1998 Policy Studies

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As Good as it Should Get: Making Health Care Better in the New Millennium – September 1998
By Donald M. Berwick, M.D., M.P.P., Institute for Healthcare Improvement, September 1998.

The study “As Good as It Should Get: Making Health Care Better in the New Millennium,” cites numerous examples known as “best practices” where clinicians and health care administrators have either reduced inappropriate care or improved care and saved money in the process. The report developed by Donald Berwick, M.D., President of the Institute for Healthcare Improvement, estimates that with modest assumptions about defect rates in health care, total cost reductions of nearly 30 percent below current levels should be attainable while improving the overall quality of care. However, the report indicates that quality improvements and innovations achieved by hospitals and doctors at the local level have not caught fire nationwide. The report calls on the health care providers to develop breakthrough examples of system-level performance of unprecedented quality at affordable cost.

Comprehensive Medicare Reform: Defined Benefit vs. Defined Contribution – September 1998
By John Sheils and Andrea Fishman, The Lewin Group, September 1998.

This study examined the implications of Medicare changing from a defined benefit program which provides a defined level of services to all eligible persons to a program that provides a “defined contribution” voucher to beneficiaries. The report found that there is no guarantee that the voucher amounts will be enough to purchase coverage comparable to the existing Medicare benefits package. Further, many beneficiaries would have to supplement the voucher amount with their own funds to maintain even the Medicare benefits package that all beneficiaries now have.

The Role of Medical Savings Accounts in Health System Reform – May 1998
By Elliot K. Wicks, Ph.D. and Jack Meyer, Ph.D., Economic and Social Research Institute, May 1998.

The Coalition commissioned “The Role of Medical Savings Accounts in Health System Reform,” a study conducted by the Economic and Social Research Institute, to determine the acceptance and viability of Medical Savings Accounts (MSAs) in addressing the problems of cost, coverage and quality. The findings of the study indicate that although MSAs may prove to be one more viable choice for some people who are seeking health insurance coverage, MSAs are unlikely to have a major impact on solving larger health system problems. The study determined that MSAs are no panacea. The study also found that the sale of MSAs was far below expectations of many proponents of the concept.

Rethinking the Medicare Eligibility Age – Medicare Series Report #1, June 1998
By John Sheils, David Stapleton, Jessica Graus, and Andrea Fishman, The Lewin Group, June 1998.

In this study, The Lewin Group found that increasing the Medicare eligibility age would leave many newly ineligible individuals without health insurance because many of these people would not be able to afford the high cost of private coverage for this age group. The study also found that increasing the retirement age would increase the cost of employer-sponsored retiree coverage, which could cause some employers to discontinue these benefits, leaving still more retirees uninsured. The study shows that a program that provides at least partial subsidies to lower income individuals who would be displaced by the increase in the Medicare eligibility age would be needed if we are to avoid an increase in the number of uninsured persons age 65 to 66.

A Reality Check: The Public’s Changing Views of our Health Care System

The American public has a much broader and higher level of concern about health care than is reflected in the words and actions of many of their elected officials. People increasingly are worried about losing coverage, paying for care if they lack coverage, and the quality of their care, even if they are insured. These concerns exist independent of the types of plans in which patients are enrolled. And in contrast to the past, today those concerns also exist among middle-class Americans and especially those who have had recent contact with our health care system. (April 1998)

Key Findings on the Public’s Changing Views of our Health Care SystemExecutive Summary: A Reality Check: The Public’s Changing View’s of our Health Care SystemThe Rising Number of Uninsured Workers: An Approaching Crisis In Health Care Financing

While the United States enjoys one of the greatest economic growth periods in our history, there were over 40 million Americans uninsured for health care in 1995. Of these 40 million, nearly 24 million were uninsured workers. Based on our analysis, the number of uninsured people will continue to grow significantly each year.

Key Findings on Quality of Care in the United StatesWhy the Quality of U.S. Health Care Must Be Improved

While many consider the United States to have the finest health care in the world, a large and growing body of evidence indicates that there are widespread problems with the quality of much of America’s health care. Millions of Americans are injured and tens of thousands die unnecessarily each year because of errors or the overuse, underuse, or misuse of services. Moreover, these problems are not being recognized or addressed adequately in this country today.

Key Findings on Health Care SpendingChanges in the Growth in Health Care Spending: Implications for Consumers

Several studies have documented that growth in health care spending in the U.S. slowed between 1990 and 1995. This has led many to assume that the health care cost crisis of the 80s and early 90s has been solved. However, more recent indicators have s tarted to paint a different picture. The data in the following report clearly demonstrate that, despite a moderation in consumer spending for all types of health care during the last two years, the growth rate of private health insurance premiums has beg un to escalate once again. This report examines the current trends in health care costs and examines how various purchasers within the health care system have fared.

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