On the basis of an examination of post World War 2 trends this report offers a specific scenario ... more On the basis of an examination of post World War 2 trends this report offers a specific scenario of how demographic and economic phenomena may evolve over the next several decades. Focus is on birthrates population redistribution both documented and undocumented immigration wages and unemployment womens labor market participation and retirement ages. The US faces a transition to zero population growth. Following the post World War 2 baby boom the countrys birthrate began to decline in the early 1960s. If low fertility persists natural population growth may virtually stop early in the 21st century. Unprecedented demographic changes will result--in the populations age structure in the composition of families and households in the economic and familial activities of women and men and in the number and characteristics of foreign immigrants. The fertility rate is now hovering near record low levels and is likely to remain there. Because of the fertility decline the native born population...
New medical technologies are a leading driver of U.S. health care spending. This article identifi... more New medical technologies are a leading driver of U.S. health care spending. This article identifies promising policy options to change which medical technologies are created, with two related policy goals: (1) Reduce total health care spending with the smallest possible loss of health benefits, and (2) ensure that new medical products that increase spending are accompanied by health benefits that are worth the spending increases. The analysis synthesized information from peer-reviewed and other literature, a panel of technical advisors convened for the project, and 50 one-on-one expert interviews. The authors also conducted case studies of eight medical products. The following features of the U.S. health care environment tend to increase spending without also conferring major health benefits: lack of basic scientific knowledge about some disease processes, costs and risks of U.S. Food and Drug Administration (FDA) approval, limited rewards for medical products that could lower spend...
The emission reduction policies of the state of California are at various phases of development a... more The emission reduction policies of the state of California are at various phases of development and implementation. In general, California's strategy includes strict regulation of some consumer products; of stationary sources, such as power plants and factories; and of mobile source emissions, such as trucks and passenger cars. The purpose of this report is to offer a firmer foundation for those involved in making policy decisions. The cost and effectiveness of California's strategy of emissions reductions from light duty vehicles (passenger cars and light trucks) are evaluated. Key concepts included in the analysis are market responses to the policies, cost-benefit analysis and cost-effectiveness analysis.
OBJECTIVES To understand physician organization (PO) responses to financial incentives for qualit... more OBJECTIVES To understand physician organization (PO) responses to financial incentives for quality and total cost of care among POs that were exposed to a statewide multipayer value-based payment (VBP) program, and to identify challenges that POs face in advancing the goals of VBP. STUDY DESIGN Semistructured qualitative interviews and survey. METHODS We drew a stratified random sample of 40 multispecialty California POs (25% of the POs that were eligible for incentives). In-person interviews were conducted with physician leaders and a survey was administered on actions being taken to reduce costs and redesign care and to discuss the challenges to improving value. We performed a thematic analysis of interview transcripts to identify common actions taken and challenges to reducing costs. RESULTS VBP helps to promote care delivery transformation among POs, although efforts varied across organizations. Investments are occurring primarily in strategies to control hospital costs and rede...
Crucial to any cost containment effort is a detailed understanding of what costs are being reduce... more Crucial to any cost containment effort is a detailed understanding of what costs are being reduced, where they are coming from, and who has the potential to capture the savings. In this report we focus on the landscape of health care spending and a framework for understanding cost containment approaches in California. The financial impact of a wide range of policy proposals aimed at reducing health care spending will be the subject of a second, follow-up report in this series.
Public policy and the inner city across three decades / Robert A. Levine and Barbara R. Williams ... more Public policy and the inner city across three decades / Robert A. Levine and Barbara R. Williams -- The widening income and wage gap between rich and poo trends, causes, and policy options / Lynn A. Karoly -- Families, children, poverty, policy / Julie DaVanzo -- Helping urban teenagers avoid high-risk behavior : what we've learned from prevention research / Phyllis L. Ellickso -- Urban education / Paul T. Hill -- Crime and punishment in California : fu cells, empty pockets, and questionable benefits / Joan Petersilia -- Reformi California's approach to delinquent and high-risk youth / Peter W. Greenwood Street drug markets in inner-city neighborhoods : matching policy to reality Peter H. Reuter and Robert J. MacCoun -- Financing public services in Los Angeles / Preston Niblack and Peter J.E. Stan -- Needed : a federal role in helping communities cope with immigration / Georges Vernez -- Providing heal care for the uninsured and underinsured in Los Angeles County / Robert E....
Available Comprehensive Quality Improvement Guides What is the purpose of this tool? This tool pr... more Available Comprehensive Quality Improvement Guides What is the purpose of this tool? This tool provides information on other quality improvement guides. You may find these additional resources helpful in your quality improvement efforts. Who are the target audiences? The primary audiences are quality officers and members of the implementation teams responsible for carrying out performance improvements. These resources also might be of interest to hospital senior leadership and managers. How can it help you? As you work to improve the quality of care in your hospital and use the AHRQ Quality Indicators, these additional resources may help guide the actions you take. How does this tool relate to others? Additional information on guides to help with specific analytic or action steps is included in Specific Tools To Support Change (Tool G.2).
... staged or nonexistent accidents, claims for nonexistent injuries when the accidents were real... more ... staged or nonexistent accidents, claims for nonexistent injuries when the accidents were real, and buildup of claims for real injuries to leverage a settlement from the insurance company. We focus on medical claims because virtually all auto personal injury claims include some ...
In a 2002 commentary in Health Affairs, Joseph P. Newhouse observed, "Medical care seems to obtai... more In a 2002 commentary in Health Affairs, Joseph P. Newhouse observed, "Medical care seems to obtain less value from the resources it uses than other industries do, a phenomenon not limited to the United States." 1 Many groups, from the Kaiser Family Foundation to the Congressional Budget Office, 2, 3 have noted that the swift adoption and diffusion of expensive new devices, drugs, and procedures is a major factor driving both medical progress and growth of health care spending. What distinguishes innovation in health care from other industries is that adoption of new technologies is largely insulated from concerns about cost. ■ Rapid adoption of expensive health care technology is a major contributor to spending growth. ■ Payment policies that reimburse new technologies, irrespective of their cost, favor development of expensive innovations over those that might produce equal or greater benefit at lower cost. ■ Health information technology has not achieved its full potential, but its benefits should grow over time. ■ Because health care is largely regulated at the state level, the states can play a valuable role as "laboratories" for innovative policies.
eGEMs (Generating Evidence & Methods to improve patient outcomes)
Introduction: As hospitals and physician organizations increasingly vertically integrate, there i... more Introduction: As hospitals and physician organizations increasingly vertically integrate, there is an important opportunity to use health systems to improve performance. Prior research has largely relied on secondary data sources, but little is known about how health systems are organized "on the ground" and what mechanisms are available to influence physician practice at the front line of care. Methods: We collected in-depth information on eight health systems through key informant interviews, descriptive surveys, and document review. Qualitative data were systematically coded. We conducted analyses to identify organizational structures and mechanisms through which health systems influence practice. Results: As expected, we found that health systems vary on multiple dimensions related to organizational structure (e.g., size, complexity) which reflects history, market and mission. With regard to levers of influence, we observed within-system variation both in mechanisms (e.g., employment of physicians, system-wide EHR, standardization of service lines) and level of influence. Concepts such as "core" versus "peripheral" were more salient than "ownership" versus "contract." Discussion: Data from secondary sources can help identify and map health systems, but they do not adequately describe them or the variation that exists within and across systems. To examine the degree to which health systems can influence performance, more detailed and nuanced information on health system characteristics is necessary. Conclusion: The mixed-methods data accrual approach used in this study provides granular qualitative data that enables researchers to describe multi-layered health systems, grasp the context in which they operate, and identify the key drivers of performance.
On the basis of an examination of post World War 2 trends this report offers a specific scenario ... more On the basis of an examination of post World War 2 trends this report offers a specific scenario of how demographic and economic phenomena may evolve over the next several decades. Focus is on birthrates population redistribution both documented and undocumented immigration wages and unemployment womens labor market participation and retirement ages. The US faces a transition to zero population growth. Following the post World War 2 baby boom the countrys birthrate began to decline in the early 1960s. If low fertility persists natural population growth may virtually stop early in the 21st century. Unprecedented demographic changes will result--in the populations age structure in the composition of families and households in the economic and familial activities of women and men and in the number and characteristics of foreign immigrants. The fertility rate is now hovering near record low levels and is likely to remain there. Because of the fertility decline the native born population...
New medical technologies are a leading driver of U.S. health care spending. This article identifi... more New medical technologies are a leading driver of U.S. health care spending. This article identifies promising policy options to change which medical technologies are created, with two related policy goals: (1) Reduce total health care spending with the smallest possible loss of health benefits, and (2) ensure that new medical products that increase spending are accompanied by health benefits that are worth the spending increases. The analysis synthesized information from peer-reviewed and other literature, a panel of technical advisors convened for the project, and 50 one-on-one expert interviews. The authors also conducted case studies of eight medical products. The following features of the U.S. health care environment tend to increase spending without also conferring major health benefits: lack of basic scientific knowledge about some disease processes, costs and risks of U.S. Food and Drug Administration (FDA) approval, limited rewards for medical products that could lower spend...
The emission reduction policies of the state of California are at various phases of development a... more The emission reduction policies of the state of California are at various phases of development and implementation. In general, California's strategy includes strict regulation of some consumer products; of stationary sources, such as power plants and factories; and of mobile source emissions, such as trucks and passenger cars. The purpose of this report is to offer a firmer foundation for those involved in making policy decisions. The cost and effectiveness of California's strategy of emissions reductions from light duty vehicles (passenger cars and light trucks) are evaluated. Key concepts included in the analysis are market responses to the policies, cost-benefit analysis and cost-effectiveness analysis.
OBJECTIVES To understand physician organization (PO) responses to financial incentives for qualit... more OBJECTIVES To understand physician organization (PO) responses to financial incentives for quality and total cost of care among POs that were exposed to a statewide multipayer value-based payment (VBP) program, and to identify challenges that POs face in advancing the goals of VBP. STUDY DESIGN Semistructured qualitative interviews and survey. METHODS We drew a stratified random sample of 40 multispecialty California POs (25% of the POs that were eligible for incentives). In-person interviews were conducted with physician leaders and a survey was administered on actions being taken to reduce costs and redesign care and to discuss the challenges to improving value. We performed a thematic analysis of interview transcripts to identify common actions taken and challenges to reducing costs. RESULTS VBP helps to promote care delivery transformation among POs, although efforts varied across organizations. Investments are occurring primarily in strategies to control hospital costs and rede...
Crucial to any cost containment effort is a detailed understanding of what costs are being reduce... more Crucial to any cost containment effort is a detailed understanding of what costs are being reduced, where they are coming from, and who has the potential to capture the savings. In this report we focus on the landscape of health care spending and a framework for understanding cost containment approaches in California. The financial impact of a wide range of policy proposals aimed at reducing health care spending will be the subject of a second, follow-up report in this series.
Public policy and the inner city across three decades / Robert A. Levine and Barbara R. Williams ... more Public policy and the inner city across three decades / Robert A. Levine and Barbara R. Williams -- The widening income and wage gap between rich and poo trends, causes, and policy options / Lynn A. Karoly -- Families, children, poverty, policy / Julie DaVanzo -- Helping urban teenagers avoid high-risk behavior : what we've learned from prevention research / Phyllis L. Ellickso -- Urban education / Paul T. Hill -- Crime and punishment in California : fu cells, empty pockets, and questionable benefits / Joan Petersilia -- Reformi California's approach to delinquent and high-risk youth / Peter W. Greenwood Street drug markets in inner-city neighborhoods : matching policy to reality Peter H. Reuter and Robert J. MacCoun -- Financing public services in Los Angeles / Preston Niblack and Peter J.E. Stan -- Needed : a federal role in helping communities cope with immigration / Georges Vernez -- Providing heal care for the uninsured and underinsured in Los Angeles County / Robert E....
Available Comprehensive Quality Improvement Guides What is the purpose of this tool? This tool pr... more Available Comprehensive Quality Improvement Guides What is the purpose of this tool? This tool provides information on other quality improvement guides. You may find these additional resources helpful in your quality improvement efforts. Who are the target audiences? The primary audiences are quality officers and members of the implementation teams responsible for carrying out performance improvements. These resources also might be of interest to hospital senior leadership and managers. How can it help you? As you work to improve the quality of care in your hospital and use the AHRQ Quality Indicators, these additional resources may help guide the actions you take. How does this tool relate to others? Additional information on guides to help with specific analytic or action steps is included in Specific Tools To Support Change (Tool G.2).
... staged or nonexistent accidents, claims for nonexistent injuries when the accidents were real... more ... staged or nonexistent accidents, claims for nonexistent injuries when the accidents were real, and buildup of claims for real injuries to leverage a settlement from the insurance company. We focus on medical claims because virtually all auto personal injury claims include some ...
In a 2002 commentary in Health Affairs, Joseph P. Newhouse observed, "Medical care seems to obtai... more In a 2002 commentary in Health Affairs, Joseph P. Newhouse observed, "Medical care seems to obtain less value from the resources it uses than other industries do, a phenomenon not limited to the United States." 1 Many groups, from the Kaiser Family Foundation to the Congressional Budget Office, 2, 3 have noted that the swift adoption and diffusion of expensive new devices, drugs, and procedures is a major factor driving both medical progress and growth of health care spending. What distinguishes innovation in health care from other industries is that adoption of new technologies is largely insulated from concerns about cost. ■ Rapid adoption of expensive health care technology is a major contributor to spending growth. ■ Payment policies that reimburse new technologies, irrespective of their cost, favor development of expensive innovations over those that might produce equal or greater benefit at lower cost. ■ Health information technology has not achieved its full potential, but its benefits should grow over time. ■ Because health care is largely regulated at the state level, the states can play a valuable role as "laboratories" for innovative policies.
eGEMs (Generating Evidence & Methods to improve patient outcomes)
Introduction: As hospitals and physician organizations increasingly vertically integrate, there i... more Introduction: As hospitals and physician organizations increasingly vertically integrate, there is an important opportunity to use health systems to improve performance. Prior research has largely relied on secondary data sources, but little is known about how health systems are organized "on the ground" and what mechanisms are available to influence physician practice at the front line of care. Methods: We collected in-depth information on eight health systems through key informant interviews, descriptive surveys, and document review. Qualitative data were systematically coded. We conducted analyses to identify organizational structures and mechanisms through which health systems influence practice. Results: As expected, we found that health systems vary on multiple dimensions related to organizational structure (e.g., size, complexity) which reflects history, market and mission. With regard to levers of influence, we observed within-system variation both in mechanisms (e.g., employment of physicians, system-wide EHR, standardization of service lines) and level of influence. Concepts such as "core" versus "peripheral" were more salient than "ownership" versus "contract." Discussion: Data from secondary sources can help identify and map health systems, but they do not adequately describe them or the variation that exists within and across systems. To examine the degree to which health systems can influence performance, more detailed and nuanced information on health system characteristics is necessary. Conclusion: The mixed-methods data accrual approach used in this study provides granular qualitative data that enables researchers to describe multi-layered health systems, grasp the context in which they operate, and identify the key drivers of performance.
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