Editor’s Note: This is the last in a series of posts in response to Jon Gabel’s article “Where Do I Send Thee? Does Physician-Ownership Affect Referral Patterns To Ambulatory Surgical Centers?,” published March 18 on the Health Affairs Web site. Rep. Michael Burgess (R-TX) began the series, which also featured Jerry Cromwell.
The tension between commerce and professionalism is not new. Maimonides warned against allowing […]

A lot of pipe dreams have been stoked by the seductive notion of “aligning incentives” — a catchphrase of the managed care era that promised better quality and lower costs in one magical bubble. But the divergent interests of patients, payers, and providers are in reality more likely to collide than align, a circumstance that […]

Editor’s Note: This is the second in a series of posts in response to Jon Gabel’s article “Where Do I Send Thee? Does Physician-Ownership Affect Referral Patterns To Ambulatory Surgical Centers?,” published March 18 on the Health Affairs Web site. Rep. Michael Burgess (R-TX) began the series, which will also feature Chris Cassel.
Policymakers are increasingly concerned over incentives facing physicians to refer more lucrative, well-insured […]

Editor’s Note: This is the last in a series of posts on health and health care disparities that Health Affairs Blog is publishing in conjunction with the new March/April issue of Health Affairs on Disparities: Expanding The Focus, published with support from the Robert Wood Johnson Foundation. Brian Smedley, Richard Epstein, Dora Hughes, and […]

Like a recurring illness, stalemate looms again over the prospects for settling the issue of payment levels to private plans in Medicare, which now exceed the average per beneficiary cost of traditional fee-for-service Medicare by 13 percent, according to the Medicare Payment Advisory Commission. MedPAC recommends eliminating the differential, which funds extra benefits for private-plan […]

Will health information technology (IT) be the silver bullet to create value in the health care sector? Michael O. Leavitt, Secretary of the U.S. Department of Health and Human Services (HHS) discusses health IT and other health system management issues in an interview with Leonard Schaeffer, founding chairman and CEO of WellPoint, Inc., and currently […]

Now that it’s September and Congress is back in session, it’s time to prepare for the September policy showdown on reauthorization of the State Children’s Health Insurance Program (SCHIP). Last month Health Affairs Blog invited policy experts with wide-ranging views to set out the hot-button issues–such as the tobacco tax funding mechanism–and explain the politics. These posts […]

Editor’s Note: As Health Affairs celebrates its 25th anniversary, we look back at some health policy highlights of the past quarter century—many of which are still highly relevant to today’s debates. Watch this space for regular postings on the “classics.”
On June 12, 1986, the Wall Street Journal stated: “If you read nothing else this year […]

A new study [2 weeks free access] in Health Affairs today shows that pay-for-performance (P4P) can work in a Medicaid managed care setting, but only if plans place enough dollars at stake and communicate well with providers. Suzanne Felt-Lisk and colleagues from Mathematica Policy Research evaluated a P4P demonstration of five Medicaid managed care plans […]

What happens when a government agency in charge of assessing the effectiveness of medical interventions crunches numbers and tells pharmaceutical companies their drugs are just too expensive? Sometimes, the government gets a better deal.
Twice last week, the much-feared National Institute for Health and Clinical Excellence (NICE) in England and Wales was a factor in drug […]

This week’s Health Wonk Review is now up featuring highlights from the health policy blogosphere. Bob Laszewski of the Health Care Policy and Marketplace Review blog hosts a lively edition and shows how the same data (from Jerry Anderson’s new Health Affairs paper on hospital pricing trends for the uninsured) can be viewed very differently. Bob also […]

The Washington Convention Center was abuzz as nearly 2,000 health industry and policy wonks gathered for the 4th annual World Health Care Congress. The standard policy topics of cost, quality, and coverage were up for debate, along with competition, effectiveness, transparency, and, of course, reform. For comprehensive blogging on the event, check out the official […]

The annual debate on how to spend Medicare dollars is here again. We have many modern analytical tools to look at health care spending, but it may be worth going back to some basic insights of microeconomics. About 140 years ago, a group of economists showed that rational decision making meant looking at marginal cost […]

Today economist Gail Wilensky responds to comments about the Medicare sustainable growth rate on her earlier Health Affairs Blog post. Here’s an excerpt:
“As a market-oriented economist, I have a lot of sympathy with trying to rely on markets, but that’s hard to do in a Medicare system that in some areas dominates the market. It’s […]

Pay-for-performance (P4P) and public quality-reporting programs offer the potential to increase the quality of health care overall, but they threaten to actually decrease quality for minority and low-income patients in the process. In an article published April 10 on the Health Affairs Web site [free access through April 23], Larry Casalino of the University of […]

President Bush’s fiscal year 2008 budget will propose cutting Medicare and Medicaid by $70 billion over five years, Robert Pear reports in the New York Times. The administration is expected to propose freezing Medicare payments to home health agencies and reducing payment updates for hospitals, nursing homes, and other providers. The Bush budget also assumes […]

Democrats prioritized price negotiations on prescription drugs, but in principle, payments to private plans are an equally salient target on the new majority’s Medicare agenda. The Republicans’ Medicare Modernization Act pays Medicare Advantage (MA) plans from about 10 to nearly 20 percent more per beneficiary than the traditional fee-for-service program spends on them. The overpayments […]

Is pay-for-performance really such a new thing? After all, “aligning incentives” was the ubiquitous mantra of the ‘90s. It applied to capitation and integrated care in the managed care era. But times change. It’s a fee-for-service world again, and aligning incentives means something different now -– although it’s still assumed that how we pay for […]