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Variation in Health Care Spending - Target Decision Making, Not Geography (Paperback, New)
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Variation in Health Care Spending - Target Decision Making, Not Geography (Paperback, New)
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Health care in the United States is more expensive than in other
developed countries, costing $2.7 trillion in 2011, or 17.9 percent
of the national gross domestic product. Increasing costs strain
budgets at all levels of government and threaten the solvency of
Medicare, the nation's largest health insurer. At the same time,
despite advances in biomedical science, medicine, and public
health, health care quality remains inconsistent. In fact,
underuse, misuse, and overuse of various services often put
patients in danger. Many efforts to improve this situation are
focused on Medicare, which mainly pays practitioners on a
fee-for-service basis and hospitals on a diagnoses-related group
basis, which is a fee for a group of services related to a
particular diagnosis. Research has long shown that Medicare
spending varies greatly in different regions of the country even
when expenditures are adjusted for variation in the costs of doing
business, meaning that certain regions have much higher volume
and/or intensity of services than others. Further, regions that
deliver more services do not appear to achieve better health
outcomes than those that deliver less. Variation in Health Care
Spending investigates geographic variation in health care spending
and quality for Medicare beneficiaries as well as other
populations, and analyzes Medicare payment policies that could
encourage high-value care. This report concludes that regional
differences in Medicare and commercial health care spending and use
are real and persist over time. Furthermore, there is much
variation within geographic areas, no matter how broadly or
narrowly these areas are defined. The report recommends against
adoption of a geographically based value index for Medicare
payments, because the majority of health care decisions are made at
the provider or health care organization level, not by geographic
units. Rather, to promote high value services from all providers,
Medicare and Medicaid Services should continue to test payment
reforms that offer incentives to providers to share clinical data,
coordinate patient care, and assume some financial risk for the
care of their patients. Medicare covers more than 47 million
Americans, including 39 million people age 65 and older and 8
million people with disabilities. Medicare payment reform has the
potential to improve health, promote efficiency in the U.S. health
care system, and reorient competition in the health care market
around the value of services rather than the volume of services
provided. The recommendations of Variation in Health Care Spending
are designed to help Medicare and Medicaid Services encourage
providers to efficiently manage the full range of care for their
patients, thereby increasing the value of health care in the United
States.
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