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

Experts have projected that as much as a third of U.S. health care spending is unnecessary and wasteful. Of the estimated $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?

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?

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

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

Pharmaceutical Pricing and Reimbursement Policies in Mexico

This paper examines aspects of the policy environment and market characteristics of Mexico's pharmaceutical sector, and assesses the degree to which Mexico has achieved certain policy goals. This paper questions the effectiveness of the maximum price regulation. It notes that retail prices for pharmaceuticals are relatively high, although proximity to the United States may have some influence. Although not wholly successful in containing overall drug expenditures, the federal government can claim some measure of success for the public sector market. A high reliance on out-of-pocket spending brings into question the sustainability of financing pharmaceuticals in Mexico. It also contributes to greater inequality, although a new health insurance scheme, the Seguro Popular, is addressing the latter with some success as it endeavours to provide coverage for the half of Mexico's population without health insurance. Finally, the paper acknowledges the government.s efforts in improving efficiency of expenditures and quality of care through new bioequivalency requirements for generics. However, an unintended side-effect of the loss of low cost, non-bioequivalent drugs may be higher average prices for pharmaceuticals. Le présent document examine certains aspects touchant l'environnement politique et les caractéristiques du marché du secteur pharmaceutique du Mexique, et évalue la mesure dans laquelle le Mexique a atteint certains objectifs politiques. Il met en doute l'efficacité de la réglementation sur les prix maximums et fait observer que les prix de détail des produits pharmaceutiques sont relativement élevés, mais que cette situation est peut-être due en partie à la proximité des États-Unis. Bien que le gouvernement fédéral n'ait pas totalement réussi à maîtriser les dépenses globales de médicaments, il peut revendiquer d'un certain succès en ce qui concerne le marché du secteur public. Un large recours aux versements directs amène à s'interroger sur la viabilité du financement des produits pharmaceutiques au Mexique. Un tel recours contribue également à un accroissement des inégalités, bien qu'un nouveau dispositif d'assurance maladie, le Seguro Popular, remédie dans une certaine mesure à ce problème en s'efforçant d'offrir une couverture maladie à la moitié de la population du Mexique qui n'est pas assurée. Enfin, le document fait état des efforts déployés par le gouvernement pour rationaliser les dépenses et améliorer la qualité des soins moyennant l'adoption de nouvelles dispositions en matière de bioéquivalence des médicaments génériques. Cela étant, la disparition des médicaments peu coûteux non bioéquivalents risque d'avoir pour effet involontaire une augmentation des prix moyens des produits pharmaceutiques.Mexico, pricing, pharmaceutical policy, reimbursement, market, marché, remboursement, fixation des prix, politique du médicament, Mexique