What is good care, and what is bad?
National health care goals generally include providing broad access to appropriate amounts of high-quality health care at appropriate cost to the ultimate payers. Yet all countries, regardless of how they deliver and finance health care, struggle to achieve a sustainable balance among the implicit tradeoffs. Does this struggle stem from the limited scope for competition in health care or from information asymmetries? Or does it simply reflect the inherent difficulty of measuring health care output and quality? Alternatively, does it result from deep-seated human behavior - a tendency for ...
Equilibrium Labor Market Search and Health Insurance Reform
We present and empirically implement an equilibrium labor market search model where risk averse workers facing medical expenditure shocks are matched with firms making health insurance coverage decisions. Our model delivers a rich set of predictions that can account for a wide variety of phenomenon observed in the data including the correlations among firm sizes, wages, health insurance offering rates, turnover rates and workers? health compositions. We estimate our model by Generalized Method of Moments using a combination of micro datasets including Survey of Income and Program ...
It’s health care, stupid! why control of health care spending is vital for long-term fiscal stability
What are the implications of the current structure of the U.S. health care system for U.S. fiscal stability at the federal and state levels over the medium and long terms? What are the national, global, and inter-generational distribution effects? How will a growing recognition of the need for ?reform? affect saving decisions? Is the macro adjustment to ?broken? health care promises likely to be smooth? What are the policy implications?
Comments on Enthoven’s “The U.S. Experience with Managed Care and Managed Competition”
This session will provide an overview of the U.S. health care system with an emphasis on trends observed since the reforms of the early 1990s. ; How has the health care system adjusted to the introduction of market-oriented medicine? And what have been the consequences for access to care, health care costs (public and private), and the quality of care over the past decade? How does the U.S. health care system measure up in international comparisons, for instance? Does managed care work as its advocates expected or have inappropriate consumer and provider incentives undermined this experiment? ...
Reforming the U. S. health care system: where there's a will, there could be a way
The essay in the 2005 annual report summarizes the themes and consensus-based prescriptions for action that emerged from the Boston Fed's 50th economic conference, Wanting It All: The Challenge of Reforming the U.S. Health Care System, held in June 2005.
Health financing: challenges and opportunities, coverage and cost
This policy panel will present and debate proposals for the next steps in reforming the U.S. health care system. Which challenge deserves the highest priority – providing universal access; instituting better measures of quality and outcomes and better management systems; or reining in costs? How should these challenges be addressed? What keeps us from "having it all"? Does the fundamental obstacle lie in market behavior, inadequate or asymmetric information, lack of political will, or the human psyche? How would the proposed reforms tackle the underlying issue and help us maintain a ...
How do Doctors Respond to Incentives? Unintended Consequences of Paying Doctors to Reduce Costs
Billions of dollars have been spent on pilot programs searching for ways to reduce healthcare costs. I study one such program, where hospitals pay doctors bonuses for reducing the total hospital costs of admitted Medicare patients (a ?bundled payment?). Doctors respond to the bonuses by becoming more likely to admit patients whose treatment can generate high bonuses, and sorting healthier patients into participating hospitals. Conditional on patient health, however, doctors do not reduce costs or change procedure use. These results highlight the ability of doctors to game incentive schemes, ...
Physician Payments Under Health Care Reform
This study assesses the impact of major health insurance reform in Massachusetts on the prices of services paid to physicians in the privately insured market. We estimate that the reform caused physician payments to increase at least 10.8 percentage points. This impact occurred while the legislation was materializing but before the final compromised version of the reform was enacted in April 2006. This finding is consistent with prices being set in a forward-looking manner, in anticipation of the reform. Overall, one-sixth of physician service price growth in Massachusetts between 2003 and ...
The 2009 Health Care Leader Forum - a conference summary
On March 30?31, 2009, the Federal Reserve Bank of Chicago and the Detroit Regional Chamber co-sponsored the third annual forum on health care. This year?s program focused on the role of employers in improving the health care system in terms of cost, quality, and accessibility.