179 research outputs found

    Doing Better by Doing Less: Approaches to Tackle Overuse of Services

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    Experts have projected that as much as a third of U.S. health care spending is unnecessary and wasteful. Of the estimated 765billionofhealthcaredollarswastedin2009,aquarter−−765 billion of health care dollars wasted in 2009, a quarter -- 210 billion -- was spent on the overuse of services, which includes services that are provided more frequently than necessary or services that are higher-cost, but no more beneficial than lower-cost alternatives.This paper provides a summary of the problem of overuse in the U.S. health care system. The analysis gives an overview of the provision of medically inappropriate and unnecessary services that drive up health care spending without making a positive impact on patients' health outcomes. It also describes approaches that have already been used to address overuse of health care services and outlines the broader payment reforms needed to minimize incentives to overdiagnose and overtreat.This overuse of services has implications for both health care costs and outcomes. There is substantial variation in the level of inappropriate use across different health care services. Research shows that the rates at which particular procedures, tests, and medications were performed or prescribed when clinically inappropriate ranged from a low of 1 percent to a high of 89 percent

    How Does the Quality of U.S. Health Care Compare Internationally?

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    Explores definitions of high-quality health care and evidence for comparing U.S. health care with care in other countries. Discusses measures of specific types of care; findings on over-utilization, patient safety, and uninsurance; and implications

    How Will Comparative Effectiveness Research Affect the Quality of Health Care?

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    Outlines how the use of comparative effectiveness research on the relative merits of a healthcare intervention compared with others could improve quality of care and outcomes. Presents challenges in enhancing CE research and expanding its adoption

    An inquiry into good hospital governance: A New Zealand-Czech comparison

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    BACKGROUND: This paper contributes to research in health systems literature by examining the role of health boards in hospital governance. Health care ranks among the largest public sectors in OECD countries. Efficient governance of hospitals requires the responsible and effective use of funds, professional management and competent governing structures. In this study hospital governance practice in two health care systems – Czech Republic and New Zealand – is compared and contrasted. These countries were chosen as both, even though they are geographically distant, have a universal right to 'free' health care provided by the state and each has experienced periods of political change and ensuing economic restructuring. Ongoing change has provided the impetus for policy reform in their public hospital governance systems. METHODS: Two comparative case studies are presented. They define key similarities and differences between the two countries' health care systems. Each public hospital governance system is critically analysed and discussed in light of D W Taylor's nine principles of 'good governance'. RESULTS: While some similarities were found to exist, the key difference between the two countries is that while many forms of 'ad hoc' hospital governance exist in Czech hospitals, public hospitals in New Zealand are governed in a 'collegiate' way by elected District Health Boards. These findings are discussed in relation to each of the suggested nine principles utilized by Taylor. CONCLUSION: This comparative case analysis demonstrates that although the New Zealand and Czech Republic health systems appear to show a large degree of convergence, their approaches to public hospital governance differ on several counts. Some of the principles of 'good governance' existed in the Czech hospitals and many were practiced in New Zealand. It would appear that the governance styles have evolved from particular historical circumstances to meet each country's specific requirements. Whether or not current practice could be improved by paying closer attention to theoretical models of 'good governance' is debatable

    Altered multisensory temporal integration in obesity

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    Eating is a multisensory behavior. The act of placing food in the mouth provides us with a variety of sensory information, including gustatory, olfactory, somatosensory, visual, and auditory. Evidence suggests altered eating behavior in obesity. Nonetheless, multisensory integration in obesity has been scantily investigated so far. Starting from this gap in the literature, we seek to provide the first comprehensive investigation of multisensory integration in obesity. Twenty male obese participants and twenty male healthy-weight participants took part in the study aimed at describing the multisensory temporal binding window (TBW). The TBW is defined as the range of stimulus onset asynchrony in which multiple sensory inputs have a high probability of being integrated. To investigate possible multisensory temporal processing deficits in obesity, we investigated performance in two multisensory audiovisual temporal tasks, namely simultaneity judgment and temporal order judgment. Results showed a wider TBW in obese participants as compared to healthy-weight controls. This holds true for both the simultaneity judgment and the temporal order judgment tasks. An explanatory hypothesis would regard the effect of metabolic alterations and low-grade inflammatory state, clinically observed in obesity, on the temporal organization of brain ongoing activity, which one of the neural mechanisms enabling multisensory integration

    An Outlier-Robust Extreme Bounds Analysis of the Determinants of Health-Care Expenditure Growth

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    Hartwig (2008) has presented empirical evidence that the difference between real wage growth and productivity growth at the macroeconomic level is a robust explanatory variable for deflated health-care expenditure growth in OECD countries. In this paper, we test whether this finding is robust to the inclusion of additional covariates, applying different versions of Extreme Bounds Analysis (EBA) to data for 33 OECD countries over the period 1970-2010. As far as it is statistically feasible, all macroeconomic and institutional determinants of health-care expenditure growth that have been suggested in the literature are included in the EBA. Furthermore, we analyse to what extent outliers in the data influence the results using an outlier-robust MM estimator. Our results confirm Hartwig's earlier finding. A number of additional both covariate- and outlier-robust determinants are also identified
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