考点分类抓基础.pptVIP

Policies to Control Costs October 24, 2006 Policies to Control Costs Key policy question: How can a health care system that relies on third-party insurance control spending???? Keep in mind the 3 objectives associated with health care reform keep costs down (expenditures) provide access to care provide quality of care Expenditures = price x quantity (Some argue that controls lead to rationing. Be careful though since we have rationing in the U.S. It’s just not as obvious.) Policy Options for Government Run Systems: mandated fee schedules global budgeting (spending caps) resource rationing Mandated Fee Schedules Keep in mind that fee schedules in and of themselves cannot keep expenditure low since: Expenditures = price x quantity Price Controls To the extent that the controls lead docs to lower their expenses, waste can be reduced. But in the longer run these gains are exhausted. Price controls might not reduce expenditure: Expenditures = price x quantity see more patients treat them more intensively Un bundle services Unbundling Instead of billing for the service, the provider bills for each part of the treatment. The practice defies logic because the sum of the parts is greater than the whole. e.g. Standard care for treating a broken bone, when broken into its component parts with a separate bill for each, will cost more than the complete item. (The amount that can be billed for an office visit, two x-rays and a follow-up visit is often greater than the bill for the total package including the cast and its removal.) Mandated Fee Schedules Expenditures = price x quantity Usually controlled prices don’t last. fee schedule is usually adjusted downward negotiated fee schedules eventually become one of regulated fee schedules (Note: Providers often find that they can get around controls by seeing more patients and treating them more intensively.) Global Budgeting – Spending Caps Canada and Germany: set global budgets for hospitals (set amount of mon