Effectiveness Of The US Health Care
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Effectiveness Of The US Health Care
Effectiveness Of The US Health Care
What is your evaluation of the effectiveness of the U.S. health care system in the context of delivery, finance, management, and/or sustainability? What are the issues that prompted a need for health care reform? Support your answer with a credible data reference. Do not use a reference already used by another student.
Medicare and Medicaid have a far greater impact on the American health care system than the millions of dollars they spend each year.
Despite the fact that they only cover a small portion of the population, these two public programs have a significant impact on the overall health care system and on all Americans.
They have also inadvertently contributed to the rapid rise in health care prices through some of their reimbursement policies, particularly those supporting traditional fee-for-service healthcare.
An important potential role for CMS in providing leadership on issues of evidence-based care and creating a value-driven system was recognized by the Institute of Medicine (IOM) committee as they considered their charge to examine how HHS could be more effective in “advancing the health of the nation.” This is perhaps the most promising current approach to the problems of rapid
For more information, see: KNOWING WHAT WORKS: EVALUATING HEALTH CARE
In order to better understand which diagnostic, therapeutic, and prevention services actually work and under what conditions, an IOM committee has recommended a multi-part national program (IOM, 2008).
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A growing awareness of the need for a more in-depth look at numerous aspects of health care led to the creation of this study.
Many people aren’t receiving services that have been proven to be helpful and appropriate.
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As a result of this, new technology and care routines may be embraced without understanding whether they are the most successful.
There is overwhelming evidence that the vast majority of Americans are receiving care that is unnecessary.
A team of Dartmouth College researchers has conducted two decades of study that has demonstrated major discrepancies in treatment patterns, such as the frequency with which patients are admitted to intensive care units or undergo particular surgical procedures (ICUs).
Local doctors’ practices and clinical resources—hospital beds, intensive care units (ICUs), high-tech medical equipment, and specialty physicians—are mostly responsible for these disparities.
Even after accounting for factors such as age, illness severity, and comorbidities, Medicare spent an average of $60,000 on New Jersey patients in the last 24 months of their lives, but just $30,000 on similar patients in North Dakota (Wennberg et al., 1999). (Wennberg et al., 2008).
Both in high-cost and low-cost regions, useful preventive interventions like mammography and pneumonia immunizations go mostly unutilized (Wennberg et al., 1999).
A higher level of care does not inevitably lead to better outcomes for patients.
They’ve had worse luck on occasion.
For the same set of patient characteristics and disease, mortality rates in places with more regular access to healthcare are frequently higher (Wennberg et al., 2008).
Even if the least efficient healthcare providers followed the examples set by the most effective, significant savings may be realized throughout our entire health care system (Antos and Rivlin, 2007).
About 30 percent of Medicare and other spending might be saved if all patients received the same level of treatment as those in the least intensive, most conservative settings (such as Mayo Clinic in Rochester, Minnesota, and Intermountain Healthcare in Salt Lake City) (Wennberg et al., 2002).
Some patients may benefit more from an intensive approach, but the expenses of paying for these few would be more than offset by reducing the intensity of services for the larger number who receive too much care (Wennberg et al., 2008).
Figure 4-1 shows state-level statistics on Medicare spending per beneficiary and how the quality of treatment for beneficiaries is assessed in that state, with an average of Medicare spending per beneficiary.
It’s easy to see that there is no correlation between money and quality in this graph.
Accordingly, low-spending states would be clustered to their left and higher-spending states would rise on the quality scale if the two were linked.
Beneficiaries in states with low spending receive high-quality care, whereas beneficiaries in states with high spending receive low-quality care.
To put it another way, in terms of cost per beneficiary, one state has the highest quality treatment while the two states with the highest prices (about $9,000 per year) have some of the lowest quality ratings.
Quality of care and Medicare spending are shown in Figure 4-1 by state (2004).
FIGURE 4-1 shows how states differ when it comes to quality of service and the amount of money spent on Medicaid (2004).
NOTES:
The percentage of Medicare fee-for-service beneficiaries who were hospitalized in 2004 is used to create a composite quality of care metric (more…)
Care costs vary greatly amongst hospitals that are integrated academic medical centers and members of the Council of Teaching Hospitals and Health Systems (CTHS).
Care for Medicare individuals with certain chronic conditions ranges from $24,000 to approximately $92,000 in the latter two years of life in 93 of these institutions, as shown in Figure 4-2. This is a nearly fourfold difference in cost.
A similar reduction in costs and maintenance of quality treatment can be achieved by altering physician and hospital practice patterns.
Patients with at least one of nine chronic illnesses who received most of their care from chosen Council of Teaching Hospitals (COTHs) integrated academic medical facilities (deaths occuring 2001–2005) are shown in Figure 4-2.
Chart illustrating Medicare spending on inpatient physician services and hospitalizations during the final two years of life for patients with at least one of nine chronic diseases whose primary care is provided by chosen Council of Teaching Hospitals hospitals (figure 4-2). (COTHs)
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The clinical substance of care, as well as how care is integrated, structured, provided, and paid for, affects patient outcomes.
An “integrated care” plan takes into account the individual’s needs and goals, as well as the patient’s preferences once they are told of the benefits, dangers, and availability of alternative therapies.
Integrated care involves the use of interactive electronic medical and personal health records and is coordinated across all providers and locations over time. It is also culturally and linguistically appropriate.
There are many different ways to organize and deliver health care, including using nurse practitioners, physician assistants, nutritionists, health educators, and other types of health professionals. The care can be provided in private offices or by multispecialty groups, and it can be paid for in a fee-for-service or managed care model.
Paying for health care has a significant impact on results.
To maximize revenue, fee-for-service payment systems encourage physicians to do more tests, surgeries, and treatments.
When it comes to health care, there is likely no one-size-fits-all solution; rather, diverse techniques may be more effective in particular circumstances.
These elements are plainly too complex for any one doctor or facility to analyze.
Insurers and payers are also unlikely to put money into these kinds of studies if the results would only benefit their own companies.
Moreover, none of these organizations is likely to commission new research to fill up any gaps in knowledge.
In order to describe more effective health care, the government should promote a number of intra- and cross-agency approaches.
The enormous costs of Medicare and Medicaid serve as a tremendous motivator.
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a. The secretary should engage with Congress to establish a capability for analyzing the comparative value—including clinical and cost-effectiveness—of medical interventions and procedures, preventative and therapeutic technologies, and methods of organizing and providing care. b.
Comparative value should be evaluated by utilizing departmental data sources and supporting information from providers, payers and health researchers.
Visit: Using Evidence to Achieve Better Results
It is necessary to improve coordination in order to take advantage of the comprehensive data gathered by the CMS, FDA, NIH, CDC, and other government agencies, as well as the data collected by nongovernmental payers, providers, and researchers from the National Institutes of Health.
The value of health care can be better assessed (in terms of costs and benefits) if there is better coordination of the available data.
The methodological limitations of a study must also be taken into account.
For example, randomized controlled trials and observational studies provide valuable population-level information but do not always provide definite guidance for individual patient management.
However, best available data can be utilized to support policy decisions and the formulation of clinical guidelines.
A greater knowledge of which policies lead to better results and less wasteful spending can help enhance the health care system’s overall efficiency.
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