Search

Background The gender gap in physician pay is often attributed in part to women working fewer hours than men, but evidence to date is limited by self-report and a lack of detail regarding ...

While there is broad acceptance of the need for providers to assume financial responsibility for the management of their patients by providing warranties through the implementation of alternative payment models, many of those models fall short in practice because of inherent design flaws., Summary To accelerate wider adoption of the health care warranty, stakeholders will need to refine the allocation of risk between payer and provider while simultaneously minimizing the real or perceived uncertainty for providers. This must be done through a contract that binds buyer and seller in ways that will align incentives. The authors define a warranty as an implicit acceptance by providers to bear the cost of any complications related to the management of a procedure or condition. So, when providers accept a fixed budget or price for a patient’s total care for a condition or procedure, they are offering an implicit warranty on that care. Current models that strive for a warranty blur the line between risk (which is measurable) and uncertainty (which is not measurable). The authors offer specific design elements for Warranty-Based Alternative Payment Models.

Beyond Nudges In recent years, health care leaders have increasingly turned to “nudges” to influence health-related behaviors. But harmful health and health care behaviors often arise in circumstan...

In response to concern about high prices of prescription drugs, presidential candidates and lawmakers have proposed a number of policy changes, including enhancing market forces that put pressure on companies to set lower prescription-drug prices out of self-interest.

Two Sounding Board articles, by Emanuel et al. and Antos et al., discuss different approaches to controlling rising health care costs in the United States. The editors hope that the range of options presented will stimulate discussion and debate on the best ways to bend the health care cost curve.

One tactic for reducing health care spending is to increase price transparency, aiming to spur cost-conscious shopping by consumers and competitive price-lowering by providers. But implementing such an approach is challenging, and it might not have the desired effect.

What kind of payment system could promote and sustain high-value care and motivate the development of accountable care organizations? Francois de Brantes, Meredith Rosenthal, and Dr. Michael Painter describe the Prometheus Payment model.

The use of market forces in health policy typically involves altering out-of-pocket prices and information for consumers (the demand side) and incentives for providers (the supply side). Meredith Rosenthal writes that the main question is how to design these interventions to improve the medical system, without harmful side effects.

Both the enthusiastic adoption and somewhat lackluster early results of pay for performance have given rise to a broader payment-reform movement, with proposals and pilots emerging from a wide variety of stakeholders and policy leaders. Meredith Rosenthal describes these novel approaches to payment reform.

Many health plans and employers offer wellness programs and incentives for participation. In this article, the authors examine the legal issues employers and health plans must consider as they develop programs to reward healthy behaviors and discourage unhealthy ones.

Background Evidence suggests that direct-to-consumer advertising of prescription drugs increases pharmaceutical sales and both helps to avert underuse of medicines and leads to potential overuse. Concern about such advertising has increased recently owing to the withdrawal from the market of heavily advertised drugs found to carry serious risks. Moreover, the Food and Drug Administration (FDA) has been criticized for its weak enforcement of laws regulating such advertising. Methods We examined industry-wide trends in spending by pharmaceutical companies on direct-to-consumer advertising and promotion to physicians during the past decade. We characterized the drugs for which such advertising is used and assessed the timing of advertising after a drug is introduced. Finally, we examined trends in the FDA's regulation of drug advertising. Results Total spending on pharmaceutical promotion grew from $11.4 billion in 1996 to $29.9 billion in 2005. Although during that time spending on direct-to-consumer advertising increased by 330%, it made up only 14% of total promotional expenditures in 2005. Directto- consumer campaigns generally begin within a year after the approval of a product by the FDA. In the context of regulatory changes requiring legal review before issuing letters, the number of letters sent by the FDA to pharmaceutical manufacturers regarding violations of drug-advertising regulations fell from 142 in 1997 to only 21 in 2006. Conclusions Spending on direct-to-consumer advertising has continued to increase in recent years in spite of the criticisms leveled against it. Our findings suggest that calls for a moratorium on such advertising for new drugs would represent a dramatic departure from current practices.

Will new rules requiring drug and device companies to disclose payments to physicians and teaching hospitals have the intended effects? Disclosure's benefits are unlikely to be realized without the activation of “learned intermediaries,” such as health insurers.

Overconsumption of foods containing excessive salt, sugar, and unhealthful fats poses a public health threat in the United States. A possible policy approach to addressing the threat that recognizes our free-market ideals is “cap and trade” of unhealthy ingredients.

An accountable care organization (ACO) model that does not attend to the way patients seek care may fail to achieve its cost-saving and quality goals and may give rise to a backlash. Policymakers should focus on creating incentives to build patients' loyalty to an ACO.

President Barack Obama has argued that health care reform is essential to the future economic health of the United States. But the economics of both health care and reform are daunting. Is it possible to pay for health care coverage for all Americans without moderating our rapidly rising health care costs? And what do we know about the best ways of achieving cost savings? On September 14, 2009, the Journal hosted a roundtable discussion about the most promising ways of slowing the growth of health care costs, their potential effects on medical practice, and the likelihood that the current health . . .

Recently, the Centers for Medicare and Medicaid Services announced its decision to cease paying hospitals for some of the care made necessary by “preventable complications.” Meredith Rosenthal writes that this rule is the latest in a series of steps that have rendered Medicare's payment policy far less passive than it once was. Meredith Rosenthal discusses current and future reforms of Medicare's payment policies. Dr. Rosenthal is an associate professor of health economics and policy at the Harvard School of Public Health, Boston.

In April, the Centers for Medicare and Medicaid Services (CMS) issued a long-awaited Notice of Proposed Rulemaking with a proposed policy for the accountable care organization (ACO) program authorized by the Affordable Care Act (ACA). Under this policy, ACOs could participate in one of two types of 3-year arrangements. In the first path, in years 1 and 2 they would be eligible to share any savings they achieved relative to a spending target without accepting “downside” risk. In year 3, the ACOs would be required to repay Medicare for a percentage of any spending over their target level. In the . . .