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Lessons From Abroad:. International Efforts to Improve Quality, Reduce Costs and Increase Transparency. Robert S. Galvin, MD Bipartisan Congressional Health Policy Conference January 13, 2007. Lessons From Abroad. Where The U.S. Is Different Much Larger, More Heterogeneous Population

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lessons from abroad

Lessons From Abroad:

International Efforts to Improve Quality, Reduce Costs and Increase Transparency

Robert S. Galvin, MD

Bipartisan Congressional Health Policy Conference

January 13, 2007

lessons from abroad1
Lessons From Abroad
  • Where The U.S. Is Different
    • Much Larger, More Heterogeneous Population
    • Health System Much Less Centralized…By Design(?)
      • - Federal vs. State vs. Private Sector
    • No Consensus On How To Control Costs
    • Very Medical Innovation-Technology “Friendly”
  • Where The U.S. Is Most Similar
    • Common Belief: Driving Value vs. Cost Containment
strategic framework board 2003

Purpose

Goals

Results

(Performance)

PATHWAY #1

PATHWAY #2

Improvement

Selection + Payment

Consumers

Purchasers

Patients

Motivation

Professional Organizations

Care Delivery Teams

Strategic Framework Board - 2003
the power of transparency
The Power Of Transparency

Death Rate (RAMR)

Hospital

Columbia Presbyterian 3.93*

Lenox Hill 2.26

NYU Hospitals Center 1.95

Weil Cornell – NYP 0.95*

Surgeon

RAMR

State Total 2.25

Smith, C 4.15

payment and improvement
Payment and Improvement

Institute of Medicine (2001)

MedPAC 2004 (2004)

“Purchasers should…Remove

Barriers that…Impede Quality Improvement

And Build In Stronger Incentives

For Quality Enhancement”

“Current Payment Systems . . . Are at Best Neutral and at Worst Negative Towards Quality”

Glen Hackbarth

“If I keep getting better, Dr Galvin,

I’m going to improve myself

right out of business”

slide7

Health Costs: Lots of Opportunity, Little Focus

Immutable &

Desirable

Ageing

Technology

Unhealthy Lifestyles

Malpractice

End of Life Care

Cultural

Uninsured

Administrative Costs

High Prices/Specialist Incomes

Waste and Quality Shortfalls

Lack of Accountability/Transparency

System

of

Care