No abstract

The introduction of diagnosis-related groups (DRGs) created a clear misalignment between the incentives facing hospitals and those facing physicians. The interest in gain sharing that developed in the 1990s represented an attempt by physicians to extract and hospitals to offer some of the savings being produced by physicians. Advisory bulletins by the Office of Inspector General (Department of Health and Human Services) quickly put a stop to further interest in these strategies. Newer, narrowly defined types of gain sharing have been under consideration. More broadly defined strategies that will be tested under a new Centers for Medicare and Medicaid Services demonstration are more promising. H e a lt h c a r e c o s ts an d t h e i m p e r at i v e to improve patient safety and quality represent two of the most important issues on the U.S. health care agenda. Health care spending, which continues to grow more than two percentage points faster each year than the rest of the economy, in real terms per capita, is creating an unsustainable strain on private and health care budgets and exacerbating already major access problems for millions of Americans.1 In spite of these high spending levels, the Institute of Medicine (IOM) and others continue to highlight the need to improve patient safety and quality performance. 2One opportunity involves the care of complex, high-cost patients. The fragmentation of the current health care delivery system, along with cultural and regulatory barriers, frequently inhibits physicians' and hospitals' ability to engage in collaborative approaches that both reduce cost and improve quality.Some policymakers believe that insurance companies that form and manage physician and hospital networks can increase their focus on cost and quality improvement, perhaps through network competition. Some believe that forming accountable provider units consisting of physicians and hospitals will be a key inw 5 85 D e c e m b e r 2 0 0 6

No abstract