A Competitive Bidding Approach to Medicare Reform

Medicare reform is a critical issue for the public agenda. The most promising option for addressing Medicare reform is competitive bidding -- using health plans' bids to determine the government's contribution to a basic set of benefits in every market area. This paper begins with a review of the history of competitive bidding in Medicare. It then moves to a definition of terms, which is crucial in any discussion of competitive pricing because the often-heated public debate around these issues frequently distorts positions and confuses issues by conflating different terms and making some arguments appear other than they are. Following this terminological exercise, the report includes a series of sections discussing competitive bidding in Medicare, with special focus on the challenges to introducing it

What's the 'big deal', and why is it bad deal for universities?

At first sight the “big (or all-you-can-eat) deal” seems excellent value for libraries and their users, and represents the shining possibilities of the electronic age. A more thorough-going evaluation, however, exposes dangers for universities, their funders and publishers. This paper examines the big deal in the light of fundamental market conditions and suggests alternative models for procuring electronic resources. The roles and strengths of the players in the information supply chain are defined and traditional hard-copy procurement is analysed in terms of these roles and the concepts of authority, branding and monopoly. The fundamentals of procuring electronic resources and prevalent purchasing models are discussed in terms of the same roles and concepts. The advantages of the big deal are laid out - access to resources, low unit costs etc. The dangers are also discussed. These arise mainly from the publishers’ position as monopolists. The possible long-term effects, on library budgets and academic publishing, of dealing with monopoly suppliers are examined. Means of avoiding or minimising these dangers – consortia, alternative publishing methods, new economic models to promote competition – are examined

Policy Issues in U.S. Transportation Public-Private Partnerships: Lessons from Australia, Research Report 09-15

In this report, the authors examine Australia’s experience with transportation public-private partnerships (PPPs) and the lessons that experience holds for the use of PPPs in the United States. Australia now has decades of experience in PPP use in transportation, and has used the approach to deliver billions of dollars in project value. Although this report explores a range of issues, the authors focus on four policy issues that have been salient in the United States: (1) how the risks inherent in PPP contracts should be distributed across public and private sector partners; (2) when and how to use non-compete (or compensation) clauses in PPP contracts; (3) how concerns about monopoly power are best addressed; and (4) the role and importance of concession length. The study examines those and other questions by surveying the relevant literature on PPP international use. The authors also interviewed 23 Australian PPP experts from the academic, public and private sectors, and distilled lessons from those interviews

Integrated Delivery Networks: In Search of Benefits and Market Effects

Integrated Delivery Networks (IDNs) have very different stated purposes than mere collections of hospitals: to coordinate care across the continuum of health services and to manage population health. IDN advocates claim that these complex enterprises yield both societal benefits and performance advantages over less integrated competitors. The purpose of this analysis is to evaluate the evidence to support these claims.For the study, researchers performed a review of the academic literature on IDN performance, as well as an analysis of publicly available quality and financial data from 15 of the biggest not-for-profit IDNs in the U.S., including Sutter Health in Northern California. The authors compared the publicly available performance information on the IDNs' flagship hospital in its principal regional market with that flagship's most significant in-market competitor. The study found that it is possible for integrated delivery networks to offer meaningful benefits, but there is little evidence they have reduced costs or improved the quality of care. Findings include:Hospital-physician integration has raised physician costs, hospital prices and per capita medical care spending;Hospital integration into health plan operations and capitated contracting was not associated either with clinical efficiency or financial efficiencyProviders are likely to see a decrease in operating margins and return on capital as they invest in IDN developmen