Realizing the Value Proposition: A Longitudinal Assessment of Hospitals’ Total Factor Productivity

U.S. hospitals are under continual pressure both to increase productivity and to improve quality through the use of Health Information Technology. This paper analyzes 3,187 US hospitals, using data reported to the American Hospital Association, to assess changes in productivity over a five- year period (2002-2006). The Malmquist Indices derived indicate that Total Factor Productivity (TFP) and Efficiency Change (EFFCH) both increased during that timeframe. The low Technological Change (TC) index indicates that improvements to organizational processes did not contribute substantially to productivity. A secondary analysis examined the use of Computerized Physician Order Entry (CPOE) in relationship to the three indices. TFP trended positively for those hospitals further into the CPOE implementation process

Vertical Restraints and Powerful Health Insurers: Exclusionary Conduct Masquerading as Managed Care?

Overt competition is a relative newcomer to the health care field-a field rarely even referred to as an industry a mere twenty-five years ago. In the early sixties most observers still considered commercial motives basically inapplicable to the delivery of medical services.\u27 But perceptions have changed now that more than 11 percent of the gross national product is spent on the health sector of the economy, a development made possible primarily because insurance to pay for expensive treatment and technology has become more widely available. Delivering medical services is commonly considered big business now, and the same kinds of competitive and anticompetitive behavior that have always been found in commercial markets can be clearly observed in the health industry of the 1980\u27s.2 Moreover, health insurers have evolved into major actors in the medical morality play, shaping policy as middlemen by managing the costs of care through vertical restraints on provider autonomy that might have seemed inconceivable to their cost-passthrough predecessors.

Health Worker Shortages & the Potential of Immigration Policy

Foreign-born and foreign-trained professionals play an important role in the delivery of health care in the United States. This report examines the important role of immigrant doctors and nurses -- many of whom have receivedtheir training abroad -- in the U.S. health industry, using new Census Bureau data as well as information from numerous interviews with health industry experts

Healthcare Price Transparency: Policy Approaches and Estimated Impacts on Spending

Healthcare price transparency discussions typically focus on increasing patients' access to information about their out-of-pocket costs, but that focus is too narrow and should include other audiences -- physicians, employers, health plans and policymakers -- each with distinct needs and uses for healthcare price information. Greater price transparency can reduce U.S. healthcare spending.For example, an estimated $100 billion could be saved over the next 10 years if three select interventions were undertaken. However, most of the projected savings come from making price information available to employers and physicians, according to an analysis by researchers at the former Center for Studying Health System Change (HSC). Based on the current availability and modest impact of plan-based transparency tools, requiring all private plans to provide personalized out-of-pocket price data to enrollees would reduce total health spending by an estimated$18 billion over the next decade. While $18 billion is a substantial dollar amount, it is less than a tenth of a percent of the$40 trillionin total projected health spending over the same period. In contrast, using state all-payer claims databases to gather and report hospital-specific prices might reduce spending by an estimated $61 billion over 10 years.The effects of price transparency depend critically on the intended audience, the decision-making context and how prices are presented. And the impact of price transparency can be greatly amplified if target audiences are able and motivated to act on the information. Simply providing prices is insufficient to control spending without other shifts in healthcare financing, including changes in benefit design to make patients more sensitive to price differences among providers and alternative treatments. Other reforms that can amplify the impact of price transparency include shifting from fee-for-service payments that reward providers for volume to payment methods that put providers at risk for spending for episodes of care or defined patient populations. While price transparency alone seems unlikely to transform the healthcare system, it can play a needed role in enabling effective reforms in value-based benefit design and provider payment

Electronic Health Records: An International Perspective on "Meaningful Use"

Examines the extent of meaningful use of electronic health records in Denmark, New Zealand, and Sweden, including sharing information with organizations, health authorities, and patients. Outlines challenges of and insights into encouraging U.S. adoption

The Great Medical Malpractice Hoax: NPDB Data Continue to Show Medical Liability System Produces Rational Outcomes

Despite claims by business and medical lobbying interests and the Bush administration, there is no medical malpractice lawsuit crisis in America, according to this report by Public Citizen. The report dispels oft-repeated myths of dwindling doctors and spiraling insurance premiums used to support limits on the ability of injured patients to seek redress in the courts.The real problems are a lack of attention to patient safety, the high incidence of preventable medical error and the lack of accountability for a small set of doctors who account for a majority of medical malpractice payments, the report reveals. The report also presents several recommendations for Congress, state governments and hospitals to reduce health care costs and save lives.Public Citizen reviewed publicly available information from 1990 to 2005 from the federal government's National Practitioner Data Bank (NPDB), which contains data on malpractice payments made on behalf of doctors as well as disciplinary actions taken against them by state medical boards or hospitals. According to the analysis, the total number of malpractice payments paid on behalf of doctors, with judgments and settlements, declined 15.4 percent between 1991 and 2005, and the number of payments per 100,000 people in the country declined more than 10 percent. In addition, the average payment for a medical malpractice verdict, adjusted for inflation, dropped eight percent in the same period.The numbers show that patients do not win large jury awards for less serious claims but that payments usually correspond to the severity of injury. In 2005, less than three percent of all payments were for million-dollar verdicts and more than 64 percent of payments involved death or significant injury -- while less than one-third of one percent were for "insignificant injury.

Organizing the U.S. Health Care Delivery System for High Performance

Analyzes the fragmentation of the healthcare delivery system and makes policy recommendations -- including payment reform, regulatory changes, and infrastructure -- for creating mechanisms to coordinate care across providers and settings

Organizing for Higher Performance: Case Studies of Organized Delivery Systems

Offers lessons learned from healthcare delivery systems promoting the attributes of an ideal model as defined by the Fund: information continuity, care coordination and transitions, system accountability, teamwork, continuous innovation, and easy access

Barriers to Entering Medical Specialties

Non-primary care physicians earn considerably more than primary care physicians in the United States. I examine a number of explanations for the persistent high rates of return to medical specialization and conclude that barriers to entry may be creating an economic shortage of non-primary care physicians. I estimate that medical students would be willing to pay teaching hospitals to obtain residency positions in dermatology, general surgery, orthopedic surgery, and radiology rather than receiving the mean residents' salary of $34,000. In the simulation, the quantity of residents in these four specialties would increase by an estimated six to 30 percent, rates of return would fall substantially, and teaching hospitals would save an estimated$0.6 to $1.0 billion per year in labor costs.

HITECH Revisited

Assesses the 2009 Health Information Technology for Economic and Clinical Health Act, which offers incentives to adopt and meaningfully use electronic health records. Recommendations include revised criteria, incremental approaches, and targeted policies