Wednesday, December 17, 2008

"Expanding Coverage Without Increasing Health Care Spending: Dartmouth Institute White Paper Recommends Course for the Obama Administration"

Once again the Dartmouth Institute for Health Policy and Clinical Practice has provided a valuable contribution to our health care reform discussion with their new paper, "Improving Quality and Curbing Health Care Spending: Opportunities for the Congress and the Obama Administration."

In my mind the authors made two critical points:
  1. We can insure everyone without dramatically increasing national health care spending.
  2. But only if we make some really hard decisions about making our system more efficient--the really big cost containment issues we have discussed on this blog before.
As the authors say, "Were lower-performing, higher-cost, higher intensity hospitals and providers to adopt the practices of these high value integrated systems, costs would be greatly reduced."

And, there is the challenge.

This simply underscores that until we are ready to tackle the real problem--cost and quality--head-on, just dumping more trillions of dollars into subsidizing access to this mess we call a health care system will only make matters worse.

Here is a portion of their study overview and a link to the full document:
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The United States can extend coverage to the country's uninsured without substantially increasing overall health care costs, according to a Dartmouth Atlas white paper released by The Dartmouth Institute for Health Policy and Clinical Practice (TDI).

"Most analyses of coverage reform predict that we will spend more as a nation on health care once theuninsured gain coverage and begin consuming more care," write lead authors John E. Wennberg and Shannon Brownlee. "But we predict that covering everyone will have a much smaller impact on the trend in health care costs, provided that capacity is not increased." Co-authors of the paper are Elliott S.Fisher, Jonathan S. Skinner, and James N. Weinstein, all of TDI.

Not increasing capacity while improving quality and increasing coverage, say the authors, can be
achieved in a number of ways, including reducing oversupply of health care services in high spending regions of the country. As documented repeatedly over 20 years of research by the Dartmouth Atlas Project, more spending on health care, more procedures and more hospitalizations, do not result in better health outcomes for patients.

The paper, An Agenda for Change-- Improving Quality and Curbing Health Care Spending: Opportunities for the Congress and the Obama Administration, presents four priorities for achieving true health care reform:
  • Promote the growth of organized systems of care. Atlas research has shown that the best, most effective, efficient, and appropriate health care is delivered by systems such as the Geisinger Clinic, Mayo Clinic, and others. Were lower-performing, higher-cost, higher intensity hospitals and providers to adopt the practices of these high value integrated systems, costs would be greatly reduced. Most importantly, patients would receive better care. The paper lays outspecific changes that would encourage health providers to move to organized delivery systems.
  • Require informed patient choice and shared decision-making. By not adequately informing patients about risks and benefits and the full range of treatment options available to them, patients often receive care that they do not want ­ and would not choose had they been fully informed.
  • Establish a federal physician workforce policy that achieves the goals of organized care. TDI research has shown that the U.S. does not need more physicians; we have enough to care for America's needs well into the future.
  • Fund a Federal science policy that builds the scientific basis for cost-effective care.
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