The Challenge of Rising Health Care Costs — A View from the Congressional Budget Office

Orszag, Peter R.; Ellis, Philip A

doi:10.1056/nejmp078190

Cited by 155 publications

(97 citation statements)

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“…[23][24][25][26][27] Furthermore, high-intensity care at the end of life for advanced cancer patients may contribute to wasteful spending in the United States. [28][29][30] There are several possible explanations for our finding of less high-intensity care in the VHA at the end of life. First, there is an absence of financial incentives for providing care in the VHA, whereas in fee-for-service Medicare, physicians and hospitals typically are reimbursed more when patients receive chemotherapy, visit physicians in office or emergency settings, and are hospitalized.…”

Section: Discussionmentioning

confidence: 95%

End‐of‐life care for older cancer patients in the Veterans Health Administration versus the private sector

Keating

Landrum

Lamont

et al. 2010

Cancer

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SiC‐ and B4C‐filled NBR rubber composites were prepared with various volume fractions of filler by a conventional roll‐mill method. The morphological structures of the NBR–SiC and NBR–B4C composites were analyzed by scanning electron microscopy. The dependence of room‐temperature volume resistivity (ρv) on the concentration of filler in the two systems was studied. In addition, variation in the number of current carriers (n), mobility carriers (μ), dielectric constant (ε), and dielectric loss factor (tan δ) on filler concentration in the two systems were investigated in detail. The applicability of composites as negative temperature coefficient (NTCR) linear thermistors was studied by the dependence of volume resistivity on temperature. The resistivity showed negative temperature dependence and changed linearly with temperature parallel. The conduction mechanism of the conductivity of the two composites was analyzed in terms of the computed activation energy and hopping energy. Change in volume resistivity as a function of frequency for the two systems was also investigated. Finally, the dependence of volume resistivity on applied pressure and possible real applications of these composites as transducers in pressure sensors were also studied. © 2006 Wiley Periodicals, Inc. J Appl Polym Sci 103: 2158–2165, 2007

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Section: Discussionmentioning

confidence: 95%

End‐of‐life care for older cancer patients in the Veterans Health Administration versus the private sector

Keating

Landrum

Lamont

et al. 2010

Cancer

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“…[1][2][3][4] Recently the American Board of Internal Medicine, in collaboration with numerous specialty societies, initiated the Choosing Wisely program to publicize common clinical practices inconsistent with evidence. 5 Many studies have observed large variations in clinical practice, across geographic areas and within local areas or even specific physician organizations.…”

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confidence: 99%

Factors Contributing to Variations in Physicians’ Use of Evidence at The Point of Care: A Conceptual Model

2015

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There is ample evidence that many clinical decisions made by physicians are inconsistent with current and generally accepted evidence. This leads to the underuse of some efficacious diagnostic, preventive or therapeutic services, and the overuse of others of marginal or no value to the patient. Evolving new payment and delivery models place greater emphasis on the provision of evidence-based services at the point of care. However, changing physician clinical behaviors is likely to be difficult and slow. Policy makers therefore need to design interventions that are most effective in promoting greater evidence-based care. To help identify modifiable factors that can influence clinical decisions at the point of care, we present a conceptual model and literature review of physician decision making. We describe the multitude of factors-drawn from different disciplines-that have been shown to influence physician point-of-care decisions. We present a conceptual framework for organizing these factors, dividing them into patient, physician, practice site, physician organization, network, market, and public policy influences. In doing so, we review some of the literature that speak to these factors. We then identify areas where additional research is especially needed, and discuss the challenges and opportunities for health services and policy researchers to gain a better understanding of these factors, particularly those that are potentially modifiable by policymakers and organizational leaders. 5 Many studies have observed large variations in clinical practice, across geographic areas and within local areas or even specific physician organizations. 6 We are undergoing rapid change in healthcare organization and delivery. Physicians are increasingly practicing in larger organizations and systems of care, in part prompted by widespread initiatives by federal, state, and private payers to improve care quality and lower costs. These reform efforts, such as patient-centered medical homes and accountable care organizations, along with significant federal funding of comparative effectiveness research, incentives for adoption of health information technology that includes decision support, and feedback on clinical quality performance raise the hope and expectation that clinical decision making will improve, with greater adherence to accepted evidence.Within this context, research and requisite data collection on key factors affecting physician decision making is necessary to design interventions and refine current ones. In this article, we present a conceptual framework for understanding factors contributing to physician clinical decision making, specifically those related to physicians' use of evidence at the point of care. With this framework, we conclude with directions for future research and the data needs necessary to conduct this research.We frame our discussion in the context of physician decision making as part of a broader inquiry into collecting data on physicians and their practice organizations. Of course, evidence...

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“…But at present, as the cost of medical care, especially through Medicare, looms as the single largest threat to the US economy, attention must be paid. 9 The argument is most starkly obvious in considering the plight of the nation's strapped state Medicaid programs. Adding several tens of millions of dollars to a Medicaid program's costs will not simply strain its budget; with little likelihood of increasing appropriations, it will mean that other expenses will have to be foregone-for other services, for payments to providers, or for maintenance of program eligibility for many indigent patients.…”

Section: Article See P 2562mentioning

confidence: 99%

The Relative Cost-Effectiveness of Anticoagulants

Avorn

2011

Circulation

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The Challenge of Rising Health Care Costs — A View from the Congressional Budget Office

Cited by 155 publications

References 3 publications

End‐of‐life care for older cancer patients in the Veterans Health Administration versus the private sector

End‐of‐life care for older cancer patients in the Veterans Health Administration versus the private sector

Factors Contributing to Variations in Physicians’ Use of Evidence at The Point of Care: A Conceptual Model

The Relative Cost-Effectiveness of Anticoagulants

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