Health affairs
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Single-payer health care systems consist of publicly financed insurance that provides basic benefits for all citizens. The design is intended to achieve universal coverage and allow greater cost control. ⋯ According to our estimates, after the first full year of operation in 2015, our proposed single-payer system is expected to produce an annual savings of 25.3 percent when compared to current state health spending levels; cut employer and household health care spending by $200 million; create 3,800 jobs; and boost the state's overall economic output by $100 million. We describe how this plan was designed, and we discuss lessons for other states considering health system reform.
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The Affordable Care Act of 2010 promotes a clinically integrated, systems-based approach to health care. This means coordinating a patient's care over time and across all conditions, diseases, providers, and care settings. ⋯ Boards will have to focus less on the competence of individual providers and more on the functioning of the entire system of inpatient and outpatient care. We discuss the increased role of the boards in a systems-based approach to quality, and what steps they can take to meet the quality mandates of the Affordable Care Act.
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Comparative Study
Polling analysis: public support for health reform was broader than reported and depended on how proposals were framed.
The excessive focus of news organizations on "horse race" public opinion polls during the debate about health reform in 2010 left the impression that the public was fickle, as well as sharply divided on whether the government's role in health care should expand. We examined polling data and found that public support for health reform depended very much on how individual policies were described. ⋯ Our findings indicate that public support for health reform was broader and more consistent than portrayed at the time. Going forward, policy makers should strive to communicate how health care policy choices are consistent with existing public preferences or should make changes to policy that reflect those preferences.
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Comparative Study
Hospitals respond to Medicare payment shortfalls by both shifting costs and cutting them, based on market concentration.
The coverage expansions planned under the Affordable Care Act are to be financed in part by slowing Medicare payment updates to hospitals, thereby reigniting the debate over whether low prices paid by public payers cause hospitals to increase prices to private insurers--a practice known as cost shifting. Recently, the Medicare Payment Advisory Commission (MedPAC) proposed an alternative explanation of hospital pricing and profitability that could be used to support policies that pressure hospitals to reduce overall costs rather than to only raise prices. ⋯ The study presents empirical evidence that, faced with shortfalls between Medicare payments and projected costs, hospitals in concentrated markets focus on raising prices to private insurers, while hospitals in competitive markets focus on cutting costs. Policy makers need to examine whether efforts to promote clinical coordination through provider integration may interfere with efforts to restrain overall health care cost growth by restraining Medicare payment rates.
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Comparative Study
Dropped medical malpractice claims: their surprising frequency, apparent causes, and potential remedies.
Most medical malpractice claims are neither settled nor adjudicated. Instead, they are abandoned by the plaintiffs who bring them. This study measured the frequency and cost of abandoned claims and gathered opinions from attorneys and other experts on why plaintiffs drop claims. ⋯ The most important is that as plaintiffs acquire more information in the course of a lawsuit, they often conclude that a claim is weaker than they had first thought. The author recommends that insurers and hospitals adopt new procedures to encourage both plaintiff attorneys and defense representatives to exchange information more efficiently, discuss the merits of malpractice cases more candidly, and resolve cases quickly. Such reforms would greatly reduce both the frequency and the duration of cases that are dropped, and thus the cost of malpractice litigation.