Assessing the effectiveness of health care cost containment measures: evidence from the market for rehabilitation care

This study empirically evaluates the effectiveness of different health care cost containment measures. The measures investigated were introduced in Germany in 1997 to reduce moral hazard and public health expenditures in the market for rehabilitation care. Of the analyzed measures, doubling the daily copayments was clearly the most effective cost containment measure, resulting in a reduction in utilization of about $20\,\%$ . Indirect measures such as allowing employers to cut federally mandated sick pay or paid vacation during inpatient post-acute care stays did not significantly reduce utilization. There is evidence neither for adverse health effects nor for substitution effects in terms of more doctor visits.     

The debate over health care rationing: Déjà vu all over again?

Health care rationing has been a source of contentious debate in the United States for nearly 30 years. Because rationing is bewildering to many Americans, persistent myths about "death panels" and critical health care decisions to be made by faceless bureaucrats abound, instilling fear about health care reform and cost containment measures aimed at slowing spending growth. This paper retrospectively reviews the policy literature on health care rationing over the past quarter century, examines alternative definitions and classification schemes, traces the evolution of the debate, and explores ways in which rationing may be made more rational, transparent, and equitable in the future allocation of scarce health care resources.     

Direct contract tactic for health care marketplace

Direct contracting offers an aggressive approach to health care cost containment in an era when employers, patients and providers must do more than just talk about saving dollars. Eliminating the "middleman" through customized insurance plans, direct contracts can combat rising costs. The author explains what hospitals must do to initiate a program.     

Legal challenges to managed care cost containment programs: an initial assessment.

The success of managed care cost containment innovations depends on many factors, including how courts decide litigation challenging various cost containment initiatives. Although such litigation is just emerging, enough cases have been reported to enable an initial assessment of court rulings. To date there is no evidence that courts have systematically impeded cost containment initiatives. Few courts seem willing to usurp legislative choices in formulating health policy or to obstruct the market in organizing and delivering health care services. The anticipated role of the courts as policymakers in shaping health care delivery has yet to emerge.     

US-style commissioning. Raising Arizona

Strategic health authorities can learn a lot about strategic vision from Arizona's healthcare cost containment system. The Arizona commissioners have greater power than primary care trusts to push through new and more effective models of community care. Commissioner/provider relations can be fraught as health plans hold out for big discounts.     

Assessing the need for multicompetent allied health care professionals in the HMO setting

In the past decade, changes in health care reimbursement and emphasis on cost containment have changed patterns of health care delivery. Among these changes are the rapid decline of the hospital as the center of care, and an emphasis on managed systems of health care delivery. Health maintenance organizations (HMOs) have grown rapidly, and now control a significant portion of the health care marketplace. As such, HMOs provide nontraditional employment settings for allied health professionals. To date, little is known regarding the status of allied health professionals in the HMO setting. The purpose of this study was to describe the perceived need for nontraditional multicompetent allied health professionals in the HMO setting. Results indicate that group and staff model HMOs have a high number of traditionally prepared allied health professionals. In addition, a large number of these sites employ multicompetent professionals, most of whom receive "in-house" training. Further research regarding the role expectations for such professionals is indicated.     

Developing and implementing a personnel budget report

Few issues are as vital to the health care industry as those surrounding the notion of cost containment and cost control. If hospital executives are to gain a handle by which to institute programs of cost containment, however, they must have access to pertinent and timely information on hospital operations. Because labor costs represent such a large percentage of total hospital costs, a personnel budgeting report can be a useful first step in gaining valuable management information.     

Transportation or CT scanners: a theory and method of health resources allocation.

Cost containment and access to appropriate care are the two most frequently discussed issues in contemporary health policy. Conceiving of the health services available in specific regions as "packages" of diverse items, the authors of this article consider the economic trade-offs among the various resources needed for appropriate care. In the discussion that follows, we examine the trade-offs between two divergent offering of the health care system: high technology medicine and support services. Specifically, we examine several strategies designed to achieve an optimal mix of investments in CT scanners and transportation resources in the South Chicago region. Using linear programming as a method for examining these options, the authors found that 1) the proper location of CT scanners is as important for cost containment as optimal number, and 2) excess capacity in the utilization of a single resource--CT scanners--need not imply inefficiency in the overall delivery of the service. These findings help demonstrate the importance of viewing health care as a package of interrelated services, both for achieving cost containment and for providing access to appropriate care.     

Managed competition and the health care crisis

The politics of health care reform has created gridlock despite public support for control of increasing costs, expanded coverage, and greater patient satisfaction. Managed care has become the watchword for meeting such goals, despite serious doubts about its ability to succeed. The author examines the pitfalls of managed care, particularly in regard to cost containment and patient satisfaction.     

Convergence and dissonance: evolution in private-sector approaches to disease management and care coordination

Disease management (DM) approaches survived the 1990s backlash against managed care because of their potential for consumer-friendly cost containment, but purchasers have been cautious about investing heavily in them because of uncertainty about return on investment. This study examines how private-sector approaches to DM have evolved over the past two years in the midst of the movement toward consumer-driven health care. Findings indicate that these programs have become standard features of health plan design, despite a thin evidence base concerning their effectiveness. Uncertainties remain regarding how well these programs will function within benefit designs that require higher consumer cost sharing.     

Health care reform and the paradox of efficiency: "writing in" culture.

Widespread global migration is occurring at the same time that health care delivery systems in Western nations are undergoing major restructuring. The call for health care to be more efficient, economical, and responsive to diverse cultural populations has come from several sectors, including governments and researchers. This has led to policies to address perceived deficiencies in health care services. The authors draw on their research at health care institutions in a western Canadian city to probe, first, how the concept of culture is interpreted within organizations; and second, how culture is "written into health systems" as they undergo restructuring. Meanings and interpretations of culture are not transparent; moreover, "writing in" culture is not simply a matter of health care providers learning about their clients' "belief systems" and being sensitive to these beliefs. Belief systems and people's experiences of the care they receive are negotiated within highly complex "organizational cultures," located in broader macroeconomic and political structures, and discourses that shape how health care systems are organized. The authors consider whether current discourses on cost containment are in competition with providing equitable health care services to diverse client populations.     

Kostendämpfungspolitik in den Niederlanden und in Deutschland: Eine Untersuchung von Maßnahmen in drei Leistungsbereichen

Cost containment is an important endpoint of successful health policy. The strategic objectives of cost control, especially the one to reduce statutory charges on labour are not uncontroversial. In terms of operational targets, the Netherlands primarily aim to contain health care expenditure according to the growth level of the gross domestic product, while Germany aims to contain expenditure according to the growth level of premium income of the statutory sickness funds. From the universe of cost containment measures, this paper investigates for both countries concurrent control measures in three health care sectors: budgeting of hospitals and specialized physicians, and fixed-price reimbursement for drugs. Concerning the global policy objectives, only comprehensive fixed budgets with a well defined balancing mechanism turned out to be effective in the short run. In the long run, fixed budgets may incur problems in the flexibility of the system to adapt to changes. In spite of the restricted effectiveness of the individual containment measures, health care expenditures have been, in international comparison and at the level of the national economy, controled quite successfully in both countries over the last twelve years which were investigated here. This relative, long term success of cost containment policy corresponds with the continuous will of the governements in both countries to work, in collaboration with all participants in the health field, towards explicit national expenditure goals. This process features analogies with the principles of quality management.     

Ideological influence in U.S. health policy: catalysts or impediments?

Although pronouncements of the ?health care crisis? have been made for thirty years, in many ways the fundamental underpinnings of the U.S. health care system have changed very little. However, calls for health care reform have progressed through four distinct phases. From before the 1965 passage of the Medicare and Medicaid programs until about 1972, the primary issue was expanding access to care. From 1972 through 1976, health care reform proposals experienced a transition period. From 1976 until about 1992, cost containment became the dominant theme. Since 1992 there has been a renewed emphasis on improving access to care. But Americans have mixed feelings about health care reform. On the one hand, Americans want improved access to care, increased efficiency, and high quality care. On the other hand, Americans are leery of higher taxes and expanding the government's role in health care decision-making. In the final analysis, it is ultimately politics which governs the form of health care reform by effecting compromises between what is ideologically desirable and what is economically plausible.     

Barriers to constraining health care cost growth

Managing health care cost growth is a fundamental challenge facing our health care system. Through analysis of semistructured interviews, we conclude that barriers to health plan-level cost containment activities and strong forces outside the control of individual health plans will prevent many health system reforms (such as more competition among plans or modest increases in patient copayments) from stemming health care cost inflation. Policy debates and budgetary discussions must recognize that health care cost growth in excess of gross domestic product (GDP) growth is likely inevitable in the foreseeable future. The policy focus should be directed toward encouraging value.     

Price controls: on the one hand ... and on the other

Controlling health care costs requires that limits be placed either on prices, quantities of services, or both. Prices are measurable and more easily controlled than is quantity and, consequently, health care cost containment has frequently focused on mechanisms for controlling prices. Regulatory approaches, however, may create market distortions and change access patterns. An alternative approach to controlling prices is to restructure the market for health services to encourage greater price competition among providers. Because this type of health reform has not previously been attempted, there is much more uncertainty about the outcome of market-oriented approaches than for direct regulatory control over prices.     

Centralized or decentralized? A case study of Norwegian hospital reform

In recent years, decentralization of financial and political power has been perceived as a useful means to improve outcomes of the health care sector of many European countries. Such reforms could be the result of fashionable policy trends, rather than being based on knowledge of "what works". If decentralization is the favored strategy in health care, studies of countries that go against the current trend will be of interest and importance as they provide information about the potential drawbacks of decentralization. In Norway, specialized health care has recently been recentralized. In this paper, we review some of the evidence now available on the economic effects of recentralization. Although recentralization has been associated with improvements in both cost efficiency and technical efficiency this may have been caused by the increasing role of activity-based funding methods used in the allocation of health care resources. However, recentralization was also associated with an increase in the rate of growth of real resources and the proportion of total costs being met by supplementary funding. As a result, recentralization failed to address the issues of cost containment and reductions in budget deficits.     

Cost containment for the public health

The U.S. health care system has major problems with respect to patient access and cost control. Trimming excess hospital expenses and expanding public health activities are cost effective. By budgeting well, with global budgets set for the high cost sectors, the United States might emerge with lower tax hikes, a healthier population, better facilities, and enhanced access to service. Nations with global budgets have better health statistics, and lower costs, compared to the United States. With global budgets, these countries employ 75 to 85 percent fewer employees in administration and regulation, but patient satisfaction is almost double the rate in the United States. Implement a global budget for health care, or substantially raise taxes, is the basic choice faced in this country. Key words: global budget control cost containment.     

Voluntary planning forestalls excessive competition, regulation

Overemphasizing competition or regulation to control health care costs jeopardizes improved medical technology, continued specialized medical education, and care for indigent patients. Voluntary planning can help institutions to achieve cost containment without undermining long-range goals.