June 5, 2011

McClellan en estat pur

Reforming Payments to Healthcare Providers: The Key to Slowing Healthcare Cost Growth While Improving Quality?

En McClellan mostra en un article tot allò que pensa sobre com pagar als proveïdors i no va poder fer quan era el màxim responsable de Medicare. Repàs exhaustiu sobre el tema. Article clau de JEP, d'utilitat per al sector privat i públic d'aquí. Me'l guardo.
Destaco el que m'interessa ara:
The development of broader “bundles” for payment across multiple providers is a very active and challenging issue in payment reform. The opportunity
for improving quality while lowering costs could be substantial. For example,
18 percent of Medicare beneficiaries are readmitted to the hospital within 30 days of discharge, mostly with complications that were potentially preventable, which may be in part the result of a lack of payment incentives for hospitals, post-acute care providers, and physicians to coordinate care across the transition in settings (Medicare Payment Advisory Commission, 2008). The key tradeoff is how to, on the one side, provide incentives to coordinate care and to improve effifi ciency over a broader range of services for a patient, while on the other side not create too much pressure to reduce the provision of costly but valuable treatments or to avoid complex, high-risk patients. Reflfl ecting this tradeoff, Medicare generally continues to pay for outpatient hospital procedures and visits, drugs administered in medical offifi ces, physician visits and treatments, lab services, and imaging procedures on a purely fee-for-service basis using prices regulated by complex statutory formulas.

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