Health affairs
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Comparative Study
Health care spending growth: how different is the United States from the rest of the OECD?
This paper compares the long-term (1970-2002) rates of real growth in health spending per capita in the United States and a group of high-income countries in the Organization for Economic Cooperation and Development (OECD). Real health spending growth is decomposed into population aging, overall economic growth, and excess growth. Although rates of aging and overall economic growth were similar, annual excess growth was much higher in the United States (2.0 percent) versus the OECD countries studied (1.1 percent). That difference, which is of an economically important magnitude, suggests that country-specific institutional factors might contribute to long-term health spending trends.
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Many current policies and approaches to performance measurement and payment reform focus on individual providers; they risk reinforcing the fragmented care and lack of coordination experienced by patients with serious illness. In this paper we show that Medicare beneficiaries receive most of their care from relatively coherent local delivery systems comprising physicians and the hospitals where they work or admit their patients. Efforts to create accountable care organizations at this level--the extended hospital medical staff--deserve consideration as a potential means of improving the quality and lowering the cost of care.
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Pressure mounts on physicians and hospitals to disclose adverse outcomes of care to patients. Although such transparency diverges from traditional risk management strategy, recent commentary has suggested that disclosure will actually reduce providers' liability exposure. ⋯ We found that forecasts of reduced litigation volume or cost do not withstand close scrutiny. A policy question more pressing than whether moving toward routine disclosure will expand litigation is the question of how large such an expansion might be.
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Comparative Study
Estimates of health insurance coverage: comparing state surveys with the current population survey.
The Census Bureau produces annual state-level estimates of health insurance coverage using the Current Population Survey (CPS) Annual Social and Economic Supplement. Many states also conduct their own population surveys of health insurance status; in most cases, the state survey estimates of uninsurance are lower than the estimates produced by the CPS. This discrepancy fuels debate about the true count of uninsured Americans and changes in that number over time. This paper compares state survey and CPS estimates of uninsurance, highlights key reasons for these differences, and discusses the policy implications of this persistent discrepancy.