Mandatory and affordable health insurance

This paper asserts that America's health care system is broken and cannot be repaired with timid half-measures. It suggests that we need both universal coverage and a more efficient delivery system and that these are not competing objectives: Each is necessary to make the other possible. It further states that if we do not make health care more affordable and our delivery system more efficient and sustainable, a majority of Americans will be uninsured in short order. And the persistence of millions of uninsured impairs the efficiency we need to make health care and insurance affordable for all. Thus, contrary to conventional wisdom, this paper asserts that both universal coverage and delivery system reform must be pursued simultaneously.Insurance, Health ; Medical care

Baylor Health Care System: High-Performance Integrated Health Care

Describes the organization's implementation of a quality infrastructure and its strategies, interventions to improve clinical preventive services, training, and adoption of electronic health records and other quality innovations. Outlines lessons learned

Hill Physicians Medical Group: Independent Physicians Working to Improve Quality and Reduce Costs

Describes how a group of independent physicians improved clinical outcomes through an innovative incentive system -- combining pay-for-performance and fee-for-service -- implemented with quality improvement processes. Discusses lessons learned

Workers Without Health Insurance: Who Are They and How Can Policy Reach Them?

Offers a detailed picture of the 16 million uninsured working population in the U.S., identifies potential causes and effects, and examines the policy implications and options

The CareFirst Patient-Centered Medical Home Program: Cost and Utilization Effects in Its First Three Years

Background Enhanced primary care models have diffused slowly and shown uneven results. Because their structural features are costly and challenging for small practices to implement, they offer modest rewards for improved performance, and improvement takes time. Objective To test whether a patient-centered medical home (PCMH) model that significantly rewarded cost savings and accommodated small primary care practices was associated with lower spending, fewer hospital admissions, and fewer emergency room visits. Design We compared medical care expenditures and utilization among adults who participated in the PCMH program to adults who did not participate. We computed difference-in-difference estimates using two-part multivariate generalized linear models for expenditures and negative binomial models for utilization. Control variables included patient demographics, county, chronic condition indicators, and illness severity. Participants A total of 1,433,297 adults aged 18–64 years, residing in Maryland, Virginia, and the District of Columbia, and insured by CareFirst for at least 3 consecutive months between 2010 and 2013. Intervention CareFirst implemented enhanced fee-for-service payments to the practices, offered a large retrospective bonus if annual cost and quality targets were exceeded, and provided information and care coordination support. Measures Outcomes were quarterly claims expenditures per member for all covered services, inpatient care, emergency care, and prescription drugs, and quarterly inpatient admissions and emergency room visits. Results By the third intervention year, annual adjusted total claims payments were $109 per participating member (95$192, −$27), or 2.8 % lower than before the program and compared to those who did not participate. Forty-two percent of the overall decline in spending was explained by lower inpatient care, emergency care, and prescription drug spending. Much of the reduction in inpatient and emergency spending was explained by lower utilization of services. Conclusions A PCMH model that does not require practices to make infrastructure investments and that rewards cost savings can reduce spending and utilization

Wage-risk premiums and workmen's compensation : a refinement of estimates of compensating wage-differential / BEBR No. 749

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