scholarly journals Does health care spending improve health outcomes? Evidence from English programme budgeting data

2008 ◽  
Vol 27 (4) ◽  
pp. 826-842 ◽  
Author(s):  
Stephen Martin ◽  
Nigel Rice ◽  
Peter C. Smith
1994 ◽  
Vol 10 (3) ◽  
pp. 376-381 ◽  
Author(s):  
Akira Babazono ◽  
Alan L. Hillman

AbstractDoes increased spending improve health outcomes? We analyzed 1988 data from OECD countries to determine how key health care indexes correlate with health care outcomes. Total health care spending per capita and outpatient and inpatient utilization are not related to health outcomes. How our resources are allocated seems to be more important than how much money is actually spent.


2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S499-S500
Author(s):  
Traci L Wilson ◽  
Suzanne R Kunkel ◽  
Jane Straker ◽  
Marisa Scala-Foley ◽  
Elizabeth Blair

Abstract Unmet social needs negatively affect individual and population health, and better integration of community-based supports and health systems is a promising approach to improve health outcomes and avoid unnecessary health care use. Community-based organizations (CBOs) such as Area Agencies on Aging (AAAs) and Centers for Independent Living (CILs), as providers and coordinators of social services, are well-positioned within their communities to coordinate care and provide for unmet social needs. Partnerships between CBOs and health care entities have clear potential to improve health care outcomes while also reducing expenditures. This paper will present a cross-sectional analysis of a national survey of AAAs, CILS, and other CBOs at two time points (2017: n=593; 2018: n=763) to understand the extent, type, and evolution of CBO engagement with health care providers. In addition, longitudinal analysis (n=374) shows movement at the organization level: 33% of organizations who did not have a contract at T1 but were pursuing one had achieved a contract by T2. This presentation will: describe details of the services delivered, contracting arrangements, and populations served under CBO/health care contracts, as well as challenges experienced by CBOs; examine differences by state and organizational structure; and discuss the implications of state policy on integrated care and contracting.


2017 ◽  
Vol 43 (4) ◽  
pp. 426-467 ◽  
Author(s):  
Michael W. King

Despite the U.S. substantially outspending peer high income nations with almost 18% of GDP dedicated to health care, on any number of statistical measurements from life expectancy to birth rates to chronic disease,1 the U.S. achieves inferior health outcomes. In short, Americans receive a very disappointing return on investment on their health care dollars, causing economic and social strain.2 Accordingly, the debates rage on: what is the top driver of health care spending? Among the culprits: poor communication and coordination among disparate providers, paperwork required by payors and regulations, well-intentioned physicians overprescribing treatments, drugs and devices, outright fraud and abuse, and medical malpractice litigation.Fundamentally, what is the best way to reduce U.S. health care spending, while improving the patient experience of care in terms of quality and satisfaction, and driving better patient health outcomes? Mergers, partnerships, and consolidation in the health care industry, new care delivery models like Accountable Care Organizations and integrated care systems, bundled payments, information technology, innovation through new drugs and new medical devices, or some combination of the foregoing? More importantly, recent ambitious reform efforts fall short of a cohesive approach, leaving fundamental internal inconsistencies across divergent arms of the federal government, raising the issue of whether the U.S. health care system can drive sufficient efficiencies within the current health care and antitrust regulatory environments.While debate rages on Capitol Hill over “repeal and replace,” only limited attention has been directed toward reforming the current “fee-for-service” model pursuant to which providers are paid for volume of care rather than quality or outcomes. Indeed, both the Patient Protection and Affordable Care Act (“ACA”)3 and proposals for its replacement focus primarily on the reach and cost of providing coverage for health care, rather than specifics for the delivery of health care.4 With the U.S. expenditures on health care producing inferior results, experts see consolidation and alternatives to fee-for-service as fundamental to reducing costs.5 Integrating care coordination and delivery and increasing scale to drive efficiencies allows organizations to benefit from shared savings and relationships with payors and vendors.6 Deloitte forecasts that, by 2024, the current health system landscape—which includes roughly 80 national health systems, 275 regional systems, 130 academic medical centers, and 1,300 small community systems—will morph into just over 900 multi-hospital systems.7Even though health care market and payment reforms encourage organizations to consolidate and integrate, innovators must proceed with extreme caution. Health care organizations attempting to drive efficiencies and bring down costs through mergers may run afoul of numerous federal and state laws and regulations.8 Calls for updates or leniency in these laws are growing, including the possible recognition of an “Obamacare defense” to antitrust restrictions9 and speculation that laws restricting physicians from having financial relationships will be repealed, ostensibly to allow sharing of the rewards reaped from coordinated care.10 In the meantime, however, absent specific waivers or exemptions, all the usual rules and regulations apply, including antitrust constraints,11 physician self-referral12 and anti-kickback laws and regulations,13 state fraud and abuse restrictions,14 and more. In short, a maelstrom of conflicting political prescriptions, health care regulations, and antitrust restrictions undermine the ability of innovators to achieve efficiencies through joint ventures, transactions, innovative models, and other structures.This article first considers the conflicting positions taken by the United States government with respect to achieving efficiencies in health care under the ACA and alternative delivery models, on the one hand, and health care regulatory enforcement and antitrust enforcement, on the other. At almost a fifth of the U.S. economy,15 health care arguably has grown ungovernable, exceeding the ability of any one law or branch of government to create or implement coherent reform. Indeed, the article posits that although the ACA reformed and expanded access to health care, it failed to transform the way health care is delivered beyond limited “demonstration projects”, leaving fee-for-service intact. Nonetheless, even with limited rather than revolutionary goals, the ACA still lacks sufficient authority across disparate branches of government to achieve its stated goals. The article then examines the conflicting positions of the various United States regulatory schemes and enforcement agencies governing health care, and whether they can be reconciled with the stated goal of the government, often referred to as the “Triple Aim”:16 improving quality of care, improving population health, and lowering health care costs. It examines fundamental, systemic challenges to achieving the “Triple Aim”: longstanding health care regulatory laws that impede adoption of innovative delivery systems beyond their current “demonstration project” status, and antitrust enforcement that promotes waste and duplication in densely populated areas, while preventing necessary consolidation to more efficiently reach rural areas. The article concludes with recommendations for promoting efficiency through modest reconciliation of the conflicting goals and regulations in health care.


Pained ◽  
2020 ◽  
pp. 107-110
Author(s):  
Michael D. Stein ◽  
Sandro Galea

This chapter addresses overspending in health care. Americans spend half as many days in hospital as persons living in other high-income countries. They take fewer pills per person, and they have fewer doctors per capita. Yet Americans spend two to three times as much on health care as other countries, and they have poorer health outcomes. This is because they overpay. Talking about overspending suggests that certain partners in the health system are charging more than they should. Since about one third of health care spending is related to hospitals and another 20% is paid to health care providers, these are the obvious culprits. If Americans spent less on hospitals and clinicians, they could spend more on the social services required to prevent or reduce illness, to make their entire population healthier.


2003 ◽  
Vol 14 (1) ◽  
pp. 143-152 ◽  
Author(s):  
Garry F. Barrett ◽  
Robert Conlon

We use data from the ABS National Health Surveys for 1989/95 and 1995 to examine differences in health care expenditures and health outcomes by family structure. We find that, on average, female single parents tend to experience poorer health outcomes, and exhibit more ‘risky’ health behaviours (particularly smoking), compared to adults in ‘two-parent’ families. Children in female single parent families tend to have more chronic health conditions than children in two-parent families. We also find that single parent families tend to spend a lower proportion of their income on health care, while receiving fewer indirect health care resources through government. Policies that may help reduce the economic and health disadvantages facing single parent families are considered.


2018 ◽  
Vol 17 (5-6) ◽  
pp. 557-574
Author(s):  
Jehad Yasin ◽  
Azmat Gani

AbstractEmpirical studies investigating the direct effects of private health expenditure on child health outcomes for the world’s poorest countries are rare. This study attempts to fill this gap. The methodology includes empirical estimations of cross-country annual data for the period 1995-2010 for several low-income countries. The results obtained through fixed-effects estimation provide strong evidence that private health care spending has the expected negative and statistically significant effect on neonatal, infant and under-five mortality rates. The findings also reveal that other than private health care spending, income, nutrition, urbanization, family size, immunization against measles, and access to an improved water supply and sanitation as other strong determinants of neonatal, infant and under-five mortality rates. Some policy implications are drawn.


Author(s):  
Kicky G. van Leeuwen ◽  
Maarten de Rooij ◽  
Steven Schalekamp ◽  
Bram van Ginneken ◽  
Matthieu J. C. M. Rutten

AbstractSince the introduction of artificial intelligence (AI) in radiology, the promise has been that it will improve health care and reduce costs. Has AI been able to fulfill that promise? We describe six clinical objectives that can be supported by AI: a more efficient workflow, shortened reading time, a reduction of dose and contrast agents, earlier detection of disease, improved diagnostic accuracy and more personalized diagnostics. We provide examples of use cases including the available scientific evidence for its impact based on a hierarchical model of efficacy. We conclude that the market is still maturing and little is known about the contribution of AI to clinical practice. More real-world monitoring of AI in clinical practice is expected to aid in determining the value of AI and making informed decisions on development, procurement and reimbursement.


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