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Gaffney A, McCormick D, Himmelstein G, Woolhandler S, Himmelstein DU. Demand and Supply Drivers of Medicare and Non-Medicare Health Spending: An Analysis of U.S. States, 1991-2019. INTERNATIONAL JOURNAL OF SOCIAL DETERMINANTS OF HEALTH AND HEALTH SERVICES 2024:27551938241258399. [PMID: 39053017 DOI: 10.1177/27551938241258399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
Abstract
For the last four decades, policymakers have attempted to control the United States's high health care costs by reducing patients' demand for care (e.g., by imposing managed-care restrictions or high costs on patients at the time of use). Yet studies based mostly on data from the public Medicare program, which covers mostly elderly Americans, suggest that supply (e.g., number of physicians or hospital beds) rather than demand drives aggregate service use and, hence, costs. Using variation between U.S. states in per enrollee Medicare spending versus per capita spending of all other (non-Medicare) individuals, we find that greater supply boosts costs for the entire population. Furthermore, we find that factors that suppress demand in the non-Medicare population do reduce non-Medicare health care spending, but simultaneously increase Medicare spending. This suggests that for a given supply of medical resources, suppressing demand for one group of patients may produce a compensatory increase in provision of care to those whose demand has not been suppressed. Health planning to assure adequate medical resources where they are needed while preventing excess supply where it is duplicative and wasteful is likely a more effective cost control strategy than the imposition of managed-care restrictions or imposing higher costs onto patients seeking care.
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Affiliation(s)
- Adam Gaffney
- Department of Medicine, Cambridge Health Alliance, Cambridge, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Danny McCormick
- Department of Medicine, Cambridge Health Alliance, Cambridge, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Gracie Himmelstein
- Office of Population Research, Princeton University, Princeton, NJ, USA
- Department of Medicine, University of California Los Angeles Health, Los Angeles, USA
| | - Steffie Woolhandler
- Department of Medicine, Cambridge Health Alliance, Cambridge, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Hunter College, City University of New York, New York, USA
- Public Citizen Health Research Group, Washington, DC, USA
| | - David U Himmelstein
- Department of Medicine, Cambridge Health Alliance, Cambridge, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Hunter College, City University of New York, New York, USA
- Public Citizen Health Research Group, Washington, DC, USA
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Psychometric properties of public trust in Covid-19 control and prevention policies questionnaire. BMC Public Health 2022; 22:1959. [PMID: 36280814 PMCID: PMC9589749 DOI: 10.1186/s12889-022-14272-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 09/14/2022] [Accepted: 09/28/2022] [Indexed: 11/10/2022] Open
Abstract
Background Public trust is a crucial concept in the COVID-19 pandemic, which determines public adherence with preventive rules as a success factor for disease management. This study aimed to develop and validate a tool to measure public trust in COVID-19 control and prevention policies (COV-Trust tool). Methods This is a psychometric study that was conducted in 2020 (March-August). A primary tool was developed through literature review, in-depth interviews with experts and expert panel meetings. Content and construct validity was evaluated using content validity index (CVI) and content validity ratio (CVR) indexes and exploratory and confirmatory factor analysis, respectively. Cronbach α coefficient was calculated to determine the internal consistency. Results A 28-item questionnaire with seven factors was developed. Factors included macro policy-making and management of pandemic, pandemic control policies implementing at all levels and their effectiveness, providing protective equipment and medicine for hospitals and public, prevention of negative socio-economic consequences of the pandemic, public participation, informing and public education and public behavior. The questionnaire reliability was calculated to be α = 0.959. Based on the experts’ opinion, tool content validity was estimated to be CVR = 0.73, CVI = 0.89. RMSEA = 0.07 revealed a good model fit as the confirmatory factor analysis results for the tool. Conclusion COV-Trust tool is a well-fit tool to be used during this pandemic for improving policies effectiveness and could be used in similar situations as it determines the success of public health interventions. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-14272-9. Investigating public trust during the outbreak of Covid-19 is of utmost important for both research and policy making perspectives. COV-Trust tool (Seven factors and 31 items) was developed and validated. COV-Trust tool comprehensively assesses public trust in various aspects of policies and their determinants and can provide valuable information for promoting the effectiveness of policies.
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Utilization and Reimbursement Trends Based on Certificate of Need in Single-level Cervical Discectomy. J Am Acad Orthop Surg 2021; 29:e518-e522. [PMID: 33273408 DOI: 10.5435/jaaos-d-19-00224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 10/05/2020] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVE To compare utilization and reimbursement for cervical discectomy in certificate of need (CON) and non-CON states. SUMMARY OF BACKGROUND DATA Cervical discectomy is a commonly performed procedure, but little is known about utilization and reimbursement patterns in the CON setting. INTRODUCTION Cervical discectomy is increasingly used and remains effective. Increasing healthcare costs have led to decreased reimbursement and a push toward outpatient procedures. CON programs were established to ensure that expansion of medical facilities were within acceptable use; however, the literature on their impact in spine surgery is limited. The purpose of this study was to examine the impact of CON status on both reimbursement and utilization in cervical decompression in both inpatient and outpatient settings. METHODS We analyzed a private payer and Medicare database from 2007 to 2015. All single-level cervical discectomies were selected then split into CON and non-CON states. Each group was then further split into inpatient and outpatient. Utilization and reimbursement were analyzed using the compound annual growth rate (CAGR), with reimbursement adjusted by the US Bureau of Labor Statistics Consumer Price Index. RESULTS We identified 1,580 single level cervical decompressions in our study period: 888 were done in the inpatient setting, whereas 692 were done in the outpatient setting. Adjusted reimbursement only increased in the non-CON outpatient setting, with a CAGR of 2.0%. All other settings had decreased reimbursement. Utilization increased across all four settings, with the highest growth seen in the CON outpatient setting, with a CAGR of 12.7%. The highest average reimbursement was in the non-CON outpatient setting at $4,237. DISCUSSION Cervical discectomy is seeing increased utilization most rapidly in the outpatient setting, although reimbursement is declining with the exception of procedures done in the non-CON outpatient setting. Surgeons should be aware of these trends in the changing healthcare economic climate. STUDY DESIGN A retrospective database review.
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Schultz OA, Shi L, Lee M. Assessing the Efficacy of Certificate of Need Laws Through Total Joint Arthroplasty. J Healthc Qual 2021; 43:e1-e7. [PMID: 33252369 DOI: 10.1097/jhq.0000000000000286] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Lawmakers suggest Certificate of Need (CON) laws' main goals are increasing access to healthcare, increasing quality of healthcare, and decreasing healthcare costs. This retrospective database study aims to evaluate the effectiveness of CON through analysis of total knee, hip, and shoulder arthroplasty (TKA, THA, and TSA, respectively). A review was performed using the Humana Insurance PearlDiver national database from 2007 to 2015. Access to care was approximated by the rates of total joint arthroplasty (TJA) in patients diagnosed with arthritis to the corresponding joint. The quality of care was assessed using complication rates after TJA. The total cost of TJA was approximated from average reimbursement to the healthcare facility per procedure. Patients in states without CON programs received TKA, THA, and TSA more frequently (p < .0001, p = .250, p = .019). No significant difference was found in studied complication rates between CON and non-CON states. Similarly, there was no trend found when comparing the cost of each procedure in CON versus non-CON states. These findings are consistent with other recent studies detailing the impact of CON regulation on THA and TKA. The apparent nonsuperiority of CON states in achieving their purported goals may call into question the effectiveness of additional bureaucracy and regulation, suggesting a need for further examination.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Arthroplasty, Replacement, Hip/economics
- Arthroplasty, Replacement, Hip/legislation & jurisprudence
- Arthroplasty, Replacement, Hip/statistics & numerical data
- Arthroplasty, Replacement, Knee/economics
- Arthroplasty, Replacement, Knee/legislation & jurisprudence
- Arthroplasty, Replacement, Knee/statistics & numerical data
- Certificate of Need/legislation & jurisprudence
- Female
- Health Care Costs/legislation & jurisprudence
- Health Care Costs/statistics & numerical data
- Health Policy/legislation & jurisprudence
- Humans
- Male
- Middle Aged
- Retrospective Studies
- United States
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Palmquist B. Equity, Participation, and Power: Achieving Health Justice Through Deep Democracy. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2020; 48:393-410. [PMID: 33021188 DOI: 10.1177/1073110520958863] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
This article explores how health governance has evolved into an enormously complicated-and inequitable and exclusionary-system of privatized, fragmented bureaucracy, and argues for addressing these deficiencies and promoting health justice by radically deepening democratic participation to rebalance decision-making power. It presents a framework for promoting four primary outcomes from health governance: universality, equity, democratic control, and accountability, which together define health justice through deep democracy. It highlights five mechanisms that hold potential to bring this empowered participatory mode of governance into health policy: participatory needs assessments, participatory human rights budgeting, participatory monitoring, public health care advocates, and citizen juries.
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Affiliation(s)
- Ben Palmquist
- Ben Palmquist is the Program Director for Health Care and Economic Democracy at Partners for Dignity & Rights. He has a Masters of Urban & Regional Planning from the University of California - Los Angeles in Los Angeles, CA and a B.A. from Stanford University in Palo Alto, CA
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Abstract
INTRODUCTION Anterior cervical discectomy and fusion (ACDF) remain an effective treatment option for multiple pathologies of the cervical spine. As the health care economic climate has changed, so have reimbursements with a concomitant push toward outpatient procedures. Certificate of Need (CON) programs were established in response to burgeoning health care costs which require states to demonstrate need before expansion of medical facilities. The impact of this program on spine surgery is largely unknown. The purpose of this study was to examine the impact of CON status on reimbursement and utilization trends of ACDF in both inpatient and outpatient settings. MATERIALS AND METHODS We queried a combined private payer and Medicare database from 2007 to 2015. All single-level ACDFs were identified. We then split each procedure into those performed in CON versus non-CON states. We then further split each group into the inpatient and outpatient settings. Compound annual growth rate (CAGR) was used to compare utilization and reimbursement trends. Reimbursement was adjusted for inflation using the United States Bureau of Labor Statistics consumer price index. RESULTS A total of 32,727 single-level ACDFs were identified, of which 28,441 were performed in the inpatient setting, and 4286 were performed in the outpatient setting. Reimbursement decreased across all settings, with the most pronounced decrease in the non-CON outpatient setting with an adjusted CAGR of -11.0%. Utilization increased across all groups, although the fastest growth was seen in the outpatient CON setting with a CAGR of 47.7%, and the slowest growth seen in the inpatient non-CON setting at a CAGR of 12.9%. CONCLUSIONS ACDF utilization increased most rapidly in the outpatient setting, and CON status did not appear to hinder growth. Reimbursement decreased across all settings, with the outpatient setting in non-CON states most affected. Surgeons should be aware of these trends in the changing health care environment.
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Rochefort DA. Making Single-Payer Reform Work for Behavioral Health Care: Lessons From Canada and the United States. INTERNATIONAL JOURNAL OF HEALTH SERVICES 2020; 50:334-349. [PMID: 32089054 DOI: 10.1177/0020731420906746] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The claim is often made that the adoption of single-payer health care in the United States would result in dramatic improvement of services for people with mental health and substance use disorders. Evidence from this sector in countries with such frameworks is mixed, however, presenting both positive and negative lessons for an American audience. Focusing on Canada as an example, this article sheds light on this topic by drawing on sources in the professional and academic literature, government reports, news stories and features, and research on-site by the author. A concluding section highlights key policy issues that American single-payer advocates will need to address for meaningful reform of the behavioral health care sector.
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Affiliation(s)
- David A Rochefort
- Department of Political Science, Northeastern University, Boston, Massachusetts, USA
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Does certificate-of-need status impact lumbar microdecompression reimbursement and utilization? A retrospective database review. CURRENT ORTHOPAEDIC PRACTICE 2019. [DOI: 10.1097/bco.0000000000000828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Casp AJ, Durig NE, Cancienne JM, Werner BC, Browne JA. Certificate-of-Need State Laws and Total Hip Arthroplasty. J Arthroplasty 2019; 34:401-407. [PMID: 30580894 DOI: 10.1016/j.arth.2018.11.038] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 11/25/2018] [Accepted: 11/27/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Many states have certificate-of-need (CON) programs requiring governmental approval to open or expand healthcare services, with the goal of limiting cost and coordinating utilization of healthcare resources. The purpose of the present study was to evaluate the associations between these state-level CON regulations and total hip arthroplasty (THA). METHODS States were designated as CON or non-CON based on existing laws. The 100% Medicare Standard Analytic Files from 2005 to 2014 were used to compare THA procedure volumes, charges, reimbursements, and distribution of procedures based on facility volumes between the CON and non-CON states. Adverse postoperative outcomes were also analyzed. RESULTS The per capita incidence of THA was higher in non-CON states than CON states at each time period and overall (P < .0001). However, the rate of change in THA incidence over the time period was higher in CON states (1.0 per 10,000 per year) compared to non-CON states (0.68 per 10,000 per year) although not statistically significant. Length of stay was higher and a higher percentage of patients received care in high-volume hospitals in CON states (both P < .0001). No meaningful differences in postoperative complications were found. CONCLUSION CON laws did not appear to have limited the growth in incidence of THA nor improved quality of care or outcomes during the study time period. It does appear that CON laws are associated with increased concentration of THA procedures at higher volume facilities. Given the inherent potential confounding population and geographic factors, additional research is needed to confirm these findings.
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Affiliation(s)
- Aaron J Casp
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia
| | - Nicole E Durig
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia
| | - Jourdan M Cancienne
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia
| | - Brian C Werner
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia
| | - James A Browne
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia
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Browne JA, Cancienne JM, Casp AJ, Novicoff WM, Werner BC. Certificate-of-Need State Laws and Total Knee Arthroplasty. J Arthroplasty 2018. [PMID: 29523445 DOI: 10.1016/j.arth.2018.01.063] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Many states in the United States have certificate-of-need (CON) programs designed to restrain health care costs and prevent overutilization of health care resources. The goal of this study was to characterize the associations between CON regulations and total knee arthroplasty (TKA) by comparing states with and without CON programs. METHODS Publicly available data were used to classify states in to CON or non-CON categories. The 100% Medicare Standard Analytical Files from 2005 through 2014 were then used to compare primary TKA procedure volumes, charges, reimbursements, and distribution of procedures based on facility volumes between the groups. Adverse events such as infection and emergency room visits after TKA were also evaluated. RESULTS Although CON status was associated with lower per capita utilization of TKA, the annual incidence of TKA appears to have increased over time more rapidly in states with CON laws compared with non-CON states (overall increase of 5.6% vs 2.3%, P < .01). When normalized to the Medicare population, the incidence of TKA increased 2.0% in CON states, whereas it actually decreased 7.2% in states without CON regulations (P = .011). Average reimbursement (and thus Medicare spend) was 5% to 10% lower in non-CON states at all time points (P < .0001). In non-CON states, relatively more TKAs appear to be performed in lower volume hospitals. Examination of adverse events rates did not reveal any strong associations between any adverse outcome and CON status. CONCLUSION CON programs appear to have influenced the delivery of care for TKA. Although our data suggest that these laws are associated with lower per capita utilization of TKA and the use of higher-volume facilities, we were unable to detect any strong evidence that CON regulations have been associated with improved quality of care or have limited growth in the utilization of this procedure over time. Confounding population and geographic factors may influence these findings and further study is needed to determine whether or not these programs have served their purpose and should be retained.
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Affiliation(s)
- James A Browne
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA
| | - Jourdan M Cancienne
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA
| | - Aaron J Casp
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA
| | - Wendy M Novicoff
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA
| | - Brian C Werner
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA
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Turi KN, Grigsby-Toussaint DS. Spatial spillover and the socio-ecological determinants of diabetes-related mortality across US counties. APPLIED GEOGRAPHY (SEVENOAKS, ENGLAND) 2017; 85:62-72. [PMID: 36238660 PMCID: PMC9555791 DOI: 10.1016/j.apgeog.2017.05.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The spatial structure of diabetes-related mortality in US counties is evident from previous studies. However, it is not clear if spatial variation in diabetes-related mortality is associated with spatial variation in socioecological factors. We analyze the spatial spillover effect of changes in socioeconomic gradients (education, employment, household income), retail food environments, and access to health care, on diabetes-related mortality rates across the United States. Seven-year aggregates of multiple cause mortality data from the CDC WONDER compressed mortality database were merged with several sources of county-level data to examine mortality clusters, factors associated with the clusters, and spatial spillover effects in 3109 continuous US counties. The results suggest that high diabetes-related mortality cluster counties are located throughout the Southern Plains, Southeastern, and Appalachian regions. Lower socioeconomic status, a high density of fast food restaurants, a lack of access to grocery stores, a high proportion of Blacks, and low physical activity characterize high diabetes-related mortality rates clusters. The impacts from improvements in socioeconomic gradients and the retail food environment in neighboring counties spill over, and reduce the diabetes-related mortality rate in a particular county. This result implies that improvements in socioeconomic status and access to healthy food would significantly reduce diabetes-related mortality rates in contiguous US counties.
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Affiliation(s)
- Kedir N. Turi
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Diana S. Grigsby-Toussaint
- Department of Kinesiology and Community Health, Division of Nutritional Sciences, University of Illinois-Urbana Champaign, Champaign, IL, USA
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Weil TP. What can the Canadians and Americans learn from each other's health care systems? Int J Health Plann Manage 2016; 31:349-70. [PMID: 27469581 DOI: 10.1002/hpm.2374] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 06/27/2016] [Indexed: 11/11/2022] Open
Abstract
Numerous papers have been written comparing the Canadian and US healthcare systems, and a number of health policy experts have recommended that the Americans implement their single-payer system to save 12-20% of its healthcare expenditures. This paper is different in that it assumes that neither country will undertake a significant philosophic or structural change in their healthcare system, but there are lessons to be learned that are inherent in one that could be a major breakthrough for the other. Following the model in Canada and in Western Europe, the USA could implement universal health insurance so that the 32.0 million (2015) Americans still uninsured would have at least minimal coverage when incurring medical expenditures. Also, the USA could use smart cards to evaluate eligibility and to process health insurance claims; these changes resulting in an estimated 15% reduction in US health expenditures without adversely effecting access or quality of care. Such a strategy would result in the eventual loss of 2.5 million white-collar jobs at hospitals, physician offices and insurance companies, a long-term economic gain. Only a few would agree with the statement that Canada already functions with a multi-payer reimbursement system as evidenced by (1) a federal-provincial, tax-supported plan, administered by each of the provinces, providing universal coverage for hospital and physician services and (2) roughly 60% of its residents receiving employer-paid health insurance benefits, underwritten primarily by investor-owned plans, that are less than effective to reimburse for pharmaceuticals, dental and other healthcare services. What could be learned from the USA and particularly from Western European countries is possibly implementing an approach, whereby at least upper-income Canadians could opt out of their federal-provincial plan and purchase private insurance coverage - being eligible for far more comprehensive "private" benefits for hospital, physician, pharmaceutical, dental and other healthcare services. Aside from generating billions of additional needed revenues from the private sector, it could (1) help eliminate long waits for non-emergent physicians' care by appointing newly minted specialists to their medical staffs; (2) offer prompt admissions for elective cases to "private" wings of hospitals; (3) increase available funding for what is currently an undercapitalized system; (4) enhance the system's sluggish operations; and (5) encourage more competition among various providers. Although such a two-tier approach, such as available in the USA and elsewhere, is politically dead on arrival in Canada today, private insurance being already legal and commonly available there. Interestingly, this recommended solution is utilized in most western European countries where there is a higher percentage than in Canada of public (versus private) funding of their total health expenditures. Because of various vested interests, attempts to implement any of the aforementioned proposals will undoubtedly result in considerable political rancor. There is greater likelihood, however, that the Canadians because their need to be more effective and efficient in their delivery of care, and their overall long-term fiscal outlook will agree to the further privatization of their healthcare system before the Americans will mandate universal access, use the smart card to process insurance eligibility and claims or will impose price controls on high-tech services and on pharmaceuticals. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Thomas P Weil
- Bedford Health Associates, Inc., Management Consultants for Health and Hospital Services, Asheville, North Carolina, USA
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Affiliation(s)
- Robert J Blendon
- From the Department of Health Policy and Management, Harvard School of Public Health, Boston (R.J.B., J.M.B.); and the Program in Health Policy, Harvard University, Cambridge, MA (J.O.H.)
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Certificate of need regulations and the diffusion of intensity-modulated radiotherapy. Urology 2012; 80:1015-20. [PMID: 22999447 DOI: 10.1016/j.urology.2012.07.042] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2012] [Revised: 07/18/2012] [Accepted: 07/12/2012] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To better understand the associations between the certificate of need regulations and intensity-modulated radiotherapy dissemination. METHODS Using Surveillance, Epidemiology, and End Results-Medicare data, we identified men (aged ≥ 66 years) treated with radiotherapy for prostate cancer who had been diagnosed from 2001 to 2007. Using data from the American Health Planning Association, we sorted the health service areas (HSAs) according to the stringency of certificate of need regulations (low vs high) in that market. We assessed our outcomes (ie, the probability of intensity-modulated radiotherapy adoption and intensity-modulated radiotherapy use in the HSAs) using Cox proportional hazards and Poisson regression models, respectively. RESULTS The low- and high-stringency markets were similar in terms of racial composition (80% vs 85% white, P = .08), population density (1085 vs 558 people/square mile, P = .08), and income (median $38 683 vs $40 309, P = .44). However, the low-stringency markets had more patients with stage T1 disease (45% vs 36%, P < .01). The probability of intensity-modulated radiotherapy adoption across the 2 groups of HSAs was similar (P = .65). However, among the adopting HSAs, those with high stringency consistently had greater use of intensity-modulated radiotherapy (P < .01). CONCLUSION The certificate of need regulations fail to create significant barriers to entry for intensity-modulated radiotherapy. Among the HSAs that acquired intensity-modulated radiotherapy, high-stringency markets demonstrated a greater propensity for using intensity-modulated radiotherapy. These findings raise questions regarding the ability of the certificate of need regulations to control technology dissemination.
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Perkins BB. Designing HIGH-COST medicine: hospital surveys, health planning, and the paradox of progressive reform. Am J Public Health 2010; 100:223-33. [PMID: 20019312 PMCID: PMC2804630 DOI: 10.2105/ajph.2008.155838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2009] [Indexed: 03/23/2024]
Abstract
Inspired by social medicine, some progressive US health reforms have paradoxically reinforced a business model of high-cost medical delivery that does not match social needs. In analyzing the financial status of their areas' hospitals, for example, city-wide hospital surveys of the 1910s through 1930s sought to direct capital investments and, in so doing, control competition and markets. The 2 national health planning programs that ran from the mid-1960s to the mid-1980s continued similar strategies of economic organization and management, as did the so-called market reforms that followed. Consequently, these reforms promoted large, extremely specialized, capital-intensive institutions and systems at the expense of less complex (and less costly) primary and chronic care. The current capital crisis may expose the lack of sustainability of such a model and open up new ideas and new ways to build health care designed to meet people's health needs.
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Short MN, Aloia TA, Ho V. Certificate of Need Regulations and the Availability and Use of Cancer Resections. Ann Surg Oncol 2008; 15:1837-45. [DOI: 10.1245/s10434-008-9914-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2007] [Revised: 04/02/2008] [Accepted: 04/02/2008] [Indexed: 12/29/2022]
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Siegel B, Mead H, Burke R. Private gain and public pain: financing American health care. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2008; 36:644-607. [PMID: 19093987 DOI: 10.1111/j.1748-720x.2008.00318.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Health care spending comprises about 16% of the total United States gross domestic product and continues to rise. This article examines patterns of health care spending and the factors underlying their proportional growth. We examine the "usual suspects" most frequently cited as drivers of health care costs and explain why these may not be as important as they seem. We suggest that the drive for technological advancement, coupled with the entrepreneurial nature of the health care industry, has produced inherently inequitable and unsustainable health care expenditure and growth patterns. Successful health reform will need to address these factors and their consequences.
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Affiliation(s)
- Bruce Siegel
- George Washington University School of Public Health and Health Services, Department of Health Services Management, USA
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Ho V, Ross JS, Nallamothu BK, Krumholz HM. Cardiac Certificate of Need regulations and the availability and use of revascularization services. Am Heart J 2007; 154:767-75. [PMID: 17893007 PMCID: PMC2084214 DOI: 10.1016/j.ahj.2007.06.031] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2007] [Accepted: 06/19/2007] [Indexed: 11/24/2022]
Abstract
BACKGROUND Many states enforce Certificate of Need (CON) regulations for cardiac procedures, but little is known about how CON affects utilization. We assessed the association between cardiac CON regulations, availability of revascularization facilities, and revascularization rates. METHODS We determined when state cardiac CON regulations were active and obtained data for Medicare beneficiaries > or = 65 years old who received coronary artery bypass graft surgery (CABG) or a percutaneous coronary intervention (PCI) between 1989 and 2002. We compared the number of hospitals performing revascularization and patient utilization in states with and without CON regulations, and in states which discontinued CON regulations during 1989 to 2002. RESULTS Each year, the per capita number of hospitals performing CABG and PCI was higher in states without CON (3.7 per 100,000 elderly for CABG, 4.5 for PCI in 2002), compared with CON states (2.5 for CABG, 3.0 for PCI in 2002). Multivariate regressions that adjusted for market and population characteristics found no difference in CABG utilization rates between states with and without CON (P = .7). However, CON was associated with 19.2% fewer PCIs per 1000 elderly (P = .01), equivalent to 322,526 fewer PCIs for 1989 to 2002. Among most states that discontinued CON, the number of hospitals performing PCI rose in the mid 1990s, but there were no consistent trends in the number of hospitals performing CABG or in PCIs or CABGs per capita. CONCLUSIONS Certificate of Need restricts the number of cardiac facilities, but its effect on utilization rates may vary by procedure.
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Affiliation(s)
- Vivian Ho
- Baker Institute for Public Policy, Rice University; Department of Medicine, Baylor College of Medicine
| | - Joseph S. Ross
- Department of Geriatrics and Adult Development, Mount Sinai School of Medicine, New York, NY; Geriatrics Research, Education & Clinical Center, James J. Peters VA Medical Center, Bronx, NY
| | - Brahmajee K. Nallamothu
- Health Services Research and Development Center of Excellence, Ann Arbor VA Medical Center, Ann Arbor, MI
| | - Harlan M. Krumholz
- Section of Cardiovascular Medicine and the Robert Wood Johnson Clinical Scholars Program, Department of Medicine, New Haven, CT; Section of Health Policy and Administration, Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, CT; Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT
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Research on Geographic Variations in Health Services Utilization in the United States: A Critical Review and Implications. HEALTH POLICY AND MANAGEMENT 2007. [DOI: 10.4332/kjhpa.2007.17.1.094] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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