Health Care Reform and Cost Control

Abstract

OIG's staff of more than 1,500 professionals carry out this mission through a nationwide network of audits, evaluations, investigations, and enforcement and compliance activities. Our mission encompasses more than 300 programs administered by HHS. In accordance with OIG's statutory funding allocations, we direct the majority of our resources toward safeguarding the Medicare and Medicaid programs and the health and welfare of their beneficiaries. While HHS programs continue to grow in size, scope, and complexity, the dedicated efforts of OIG's professional staff, in collaboration with our government partners, have yielded notable accomplishments in program savings, program integrity and efficiency, and quality of care.At a time when the programs administered by HHS are becoming increasingly important to all Americans, it is essential that meaningful actions are taken to enhance the economy, efficiency, and effectiveness of HHS programs. Simultaneously, we must continue to vigilantly monitor HHS programs and operations to ensure that valuable taxpayer resources are not being diminished by fraud, waste, or abuse.In FY 2008, OIG's contributions to safeguarding HHS programs from threats of fraud, waste, and abuse and to promoting economy, efficiency, and effectiveness in HHS programs included:

Should Research Ethics Encourage the Production of Cost-Effective Interventions?

“…Existing attempts to limit health care costs have not succeeded in stemming their rise. Promoting cost-effective interventions at the research stage could represent an important part of an experimental, multi-level approach-like that adopted in the United States under the Affordable Care Act (Orszag and Emanuel 2010)-to reining in the expanding cost of medical care. …”

Physician Payment Disclosure Under Health Care Reform: Will the Sun Shine?

“…Yet one of the primary goals of the ACA is containing the costs of prescription drugs and more efficient delivery of health care. 11 The ACA's Sunshine provisions aim to meet these goals by shedding light on physician-industry relationships and hopefully influencing prescribing and purchasing behavior through discouraging COIs. However, a changing landscape shifting industry-marketing dollars away from physicians and increasingly directing them toward payers and patients could blunt the potential beneficial effect.…”

“…11 Made part of this historical reform were the provisions of the Physician Payment Sunshine Act. The goals of the Sunshine Act are to "shed light" on financial ties between industry and physicians, with the aim of dissuading inappropriate COIs that may compromise clinical integrity and patient care and lead to increased costs in health care.…”

Current Status of Cost Utility Analyses in Total Joint Arthroplasty: A Systematic Review

“…TJA, although considered to be beneficial, is associated with substantial costs to the healthcare system and utilization rates have exhibited substantial regional variation [19]. Understanding the cost of care and associated value has become a focal point of healthcare policy in the United States [14,26,39,45]. Some healthcare analysts have proposed that one of the reasons that the United States outpaces other industrialized nations in healthcare expenditures is a lack of attention to healthcare economic decision analysis and cost-effectiveness analysis (CEA) [34,50].…”