Eight Decades of Discouragement: The History of Health Care Cost Containment in the USA

Jost, Timothy Stoltzfus

doi:10.1515/fhep-2012-0009

Cited by 5 publications

(3 citation statements)

References 39 publications

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“…[2,3] The federal government historically addressed rising healthcare costs with changes to existing payment models, with limited success. [4] Pay for performance programs [5][6][7] are the most recent example of these changes. These programs have disproportionately penalized safety-net hospitals (SNH) serving vulnerable populations.…”

Section: Introductionmentioning

confidence: 99%

Retrospective cohort study comparing surgical inpatient charges, total costs, and variable costs as hospital cost savings measures

Kim

Jacobs

Schmidt³

et al. 2022

Medicine

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We analyzed differences (charges, total, and variable costs) in estimating cost savings of quality improvement projects using reduction of serious/life-threatening complications (Clavien-Dindo Level IV) and insurance type (Private, Medicare, and Medicaid/ Uninsured) to evaluate the cost measures. Multiple measures are used to analyze hospital costs and compare cost outcomes across health systems with differing patient compositions. We used National Surgical Quality Improvement Program inpatient (2013-2019) with charge and cost data in a hospital serving diverse socioeconomic status patients. Simulation was used to estimate variable costs and total costs at 3 proportions of fixed costs (FC). Cases (Private 1517; Medicare 1224; Medicaid/ Uninsured 3648) with patient mean age 52.3 years (Standard Deviation = 14.7) and 47.3% male. Medicare (adjusted odds ratio = 1.55, 95% confidence interval = 1.16-2.09, P = .003) and Medicaid/Uninsured (adjusted odds ratio = 1.41, 95% confidence interval = 1.10-1.82, P = .008) had higher odds of complications versus Private. Medicaid/Uninsured had higher relative charges versus Private, while Medicaid/Uninsured and Medicare had higher relative variable and total costs versus Private. Targeting a 15% reduction in serious complications for robust patients undergoing moderate-stress procedures estimated variable cost savings of $286,392. Total cost saving estimates progressively increased with increasing proportions of FC; $443,943 (35% FC), $577,495 (50% FC), and $1184,403 (75% FC). In conclusion, charges did not identify increased costs for Medicare versus Private patients. Complications were associated with > 200% change in costs. Surgical hospitalizations for Medicare and Medicaid/ Uninsured patients cost more than Private patients. Variable costs should be used to avoid overestimating potential cost savings of quality improvement interventions, as total costs include fixed costs that are difficult to change in the short term.

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Section: Introductionmentioning

confidence: 99%

Retrospective cohort study comparing surgical inpatient charges, total costs, and variable costs as hospital cost savings measures

Kim

Jacobs

Schmidt³

et al. 2022

Medicine

View full text Add to dashboard Cite

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mentioning

confidence: 99%

“…Policy makers, economists, and administrators frequently view cost containment as the Holy Grail of economic sustainability for the health-care system (Jost, 2012; Korda & Eldridge, 2011; McConnell, 2001). Following decades of implementing various cost containment strategies, most hospitals are financially stressed and operate within a cost-driven culture (Jost, 2012; Kavanaugh, Cimiotti, Absusalem, & Coty, 2012). Because nurse labor is a major driver of hospital costs (Welton, Hughes Fischer, DeGrace, & Zone-Smith, 2006), nurse staffing practices are particularly vulnerable to administrative scrutiny and often the target for lean management strategies.…”

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confidence: 99%

Texas Nurse Staffing Trends Before and After Mandated Nurse Staffing Committees

Jones

Bae

Murry

et al. 2015

Policy, Politics, & Nursing Practice

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This article describes the evolution of mandated nurse staffing committees in Texas from 2002 to 2009 and presents a study that analyzed nurse staffing trends in Texas using a secondary analysis of hospital staffing data (N = 313 hospitals) from 2000 to 2012 obtained from the American Hospital Association Annual Survey. Nurse staffing patterns based on three staffing variables for registered nurses (RNs), licensed vocational nurses (LVNs), and total licensed nurses were identified: full-time equivalents per 1,000 adjusted patient days, productive hours per adjusted patient day, and RN skill mix. Similar to national trends between 2000 and 2012, most Texas hospitals experienced an increase in RN and total nurse staffing, decrease in LVN staffing, and an increase in RN skill mix. The magnitude of total nurse staffing changes in Texas (5% increase) was smaller than national trends (13.6% increase). Texas's small, rural, government hospitals and those with the highest preregulation staffing levels experienced the least change in staffing between 2000 and 2012: median change of 0 to .13 full-time equivalents per 1,000 adjusted patient days and median change in productive hours per patient day of 0 to .23. The varying effects of staffing committees in different organizational contexts should be considered in future staffing legislative proposals and other policy initiatives.

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

Ziebarth

2013

Int J Health Care Finance Econ

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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 [Formula: see text] . 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.

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Eight Decades of Discouragement: The History of Health Care Cost Containment in the USA

Abstract: This chapter traces the history of attempts at cost control in the United States from the origins of our modern health care financing system in the 1930s and 1940s, through health care cost regulation in the 1970s, and the deregulatory 1980s and 1990s, to the Affordable Care Act.

Cited by 5 publications

References 39 publications

Retrospective cohort study comparing surgical inpatient charges, total costs, and variable costs as hospital cost savings measures

Retrospective cohort study comparing surgical inpatient charges, total costs, and variable costs as hospital cost savings measures

Texas Nurse Staffing Trends Before and After Mandated Nurse Staffing Committees

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

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