Health affairs
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The latest work of John Wennberg and colleagues represents an important advance over earlier work by targeting different domains of clinical care at a more specific level. The findings have clear implications for those interested in constraining Medicare costs and may even point a way forward for lasting reform of purchasing practices in both the public and the private sectors. Nonetheless, the latest findings and proposals leave unresolved important research and policy questions, including those involving the basic relationship between spending and outcomes and payment reforms that would promote care of more uniform quality.
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This survey of large, private-sector employers offering retiree health benefits in 2003 provides a detailed baseline of private retiree health plans on the eve of the most sweeping changes to Medicare since its enactment. Total retiree health costs rose 13.7 percent in 2003, and average retiree contributions to premiums for employees age sixty-five and older retiring in 2003 rose 18 percent. Nearly half of surveyed employers have capped their contributions to health coverage for retirees over age sixty-five. Before passage of the new Medicare legislation, 20 percent said that they are likely to eliminate benefits for future retirees within three years.
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America's emergency departments (EDs) are in crisis. The dwindling numbers of EDs are increasingly overcrowded as they cope with rising demand. ⋯ While this may appear to make financial sense for some hospitals, it is a costly response that does little to fix the complex problems that drive ED overcrowding. Given a convergence of factors, it may now be time to radically alter and broaden our historical expectations of the role of the ED.
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By many accounts, the United States is in the midst of its third medical malpractice "crisis." Physicians in several states are facing high and rising premiums. The largest national medical malpractice carrier and some large multistate physician-backed liability firms have recently left the market. Rising premiums are traced largely to increases in claims severity. ⋯ This analysis finds that premiums in states that cap awards are 17.1 percent lower than in states that don't cap. At issue, however, is whether these stopgap solutions promote the goals of the U. S. liability system.