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Moving Towards Higher-Value Health Care. Katherine Baicker Professor of Health Economics Harvard School of Public Health and NBER. Lower Costs vs. Higher Value. Rising costs have made reform a priority Risk of uninsurance Strain on private budgets Pressure on public budgets

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moving towards higher value health care

Moving Towards Higher-Value Health Care

Katherine Baicker

Professor of Health Economics

Harvard School of Public Health and NBER

lower costs vs higher value
Lower Costs vs. Higher Value
  • Rising costs have made reform a priority
    • Risk of uninsurance
    • Strain on private budgets
    • Pressure on public budgets
  • Appeal of cost-saving quality improvements
    • Self-financing plans to cover the uninsured
    • Health-improving reductions in spending
  • But is this the right metric?
ample evidence of inefficient spending
Ample Evidence of Inefficient Spending
  • International evidence:
    • Spend much more than OECD trading partners without commensurately better outcomes
  • Domestic evidence:
    • Areas where we spend more are not areas with best outcomes
quality variation even within medicare
Quality Variation Even within Medicare

Source: Dartmouth Atlas of Health Care

variation in medicare spending
Variation in Medicare Spending

Source: Dartmouth Atlas of Health Care

but higher spending not associated with higher quality
But Higher Spending not Associated with Higher Quality

Source: Baicker and Chandra (Health Affairs 2004)

some causes of inefficiency
Some Causes of Inefficiency
  • Public side:
    • Medicare reimbursement primarily based on quantity, not quality
    • Resources for the uninsured spent on inefficient modes of care
  • Private side:
    • Biases in tax subsidy of employment-based insurance
    • Barriers to well-functioning insurance markets
    • Information on prices and quality often not available
focus on changes with system wide effects
Focus on Changes with System-wide Effects
  • Few individual interventions likely to produce better health at lower cost
    • Doesn’t mean there aren’t many worthwhile interventions
    • Wrong metric: probably willing to pay more if getting a lot more for it
  • Interventions that affect the care received by some groups likely to have “spillover” effects
    • Insurance coverage – extent and type
    • Use of high-intensity interventions
    • Information
    • Use of “best practices”
case of hospital quality
Case of Hospital Quality

Source: Baicker, Chandra, and Jha

conclusions
Conclusions
  • Bending the Curve highlights many areas in vital need of improvement and proposes many potentially high-payoff reforms
  • Need not pursue only self-financing reforms: goal should be higher value, not just cost-saving quality improvements
  • May get biggest bang for the buck from reforms that improve the quality of care system-wide