Health Care Spending, Utilization, and Quality 8 Years into Global Payment

Song, Zirui; Ji, Yunan; Safran, Dana Gelb; Chernew, Michael E.

doi:10.1056/nejmsa1813621

Cited by 78 publications

(53 citation statements)

References 25 publications

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“…Disease phenomenon [21][22][23][24].In addition, DRGs also has some practices in China, but we think it is not suitable for China's county-level regions, especially the central and western regions where the economy and medical care are underdeveloped.Relatively speaking, the current stage of medical insurance informatization in these areas and the standardization of hospital information systems are uneven, which leads to inadequate supervision and brings di culties to the collection of large amounts of data required for DRGs coding.Second, after the implementation of DRGs, doctors may increase their income by over-diagnosing and changing the level of surgery, and cannot really save medical insurance funds; when facing the same price, patients are more likely to prefer county-level hospitals with better medical conditions. Nor can it change the current contradiction between countylevel hospitals and primary health service centers, which runs counter to the reform goals;The total prepaid execution cost is low, and it can effectively control the medical cost, but its disadvantage is that it is di cult to ensure the quality of medical treatment and may cause medical institutions to reject patients [25][26][27][28].The performance-based payment method is usually implemented together with other payment methods. The purpose is to control costs while ensuring the quality of medical services.…”

Section: Comparison With Other Medical Insurance Payment Methodsmentioning

confidence: 99%

The Impact of China's Total Medical Insurance Package Payment Based on Compact County Medical Community and Its Implications for Medical Insurance Funds: Evidence from Y County, China

Liu¹,

Yang

et al. 2020

Preprint

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Background:Due to the irrational structure of medical and health resources, uneven distribution, and low level of grassroots services, traditional medical insurance payment methods in China’s underdeveloped areas have not been fully utilized in regulating medical service behaviors and guiding the allocation of medical resources. The medical insurance fund of many regions collapsed, the fund balance rate and compensation rate decreased year by year, and the medical expenses rose rapidly, which seriously affected the enthusiasm of the insured residents. As a results,the sustainable development of the medical insurance fund faced many difficulties and challenges.Based on this, we want to design a medical insurance policy suitable for underdeveloped areas in China to improve the capacity and efficiency of health services and maintain the stability of medical insurance funds.Methods:Collected medical insurance data of Y County in China from 2018 to 2019.The interruption time series(ITS) was used to evaluate the utilization of medical insurance funds in county-level hospitals, primary health service centers, and hospitals outside the medical community.Results:Inpatient expenditure(IE) per capita,out-of-pocket inpatient expenditure(OIE) per capita,and medical insurance expenditure (MIE)per capita in county-level hospitals increased by 84.682, 6.564 and 62.302 yuan per month respectively after the reform; Number of annul discharges persons(NOADP)from basic health service centers increased by 36.899 per month after the reform; IE per capita and MIE per capita increased by 18.624 yuan and 15.767 yuan per month on average after the reform; the residents hospitalized outside CCMC decreased by 9.545 per month on average after the reform. Conclusions:China should further implement the CCMC-based TMIPPM reform to control medical expenses and maintain the stability of medical insurance funds in in more trials.

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Section: Comparison With Other Medical Insurance Payment Methodsmentioning

confidence: 99%

The Impact of China's Total Medical Insurance Package Payment Based on Compact County Medical Community and Its Implications for Medical Insurance Funds: Evidence from Y County, China

Liu¹,

Yang

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…Other more complicated methods, such as generalized linear models, may in some instances perform better but require making other assumptions about the distribution of the outcome. Finally, by using linear models, we followed other articles published in leading medical and health service journals (26,(38)(39)(40)(41)(42)(43).…”

Section: Resultsmentioning

confidence: 99%

Health Care Expenditures Among Adults With Diabetes After Oregon’s Medicaid Expansion

et al. 2020

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To compare trends in Medicaid expenditures among adults with diabetes who were newly eligible due to the Affordable Care Act (ACA) Medicaid expansion to trends among those previously eligible. RESEARCH DESIGN AND METHODSUsing Oregon Medicaid administrative data from 1 January 2014 to 30 September 2016, a retrospective cohort study was conducted with propensity score-matched Medicaid eligibility groups (newly and previously eligible). Outcome measures included total per-member per-month (PMPM) Medicaid expenditures and PMPM expenditures in the following 12 categories: inpatient visits, emergency department visits, primary care physician visits, specialist visits, prescription drugs, transportation services, tests, imaging and echography, procedures, durable medical equipment, evaluation and management, and other or unknown services. RESULTSTotal PMPM Medicaid expenditures for newly eligible enrollees with diabetes were initially considerably lower compared with PMPM expenditures for matched previously eligible enrollees during the first postexpansion quarter (mean values $561 vs. $793 PMPM, P 5 0.018). Within the first three postexpansion quarters, PMPM expenditures of the newly eligible increased to a similar but slightly lower level. Afterward, PMPM expenditures of both groups continued to increase steadily. Most of the overall PMPM expenditure increase among the newly eligible was due to rapidly increasing prescription drug expenditures. CONCLUSIONSNewly eligible Medicaid enrollees with diabetes had slightly lower PMPM expenditures than previously eligible Medicaid enrollees. The increase in PMPM prescription drug expenditures suggests greater access to treatment over time.The prevalence of diabetes in the population has increased substantially in the U.S. In 2017, more than 30 million people were diagnosed with this condition, more than twice as many as compared with 20 years ago (1-3). The economic costs associated with the condition are substantial, reaching around $327 billion in 2017 (4). Among people without health insurance coverage, diabetes is more likely to remain undiagnosed and untreated, and uninsured populations also have less health care access and lower utilization than insured populations (5-8). Therefore, gaining health insurance is likely to improve treatment and well-being among people with diabetes.

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“…Currently in the medical field, the reform of health care payment systems has centered on moving providers away from fee‐for‐service payment and focusing on outcomes assessment and value‐based health care. Alternative payment models using financial rewards and penalties have demonstrated successful long‐term gains in outcome measures, while slowing medical spending 5 . While these concepts do not exist in dentistry yet, our profession may need to face this reality in the near future.…”

Section: Discussionmentioning

confidence: 99%

An innovative approach to assess comprehensive care: Temple University's patient wellness report

Téllez

Meraner

Lim

et al. 2020

Journal of Dental Education

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Purpose The transition from a paper‐based to an all‐electronic patient health record took a major step forward in 2018, with the implementation of an electronic health record that supports the School's patient‐centered comprehensive care model and facilitates outcomes assessment. The Patient Wellness Report (PWR) summarizes findings of the patient assessment, and it does so automatically by locating data already entered in axiUm forms. This study aimed to describe the PWR implementation procedures and to examine outcomes and characteristics among patients with completed treatment plans during an 18‐month period. Methods Outcome data were extracted from axiUm for patients aged ≥16 years who completed comprehensive care treatment plans. Each PWR contained 14 metrics related to “dimensions” of wellness (quality of life, general health factors, oral hygiene, caries risk, and degree of periodontal inflammation and pocketing), each of which is rated on a 3‐point scale based on best available scientific evidence. Results A total of 2074 patients completed planned procedures between July 2018 and January 2020, and met the study eligibility criteria. Improvement of several conditions was observed between baseline and follow‐up in caries lesions (21%), blood pressure (9%), and periodontal pocket (3.2%). A majority of patients rated in good condition at baseline had their scores unchanged at follow‐up in the following areas: dental anxiety (92%), speaking (88%), smoking (87%), and alcohol consumption (79%). Conclusion Improvements in dental caries and blood pressure metrics were easily monitored using the PWR. In addition, disparities exist in improvement of patient outcomes by race/ethnicity.

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Health Care Spending, Utilization, and Quality 8 Years into Global Payment

Cited by 78 publications

References 25 publications

The Impact of China's Total Medical Insurance Package Payment Based on Compact County Medical Community and Its Implications for Medical Insurance Funds: Evidence from Y County, China

The Impact of China's Total Medical Insurance Package Payment Based on Compact County Medical Community and Its Implications for Medical Insurance Funds: Evidence from Y County, China

Health Care Expenditures Among Adults With Diabetes After Oregon’s Medicaid Expansion

An innovative approach to assess comprehensive care: Temple University's patient wellness report

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