Reforming Payments to Healthcare Providers: The Key to Slowing Healthcare Cost Growth While Improving Quality?

摘要

The seemingly intractable debate about how to slow the growth of healthcare costs in the United States and elsewhere has traditionally boiled down to efforts to limit prices and quantities directly. In public healthcare programs, the focus in the United States is often on tighter price regulation. For example, the Balanced Budget Act of 1997 achieved most of its savings by reducing the growth of regulated prices in Medicare for physicians, hospitals, and most other healthcare providers. The Affordable Care Act of 2010 also achieved most of its "scored" budgetary savings (which were used as a partial offset for the costs of coverage expansions) through reducing Medicare price growth (Elmendorf, 2010). An often-discussed alternative is to regulate the quantity of care by using available evidence on benefits, and potentially also costs, to restrict use of costly treatments through coverage restrictions or denials.