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PubMedDate not supplied

Cooperation, cost control and consumer focus are critical challenges for health care.

As we move into the 21st Century, the U.S. health care system faces tremendous challenges such as care for an aging and increasingly diverse population, escalating costs and limited resources. Government, consumers, hospitals and the insurance industry are positioning themselves for the future. Physicians need to do the same. Physicians must come to the table and assert leadership by working collaboratively with major stakeholders. Examine some steps that need to be taken to help shape the future of medicine.

Aged↗
PubMed1992

Decisions without consequences: cost control and access in state Medicaid programs.

States have implemented a number of strategies to provide services, pay providers, and control Medicaid spending. We test the effects of some differences in state Medicaid policies on program enrollees' access to and use of health care services. Logistic and OLS regression analyses of cross-sectional data indicate that these policies exert significant influences on enrollees' access to health services but have a weaker direct effect on their use of them. However, we find evidence that utilization is affected indirectly (through increased access) by state policy decisions. Somewhat surprisingly, Medicaid policies designed to contain costs by limiting utilization appear to affect neither access nor utilization. Medicaid enrollees have greater access to a private physician in states with higher physician reimbursement and additional Medicare insurance for their enrollees. Other nonpolicy variables with pronounced impacts on access to private office physicians include race and the availability of private insurance.

Cost Control↗
PubMed1986

The spurious dilemma: reconciling medical progress and cost control.

In Canada, a health care system has developed that is both responsive to the health needs of the Canadian people and has shown financial stability over the past decade. The Canadians attribute their success in maintaining stable health care costs to regulation of physician fee levels and hospital services. Yet even though there exists regulation in the Canadian health care system, the effect of this government intervention has not resulted in rationing of health care. This suggests Americans should examine closely this alternative model of a health care system.

Canada↗
PubMed1996

[Cost control in public health by rationing--what are the advantages and disadvantages?].

In Germany, the discussion on the pros and cons of rationing health care services in the statutory health insurance funds has just begun, but it will probably be of great importance in the years to come. Until now, it is mainly a political discussion with only very few researches participating. In order to enhance the matter-of-factness in this controversial debate, the experiences in the USA with rationing health care services are summarised, and in the second part a more general discussion is added on different forms and consequences of rationing. The present discussion in Germany is outlined in the third part of the paper. In our own evaluation two arguments are stressed: Firstly, the central argument that rationing of health care services is inevitable because health care costs are "exploding", has as yeb no firm empirical and theoretical basis. Secondly rationing by taking medically useful benefits from the schedule of benefits in the statutory health insurance funds is not compatible with the ethical principles governing these funds.

Cost Control↗
PubMed2003

[Improving job morale of nurses despite insurance cost control. 1: Organization assessment].

Faced with declining resources for health care and greater pressures to improve productivity of nursing staff, nursing administrators must act now to develop organizational responses to morale problems among nursing staff. As part of a two-part series for JONA, the authors describe low-cost organizational approaches that address nursing morale. Presented in Part 1 is a low-cost diagnostic process for assessing needs of staff and appraising organizational dimensions contributing to morale. Assessment findings provide clear direction for developing organizational approaches for improving morale.

Cost Control↗
PubMedDate not supplied

Current national initiatives about drug policies and cost control in Europe: the Italy example.

Pharmaceutical expenditure is a challenge to the financial compatibility of health systems because it is growing faster (+11% per year in the last 5 years in Italy) than any other health sector. In order to curb public pharmaceutical expenditure 2 interventions are commonly used: delisting (de-reimbursement) and reference price, with the difference being paid by patients. The Italian Ministry of Health implemented a set of interventions with the general aim of pharmaceutical governance based on the following criteria: (a) to assure a complete coverage of all clinically and epidemiologically relevant diseases; (b) to provide health professionals with a range of different active drugs with the same therapeutic indications within the same therapeutic class; and (c) to identify a reimbursement threshold in order to save public money by narrowing the (wide) price differentials among drugs with comparable efficacy and safety. In this context, interventions have been undertaken at several levels including drug price reduction, generic drug promotion, delisting of drugs reimbursed, and direct distribution of medicines (by hospital services). Furthermore, a new National Pharmaceutical Formulary has been implemented. Medicines have been classified into homogeneous categories (ie, medicines with the same main indication(s) and with similar clinical efficacy and safety profile). Within each homogeneous category, a reimbursement level (cutoff) was then identified and, accordingly, pharmaceutical companies were asked to adjust their price. This adjustment was based on price per daily drug dose (DDD), cumulative expenditure (at least 50%), and cumulative utilization (at least 60%). This readjustment, at no cost for patients, is expected to save more than Euro 280 million of public money. Seventy-seven percent of this saving will be due to price readjustment of antiulcers, calcium channel blockers, angiotensin-converting enzyme (ACE) inhibitors, and some antibiotics (mainly cephalosporins). The Italian system was able to cover all relevant diseases and ensured citizens and health professionals a choice among a wide range of valid pharmacological therapies. At the same time it was able to save public money by narrowing wide price differentials among drugs with comparable clinical properties. The set of interventions yielded a new national formulary that was able to have a significant influence on the trend of drug expenditure in Italy. This experience can be a useful reference for other European and non-European states.

Cost Control↗
PubMed1991

Cost control should extend to legal services.

While a healthcare organization may consider legal services to be outside its management scope, control of legal spending is within a hospital's grasp. Whether an organization is large or active enough to merit an internal legal staff, an administrative position should be established to centralize management of legal services. A hospital may choose to undertake a cost reduction audit, which can determine the feasibility of an internal legal staff and coordinate competitive proposals from outside law firms handling litigation.

Contract Services↗
PubMedDate not supplied

"Trade-off" between medical cost controls and quality of care? Maybe, maybe not! Part II.

In Part I of this article, published in the last issue of the JQA (February/March 1990, Vol. 12, No. 1), Majors Varney and Schroeder reviewed the issues surrounding the impact of the Medicare prospective pricing system (PPS). After defining "quality health care" and discussing indicators of quality, the authors presented several arguments by anti-cost containment advocates. In Part II, research is presented on the effects of cost containment on access to health care, substance abuse programs, improved care, severity indexing, alternative care, and utilization review programs.

Cost Control↗
PubMed1978

Health care cost control will affect total U.S. economy.

The crisis in health care costs in being attributed primarily to hospitals although it has many causes and sources. Moreover, it typically is viewed simply as being one industry's inflation even though it affects, and is affected by, finances and spending in many other sectors of society and the economy.

Costs and Cost Analysis↗
PubMed1999

Top-performing physician groups focus on innovative cost control.

DATA BENCHMARKS: Top-performing physician group practices reveal why they are head and shoulders above their peers. A new study released by the Medical Group Management Association offers benchmark data that shows how leading group practices in various specialties are faring compared with their colleagues nationwide.

Benchmarking↗
PubMedDate not supplied

Cost control without compromising quality of care.

By focusing on creative options that meet the varied health care needs of a wide range of members, a multiemployer purchaser of health care in California is able to provide quality care at affordable prices to public employees.

California↗
PubMed1996

Re-minding our Ps and Qs: medical cost controls in Canada.

During the past few years the landscape of Canadian physician reimbursement policy has undergone dramatic change. Rapidly eroding fiscal environments for provincial (and federal) governments have forced provinces to "get serious" about controlling a significant, previously uncontrolled, budget line: physician expenditures. All provinces now impose medical expenditure caps, with eight of these being hard caps under which any overruns are the responsibility of the profession. In addition, policies in five provinces now include individual income caps. One of the effects of this new environment has been a rush to adopt supply-control policies. This paper explores a number of other side effects, such as heightened interest in alternative methods of payment, as well as the emergence of, and difficulties for, joint province/medical association management committees.

Canada↗