Health affairs
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Almost 60,000 Indian physicians practice in the United States, United Kingdom, Canada, and Australia--a workforce equal to 10 percent of the physicians in India and the largest émigré physician workforce in the world. I traveled to India to interview leaders in medical education, health policy, and public health, to better characterize and understand Indian physician emigration. A changing political and policy environment in India is raising new questions about what might be done to keep more of India's physicians at home.
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Medicare payment systems are neutral and sometimes negative toward quality of care. The Medicare Payment Advisory Commission (MedPAC) has recommended that Congress build incentives for quality into Medicare's payment systems for hospitals, physicians, home health agencies, facilities that treat dialysis patients, and Medicare Advantage plans. In this Commentary we describe the rationale for the recommendations, criteria for determining which settings are ready, program design principles, and potential measures.
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This paper examines the impact that Medicare pay-for-performance (P4P) might have upon hospital payment. It uses the initial two quarters of a national quality database to model financial gains or losses using the Premier Hospital Quality Incentive Demonstration rules, as well as the P4P approach recommended by the Medicare Payment Advisory Commission (MedPAC). Findings reveal variation among all types of hospitals and across all measures within each of the three conditions studied: heart attack, heart failure, and pneumonia. Initially, hospitals' financial gains and losses likely will be marginal using the Premier demonstration payment rules and somewhat larger under the MedPAC recommendations as modeled.
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U. S. health care spending rose 7.9 percent to $1.9 trillion in 2004, or $6,280 per person. ⋯ The pace of health spending growth has slowed, compared with the 2000-2002 period, for both public and private payers. Hospital spending accounted for 30 percent of the aggregate increase between 2002 and 2004, and prescription drugs accounted for an 11 percent share-smaller than its share of the increase in recent years and much slower in absolute terms.