Variation in Health Care Spending Target Decision Making, Not Geography
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- Englisch ausgewählt
Fr. 72.90
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Beschreibung
Produktdetails
Einband
Taschenbuch
Erscheinungsdatum
01.10.2013
Herausgeber
Ashna Kibria + weitereVerlag
National Academies PressSeitenzahl
206
Maße (L/B/H)
22.9/15.2/2.5 cm
Gewicht
344 g
Sprache
Englisch
ISBN
978-0-309-28869-9
For more than three decades, experts at the Dartmouth Institute for Health Policy and Clinical Practice have documented significant variation in Medicare spending across geographic regions apparently unrelated to health care outcomes achieved. From this seminal body of work, an idea emerged that certain regions of the country may be uniformly more efficient than others at providing high-quality health care services. Moreover, many argue that Medicare's traditional fee-for-service reimbursement system is a major driver of both variation and waste in health care because it rewards providers based on the volume and intensity rather than the value of services delivered. Seeking strategies for reducing Medicare costs, some wonder whether cutting payment rates to high-cost areas would save money without adversely affecting health care quality for Medicare beneficiaries. Other health care policy experts counter that supporters of the above policy proposal conflate the issue of improving value with that of reducing geographic variation. Some variation in health care spending is to be expected in an efficient health care system, reflecting "acceptable"--meaning driven by genuine health needs--differences in consumption of health care services by individual patients. Reducing geographic variation is desirable only to the extent that measured variation represents inefficiencies in the health care system. Further, the literature on geographic variation traditionally has focused on spending and utilization in fee-for-service Medicare. Little attention has been paid to Medicaid, the commercial health care sector, Medicare Advantage or the uninsured. Spending and utilization patterns in traditional Medicare should not be assumed to be representative of other populations or of total health care spending and utilization in the United States. Still other health care policy experts argue that regionally based payments are inherently unfair and would fail to create market incentives necessary to promote high-value, patient centered care. Furthermore, there may not exist a natural geographic unit to use in analyses of area variation, since inter-area variation remains substantial even when the areas are defined as smaller and smaller geographic units. In other words, intra-area variation can be large, and even larger than variation across areas. Finally, provider payments based on regional area performance would reward inefficient providers in low-cost regions and punish more efficient providers in high-cost regions. Variation in Health Care Spending evaluates geographic variation in health care spending levels and growth among Medicare, Medicaid, privately insured, and uninsured populations in the United States; makes recommendations for changes in Medicare payments, considers changes to Medicare payment systems under the ACA; and addresses whether Medicare payments for physicians and hospitals should incorporate a value index that would modify the payments based on geographic area performance.
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