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

Method of analysis for compressible flow through mixed-flow centrifugal impellers of arbitrary design

A method is presented for analysis of the compressible flow between the hub and the shroud of mixed-flow impellers of arbitrary design. Axial symmetry was assumed, but the forces in the meridional (hub to shroud) plane, which are derived from tangential pressure gradients, were taken into account. The method was applied to an experimental mixed-flow impeller. The analysis of the flow in the meridional plane of the impeller showed that the rotational forces, the blade curvature, and the hub-shroud profile can introduce severe velocity gradients along the hub and the shroud surfaces. Choked flow at the impeller inlet as determined by the analysis was verified by experimental results

The politics of linking educational research, policy, and practice: The case of improving educational quality in Ghana, Guatemala and Mali

This paper examines the political dimension of the educational research undertaken by Ghanian,\ud Guatemalan, and Malian teams as part of the 1991 to 1996, USAID-funded “Improving Educational\ud Quality” (IEQ) project. The following questions are addressed: (a) why were (or were not) aspects\ud of the educational reforms studied by the researchers; (b) why were (or were not) research findings\ud used in decision-makingabout the educationalpolicies and practices associatedwith the reforms; and\ud (c) why were particular institutional arrangements and funding levels constituted for the research and\ud dialogue activity. In offering answers to these questions, attentionis paid to local, national, and global\ud power relations and resource distributions

The Equivalence Problem for Deterministic MSO Tree Transducers is Decidable

It is decidable for deterministic MSO definable graph-to-string or graph-to-tree transducers whether they are equivalent on a context-free set of graphs

The assault on postcommunist courts

In the last 25 years, constitutional courts have been major players in the governance of Central and Eastern Europe, and were arguably the most important defenders of the rule of law in the region. Yet the last few years have exposed the institutional fragility of constitutional courts in the face of illiberal democracy, as several countries have moved to pack the courts. Without quick and sustained pressure, the dismantling of the hard fought freedoms associated with the rule of law will succeed, and we will again speak of an Eastern Europe that is closer to Russia than to the West