Cost of Care

Objective: To study the association between Electronic Health Record (EHR)/Computerized Physician Order Entry (CPOE) provider price display, and domains of healthcare quality (efficiency, effective care, patient centered care, patient safety, equitable care, and timeliness of care). Methods: Randomized and non-randomized studies assessing the relationship between healthcare quality domains and EHR/CPOE provider price display published between 1/1/1980 to 2/1/2018 were included...

Eight basic payment methods are applicable across all types of health care. Each method is defined by the unit of payment (per time period, beneficiary, recipient, episode, day, service, dollar of cost, or dollar of charges). These methods are more specific than common terms, such as capitation, fee for service, global payment, and cost reimbursement. They also correspond to the division of financial risk between payer and provider, with each method reflecting a risk factor within the health care spending identity...

Implementing patient cost sharing in the form of copayments, coinsurance, and deductibles is one of the more reliable methods for reducing health care costs. But imposing cost sharing reduces patients' demand for medical care, which sets the interests of insurers at odds with the interests of..

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No abstract text is available yet for this article.

The Accreditation Council for Graduate Medical Education mandates that training physicians "incorporate considerations of cost awareness" into practice. However, medical education has traditionally avoided addressing costs, and most residency programs currently lack curricula to fulfill this requirement. With the recent widespread emphasis on unsustainable costs, inefficiencies, and waste in healthcare, the need to appropriately train physicians in this domain is increasingly apparent. In this article, we describe the implementation of a resident-led, case-based cost awareness curriculum for medicine residents at the University of California, San Francisco, sharing our keys to success and defining guiding principles...

The USA has exceptional levels of health-care expenditure, but growth has slowed dramatically in recent years, amidst major efforts to close the coverage gap with other countries of the Organisation for Economic Co-operation and Development (OECD). We reviewed expenditure trends and key policies since 2000 in the USA and five other high-spending OECD countries. Higher health-sector prices explain much of the difference between the USA and other high-spending countries, and price dynamics are largely responsible for the slowdown in expenditure growth...

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BACKGROUND: Although prior randomized trials have demonstrated that procalcitonin-guided antibiotic therapy effectively reduces antibiotic use in patients with community-acquired pneumonia (CAP), uncertainties remain regarding use of procalcitonin protocols in practice. OBJECTIVE: To estimate the cost-effectiveness of procalcitonin protocols in CAP. DESIGN: Decision analysis using published observational and clinical trial data, with variation of all parameter values in sensitivity analyses...

BACKGROUND: Two clinical trials suggest that procalcitonin-guided antibiotic therapy can safely reduce antibiotic prescribing in outpatient management of acute respiratory tract infections (ARTIs) in adults. Yet, it remains unclear whether procalcitonin testing is cost-effective in this setting. OBJECTIVE: To evaluate the cost-effectiveness of procalcitonin-guided antibiotic therapy in outpatient management of ARTIs in adults. DESIGN: Cost-effectiveness model based on results from two published European clinical trials, with all parameters varied widely in sensitivity analyses...

BACKGROUND: The Massachusetts 2006 health care reform has been called a model for the Affordable Care Act. The law attained near-universal insurance coverage and increased access to care. Its effect on population health is less clear. OBJECTIVE: To determine whether the Massachusetts reform was associated with changes in all-cause mortality and mortality from causes amenable to health care. DESIGN: Comparison of mortality rates before and after reform in Massachusetts versus a control group with similar demographics and economic conditions...

Primary care organizations must transform care delivery to realize the Institute for Healthcare Improvement's Triple Aim of better healthcare, better health, and lower healthcare costs. However, few studies have considered the financial implications for primary care practices engaged in transformation. In this qualitative, comparative case study, we examine the practice-level personnel and nonpersonnel costs and the benefits involved in transformational change among 12 primary care practices participating in North Carolina's Improving Performance in Practice (IPIP) program...

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A dangerous distortion of priorities seems to be currently apparent in the dominant approaches to major public health problems, including cardiovascular disease, diabetes, obesity, cancer and some infectious diseases. Relevant examples suggest an apparently inappropriate tendency to prioritise technocratic, partial solutions rather than confronting their true behavioural and structural determinants. Technically oriented preventive medicine often takes excessive precedence over simpler, more sensible approaches to modify lifestyles, the environment and the social structure...

The Choosing Wisely campaign, with participating medical societies, spotlighted a list of 135 potentially unnecessary procedures. Critics are questioning whether patients and physicians are seeing the guidelines and if they are leading to any changes. But Dr. Glen Stream, AAFP board chairman, says his group's participation was the right choice. "It's a proactive stance, driven by the medical profession, and it really does make conversations with patients easier."

More than 40 medical specialties have identified "Choosing Wisely" lists of five overused or low-value services. But these services vary widely in potential impact on care and spending, and specialty societies often name other specialties' services as low value.

A central health care–related policy question for the United States is whether the federal government's role in financing graduate medical education (GME) increases the number of physicians trained and influences their specialty choices by subsidizing the cost of training. Total federal GME..

Most economists seem to view graduate medical education (GME) — training graduates of medical schools to become independently practicing physicians — as a stand-alone effort, without considering its relationship to other activities of major teaching hospitals within academic medical centers..

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