person of normal weight. Given the growing number of obese Americans, the resulting savings to Medicare could be substantial.

How different are the costs of treating the obese elderly versus the nonobese? An obese 70-year-old incurs $38,000 in additional medical costs in old age compared with costs for a nonobese peer. And although obese 70-year-olds will live as long as those of normal weight, they will spend 40 percent more time disabled than their nonobese counterparts. Lakdawalla and his colleagues argue that the effects of disability from obesity, rather than increased spending, might be the more important component of the social burden of obesity.

Medicare will also spend about 34 percent more on an obese person than on someone of normal weight, and obesity may cost Medicare more to treat than other diseases, because higher costs are not offset by reduced longevity, according to the study. Beginning at age 70, an obese person will cost Medicare about $149,000, the highest level of any group. In addition, Medicare spending on an obese person is 20 percent higher than for the next closest group, the overweight, and 35 percent higher than spending on a person of normal weight. Medicare could experience considerable financial burden from the increase in obesity nationwide, spending about $38,000 more over the lifetime of an obese 70-year-old than it will spend on a beneficiary of similar age and normal weight.

Three additional articles, in which researchers used the FEM for all or some of their research, round out the Health Affairs Web Exclusive collection. In �Disability and Health Care Spending among Medicare Beneficiaries,� lead author Michael E. Chernew of the University of Michigan School of Public Health projects that the cost savings associated with improved disability rates will not dramatically slow Medicare spending in the long run.

In �Technological Advances in Cancer and Future Spending by the Elderly,� lead author Jayanta Bhattacharya of Stanford University finds that no scenario holds major promise for guaranteeing the future financial health of Medicare. And in �Identifying Potential Health Care Innovations for the Future Elderly,� lead author Paul G. Shekelle evaluated innovations in cardiovascular disease, cancer, the biology of aging, and neurological disease and found that many innovations have the potential to greatly affect the costs and outcomes of health care.

This series of articles was funded in part by the National Institute on Aging and the John A. Hartford Foundation.

The articles can be read here.

Posted by: Duncan Kinder on Sep 26, 05 | 2:29 pm

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New medical technology is likely to further inflate future Medicare costs, posing great financial risk to the program, according to a RAND Corporation study issued today.

Emerging treatments such as implantable defibrillators for heart ailments or drugs to prevent Alzheimer's disease could boost spending significantly, with single treatments potentially increasing costs by as much as 70 percent, according to a series of RAND Health reports published online by the journal Health Affairs.

�An array of new medical technology on the horizon could greatly inflate elderly health care spending,� said Dana Goldman, director of health economics at RAND Health and leader of the research. �This technology is valuable because it will improve health and extend lives. But we need to begin thinking about how to pay for it.�

Some savings may be expected if disability rates among the elderly continue to drop. But those savings probably will be overshadowed by increased spending on healthy elderly recipients who will live longer, according to one of the RAND papers.

Some cost savings may be possible if the nation can reduce the number of Americans who are obese. Medicare costs among obese seniors are significantly higher and the number of obese Medicare recipients is rising, according to the studies.

The elderly currently spend more than $300 billion on health care annually. Most of this is paid for by Medicare, which provides health insurance to Americans age 65 and older.

The warnings about a potential sharp rise in elderly spending are from a series of studies using a detailed model of Medicare spending created by Goldman and other researchers from RAND Health, Stanford University and the Greater Los Angeles VA Healthcare System.

Researchers examined the spending increases that might face the elderly through 2030 under a number of different scenarios, including potential cost spikes caused by 10 new medical technologies that a panel of experts said are likely to emerge during the period.

Some of the technologies would have small impacts, including cancer vaccines and better treatments for acute stroke, each of which is predicted to increase elderly health care spending by less than 1 percent.

But other technologies could trigger major cost increases. For example, researchers estimated what the cost might be of expanding use of implantable defibrillators, which are devices implanted in patients' chests to treat life-threatening heart beat problems. The devices show promise in treating other cardiac ailments, including heart attacks and heart failure.

If half of the patients with new cases of heart failure or heart attacks received the devices, elderly health care spending would rise by $14 billion in 2015 and by $21 billion in 2030, according to researchers. The increase would amount to almost 4 percent of total spending.

Other new technologies could cost even more. A preventive treatment for Alzheimer's disease or new cancer-fighting drugs could each increase elderly spending 8 percent, and anti-aging compounds � an area of active research in biomedicine � could drive up costs from 14 to 70 percent, according to the studies.

�Would you rather have today's health care at today's cost, or 1980s health care at 1980s cost?� Goldman said. �I think all of us want today's technology and the technology that will be developed in the future. But improved technology will cost us even more in the future.�

Another report authored by RAND economist Geoffrey F. Joyce determined that even if the incidence of chronic diseases among the elderly can be reduced, Medicare is not likely to see much savings.

Examining seven different chronic diseases such as diabetes and heart disease, researchers found that the long-term costs to Medicare for treating these ailments was relatively low, in large part because patients with chronic diseases die several years earlier than others.

If chronic diseases are eliminated in younger Medicare recipients, cumulative costs for each recipient will remain similar as people live longer. In addition, many people will develop the same diseases as they live longer, negating cost savings, according to the study.

One disease-prevention program that might help trim Medicare costs would be an effort to target obesity, according to a third paper authored by RAND economist Darius Lakdawalla.

While obese elderly people live about as long as those of normal weight, they are also much more likely to be disabled, according to the RAND study. A 70-year-old obese person can expect four years of disability-free life, while a normal-weight 70-year-old can expect seven years.

The average medical expenses of an obese 70-year-old will be about $38,000 more over his or her lifetime than a normal-weight person, according to the RAND study. These findings suggest that a less-obese population may cost Medicare significantly less.

The computer model used in the RAND studies was assembled using a representative sample of about 100,000 Medicare beneficiaries from the Medicare Current Beneficiary Survey, a national effort that asks Medicare beneficiaries about chronic conditions, use of health care services, medical care spending, and health insurance coverage. Each beneficiary in the sample is linked to Medicare claims records to track actual medical care use and costs over time.

The RAND model also incorporates information about younger people into the model, allowing researchers to gauge the impact of future Medicare recipients as well as current recipients. Those cases were selected from the National Health Interview Study.

Funding for the studies was provided by the federal Centers for Medicare and Medicaid Services and the National Institute on Aging, through its support of the RAND Roybal Center for Health Policy Simulation, the RAND Center for the Study of Aging, and the Stanford Center for Demography and Economics of Health and Aging. Funding also was provided by the UCLA Claude D. Pepper Older Americans Independence Center.

Other authors of the RAND studies are: Baoping Shang, Michael Hurd and Emmett B. Keeler of RAND; Alan M. Garber and Jayanta Bhattacharya of Stanford University; Constantijn Panis of Deloitte and Touche; and Paul Shekelle of RAND and the Greater Los Angeles VA Healthcare System.

RAND Health is the nation's largest independent health policy research program, with a broad research portfolio that focuses on health care quality, costs, and delivery, among other topics.

Posted by: Duncan Kinder on Sep 26, 05 | 2:21 pm

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Thu Sep 15, 2005

Study: Providing Doctors With Financial Incentives to Rein In Their Prescription Practices Has Not Led to Cost-Cutting Innovations

With rising concern over the cost of the new Medicare prescription drug benefit program � going into effect January, 2006 and estimated to cost $593 billion over the next decade � a new UCSF study reveals that a key cost-cutting strategy employed by HMOs for 15 years is simply not working.

Health insurance companies have increasingly sought to limit the amount of expensive drugs doctors prescribe to patients in order to keep drug costs form spiraling, according to the study authors. A major strategy has been to restrain drug costs by assuring that a medical group will make money if member doctors prescribe within the drug budget set by the insurance company, and will lose money if member doctors over-prescribe.

The underlying assumption is that placing doctors at financial risk for their drug prescribing practices will lead them to adopt new practices to control drug costs, the authors explain. These practices include hiring pharmacists for expert advice, using "physician profiling" to compare doctors' prescribing patterns, and adhering to professional protocols that specify what each drug should be prescribed for, at what dose and for how long.

The new study shows that providing financial incentives for doctors to rein in their prescription practices has not led to cost-cutting innovations.

The study is being published in the August issue of the Journal of Health Policy, Politics and the Law, available mid-September. It is based on a survey of executives in more than three dozen physician groups and HMOs in four large U.S. cities.

The survey found widespread dissatisfaction with the HMO strategy of making doctors financially liable for prescription drug costs above a certain limit. It also found doctors were often confused or unaware of the incentives, either because of unclear contracts with HMOs or failure of HMOs to share drug cost information with doctors appropriately. In addition, frequent changes in the contract made it hard for physicians to know if an investment in innovation made under today�s deal would still pay off under tomorrow's, the survey shows.

"The problem lies in the contract terms and information-sharing between the HMO and doctors. Fix that, and you'll go a long way to controlling drug costs," says study co-author R. Adams Dudley, MD, UCSF associate professor of medicine and health policy.

HMOs negotiated their own prices for drugs with the manufacturers via pharmacy benefit managers but typically failed to disclose that information to physicians, the survey revealed.

"Profitably managing something as complex as prescription drug risk requires accurate, timely information, but most of the surveyed physician groups couldn't even calculate their total drug costs," says Jonathan D. Agnew, PhD, a study co-author and senior policy consultant at the British Columbia Medical Association.

Even when HMOs were willing to share price information, the study found that the data usually got to the doctors too late for them to determine if they were over or under budget.

"On the one hand, doctors get too much information from working with so many HMOs, each with its own array of prescription drug benefits and policies. On the other hand, the information they do get from the HMO is often incomplete or not timely enough to help them make good management decisions," says Helene Levens Lipton, PhD, professor of health policy and pharmacy at UCSF and lead author of the study.

The survey also found that HMO contracts with physician groups focused far more on efforts to contain costs than to maintain or improve the quality of care, Dudley said.

The researchers propose three major changes:

* Contracts between physician groups and HMOs should be clearer and more accurate, and information about changing drug-cost incentives should be provided to physicians in a more timely way.

* Doctors should not be held liable for the costs of doing the "right thing": If giving a prescription is the right thing to do, the costs should not be included in a budget target. Rather, the expenditure targets should be limited to situations in which medication use is more discretionary, such as whether or not a patient needs to continue on anti-ulcer drugs after an ulcer has healed.

* When HMOs evaluate a group's performance, the assessment should be fair. For example, in the late 1990s, doctors should not have been penalized for rising prescription costs related to the introduction of new drug therapies they could not have budgeted for, such as the first drug therapies for attention deficit disorder.

As another example of a drug-risk contract considered unfair by physician groups, the authors report that one physician group was penalized for not controlling its costs as well as another group in the HMO's network, even though the other group was in a different health care market.

Under the new Medicare drug benefit, reimbursement for HMOs depends, in part, on their establishing sound drug use management programs to contain drug costs, the authors point out.

"As HMOs establish and modify these programs, we hope the data presented here can help them avoid some of the major pitfalls we found in several large cities across the country," says study co-author Marilyn Stebbins, PharmD, UCSF professor of clinical pharmacy. "And doctors can learn to request fairer contracts and better information sharing."

Angela Kuo, MS, a former research associate with Lipton, was also a co-author on the paper.

The study was supported by the Robert Wood Johnson Foundation�s Changes in Health Care Financing and Organization initiative.

Posted by: Duncan Kinder on Sep 15, 05 | 7:14 pm

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Thu Sep 08, 2005

Competition: Is it a Boon or Bane for Health Care

Proponents assert that competition boosts health care quality while lowering its cost. Opponents assert the reverse results, according to the Williamsburg Virginia Gazette.

Posted by: Duncan Kinder on Sep 08, 05 | 12:24 am

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Sun Sep 04, 2005

While Millions Go Uninsured, Hospitals Offer Luxury Suites

According to the Washington Post, hospitals are now offering luxury suites to those willing to pay extra.

Posted by: Duncan Kinder on Sep 04, 05 | 12:44 am

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Thu Sep 01, 2005

USA Today/Kaiser/Harvard Release Comprehensive Survey

USA Today, the Kaiser Family Foundation, and the Harvard School of Public Health today released the results from a new comprehensive survey looking at how Americans are being affected by rising health care costs. A three-day series based on the results of the survey and reporting by USA Today is appearing in the paper this week.

The Health Care Costs Survey includes information on:

* The problems Americans have paying for medical care and prescription drugs;
* The impact paying health care bills has on family budgets;
* The barriers health care costs pose to obtaining medical care; and
* The special burden of medical bills for people with chronic health conditions, moderate and lower incomes, and those without insurance.

The Health Care Costs Survey is based on a nationally representative sample of 1,531 adults ages 18 years and older, conducted between April 25 and June 9, 2005. The USA Today/Kaiser Family Foundation/Harvard School of Public Health Survey Project is a three-way partnership. USA Today, Kaiser, and Harvard jointly design and analyze surveys examining health care issues. USA Today retains editorial control over the content published by the paper.

The full survey results and a link to the USA Today articles are available online.

Posted by: Duncan Kinder on Sep 01, 05 | 1:51 pm

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