Health Affairs

As US health care continues down the path of delivery system transformation, January’s Health Affairs explores areas of opportunities and challenges to achieving better health and better care at lower costs. Other articles focus on a range of topics of interest, including the length of time physicians spend with active and unresolved malpractice claims against them.

Seth Seabury at the RAND Corporation and coauthors report that the average physician spends almost 11 percent of his or her career with an open and unresolved medical claim. A major contributor is the length of the process of adjudicating such claims: The typical medical malpractice claim isn’t filed until almost two years after the incident occurred, and it isn’t resolved until 43 months post incident. When dealing with open claims, physicians spend up to 70 percent of that time with claims that never result in a payment.

Among the various distressing factors involved in this type of adjudication, patients and physicians alike may be more troubled by the length of time of the process than the potential damages, the authors say. They recommend exploring policy solutions that can decrease the time to resolution, including tort reform and alternative dispute management tools that can expedite the process and help limit meritless claims.

A new Health Policy Brief from Health Affairs and the Robert Wood Johnson Foundation examines waste in US health care. Estimates are that more than a third of annual US health spending may be wasteful. A September 2012 Institute of Medicine report estimated that $765 billion a year was wasted through provision of unnecessary services, inefficiently delivered services, excessive prices and administrative costs, and missed prevention opportunities and fraud and abuse.

This policy brief discusses these and other types of waste in health care, ideas for eliminating waste, and the considerable hurdles that must be overcome to do so. It is the companion to a July 2012 Health Policy Brief, “Eliminating Fraud and Abuse.”

The rising cost of America’s health care system – already 18 percent of GDP – is driving the country toward the fiscal brink, and nowhere is the need for a new paradigm to control costs more evident than in the area of medical liability. Doctors’ justified distrust of medical justice (which has an error rate of 25 percent) leads them to prescribe and perform treatments for no other reason than to prevent lawsuits. This “defensive medicine” is estimated to cost anywhere from $45 billion to more than $200 billion a year. Fortunately, a growing bipartisan consensus is pointing the way to a solution.

There is widespread public support for the creation of special health courts. And, despite the highly polarized nature of American politics today, there is consistent support across political parties. A nationwide poll, conducted in April by the Clarus Research Group for Common Good, the nonpartisan organization I chair, revealed that 66 percent of voters support the idea of creating health courts to decide medical claims. Only 25 percent said that those claims should be decided as they are now, and there was virtually no difference between Democrats and Republicans on the issue: 68 percent of Republicans, 67 percent of Democrats, and 61 percent of independents support health courts.

Now that the Affordable Care Act has been upheld by the U.S. Supreme Court, we must build on the progress that has been made to further improve our health care system. The American Medical Association is committed to making the system work better for patients and physicians, and I am thrilled to start my tenure... Read the rest of this entry »

The Supreme Court’s decision affirming the constitutionality of most of the Patient Protection and Affordable Care Act of 2010 (“ACA”) is likely to have a profound impact on health care quality, cost and access. This decision allows the country to move forward with ACA programs that encourage the movement from a customary-care model of medical... Read the rest of this entry »

Editor’s note: Below, we offer “Defensive Medicine,” the first health policy poetry to appear on Health Affairs Blog. The author is Adam Possner, a general internist and an assistant professor at The George Washington University School of Medicine and Health Sciences, whose poetry has been featured in the Journal of the American Medical Association and... Read the rest of this entry »

October’s list of most-read Health Affairs Blog posts is led by Maribeth Shannon’s piece on the challenges of getting consumers involved in directing their health care. Several posts on the Medicare Shared Savings Program (ACOs) final rule also make the list, as do posts on the legal fight over health reform; the process of determining... Read the rest of this entry »

With apologies to my more creative predecessors as Health Wonk Review hosts, there’s no theme today. (After all, how could one top Alistair Cookie?) I will get right to the great posts in this week’s edition. Costs And Premiums. At Managed Care Matters, Joe Paduda explores an apparent disconnect: flat medical costs coupled with rising... Read the rest of this entry »

Having both medical and law degrees typecasts me.  New acquaintances ask if I have ever sued myself.  Within the health policy community, colleagues assume I study medical malpractice. So I have let it become a self-fulfilling prophecy.  I worked on medical malpractice in the Clinton White House, and devoted my first scholarly efforts to analyzing... Read the rest of this entry »

Below, Kavita Patel, former director of policy for the White House Office of Public Engagement and Intergovernmental Affairs, discusses President Obama’s State of the Union address and House Budget Committee chairman Paul Ryan’s (R-WI) Republican response. See other posts on this topic by Len Nichols and Joseph Antos.  The Constitution mandates that the President “from time to time... Read the rest of this entry »

Editor’s Note: Below, Joseph Antos, the Wilson H. Taylor Scholar in Health Care and Retirement Policy at the American Enterprise Institute, discusses President Obama’s State of the Union address. See other posts on this topic by Len Nichols and Kavita Patel.  In his State of the Union address, Barack Obama said the key to winning the future is... Read the rest of this entry »

Editor’s Note: Below, Len Nichols, Professor of Health Policy and Director of the Center for Health Policy Research and Ethics at George Mason University, discusses President Obama’s State of the Union address and House Budget Committee chairman Paul Ryan’s (R-WI) Republican response. See other posts on this topic by Kavita Patel and Joseph Antos.  In last night’s State... Read the rest of this entry »

Of all the ghosts that haunt the Medicare program, none has been noisier, scarier or rattled more chains than the Medicare Sustainable Growth Rate (SGR) problem.   SGR has required Congress to reset physician payment policy almost every year for the last decade to avoid gutting Medicare physician compensation, a recurring reminder of how difficult Medicare... Read the rest of this entry »

In their newly released “Pledge to America,” House Republicans call for repealing the Affordable Care Act. They advocate replacing it with legislation incorporating a number of components long advocated by the GOP, including reforming the medical liability system, allowing the purchase of health insurance across state lines, and expanding health savings accounts. One of these... Read the rest of this entry »

How much does the medical liabilty system add to health care costs? How can medical errors be reduced? How often are nonemergency patients treated in hospital emergency departments, and how can those patients be shifted to more appropriate settings? These are some of the questions that were discussed at a September 7 National Press Club briefing sponsored by Health Affairs. Video of the briefing... Read the rest of this entry »

Medical malpractice and reform proposals have been a longstanding battleground of U.S. health policy. On the one hand, studies have shown that health care is rife with errors and avoidable injury to patients. On the other, doctors and hospitals fear frivolous lawsuits and resent high malpractice insurance premiums. It’s been generally agreed that one result... Read the rest of this entry »

The September 2010 issue of Health Affairs is devoted to two issues that arguably were insufficiently addressed by the Affordable Care Act:  medical liability and patient safety; and the growing nonemergency use of the nation’s hospital emergency rooms. The issue contains new estimates of how much medical liability costs the health care system overall; of... Read the rest of this entry »

The September 2010 issue of Health Affairs is devoted to two issues that arguably were insufficiently addressed by the Affordable Care Act:  medical liability and patient safety; and the growing nonemergency use of the nation’s hospital emergency rooms. The issue contains new estimates of how much medical liability costs the health care system overall; of... Read the rest of this entry »

With apologies to Arthur Miller … President Obama went back before the cameras again Wednesday, providing yet another recycling of fading rationales for his health reform product that more voters would rather leave on the Capitol Hill store shelves than purchase.   But “attention must be paid” whenever the president speaks.  He tried to claim that “we... Read the rest of this entry »

Editor’s Note: This is the first of 2 posts from Tim Jost on the summit. Part 2 looks at budget deficit, Medicare, malpractice, and possible areas of agreement. The health care summit has now been underway for almost 3 hours.  President Obama established in his opening statement what he hoped would come of the summit,... Read the rest of this entry »