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Medicare beneficiaries are rapidly moving into managed care, as attempts to restrain the growth of this costly entitlement program progress. However, advocates for patients question whether the necessary information and structures are in place to enable Medicare consumers to select wisely among private-sector managed care options. Improving the Medicare Market examines how to give Medicare beneficiaries the same choice of health plan options enjoyed in the private sectorâ€"yet protect them as consumers and patients. This book recommends approaches to ensuring accountability and informed purchasing for Medicare beneficiaries in an environment of broader choice and managed careâ€"how the government should evaluate and approve plans, what role the traditional Medicare program should play, how to help to elderly understand their options, and many other practical matters. The committee discusses the information requirements of Medicare beneficiaries and explores in detail how best to respond to their special needs. And it examines the procedures that should be developed to provide the necessary protections for the elderly in a managed care system.
Healthcare is changing and you need to know how—and what to do about it. Getting good medical care shouldn’t be so confusing—or so costly. Healthcare, Insurance, and You simplifies the many confusing details about our healthcare system so you can make informed decisions. Result? Better health at lower cost. With the advent of healthcare reform, things are changing—especially when it comes to insurance. Most people will now have to buy insurance. Do you know where to get a policy or what to look for in one? Did you know more people will now qualify for free or subsidized healthcare? Even if you get insurance through work, you'll face new choices that you'd better understand to maintain your peace of mind. As this book shows, the failure to understand how insurance and the healthcare system work can have a major impact on your physical and financial health. Healthcare, Insurance, and You is an easy-to-use guide that explains the main challenges you face when trying to get excellent healthcare: choosing the best insurance policy for your situation, finding the right doctor or hospital, buying prescription drugs the least expensive way, picking out the right Medicare plan, or fighting for your rights when dealing with insurers or medical providers. Healthcare, Insurance, and You includes tips, resources, and strategies for navigating the healthcare system and avoiding common mistakes so you can get the best healthcare for you, your family, or your organization without breaking the bank. This book shows you: How to choose a health plan that best meets your medical and financial needs, including new options under the Affordable Care Act Ways to cut through red tape and fight billing errors and claim denials What businesses need to know about offering—or not offering—insurance to employees How to plan ahead for a disability or for end-of-life care Healthcare costs rank high on the list of money concerns Americans have. And when it comes to getting great healthcare for you and your family and avoiding crippling medical bills, knowledge is power. Healthcare, Insurance, and You is a practical guide that explains the complicated healthcare system in plain language—and puts the power of good health back in your hands. What you’ll learn The impact of the Affordable Care Act on your healthcare and your finances How to take advantage of new health insurance exchanges and tax credits How to choose a health plan that best meets your medical and financial needs How to advocate for yourself, fight billing errors and denied claims, and know where to turn for help How to choose a doctor and hospital based on quality, not hype How to avoid common mistakes that can cost you big--or even put you into bankruptcy How health reform affects businesses and how they can reduce healthcare expenditures Who this book is for Consumers of healthcare in the United States, including both individuals and small businesses buying coverage for employees. Table of Contents A New Healthcare System Buying Health Insurance on your own Paying for Health Insurance Health Insurance at Work Cutting Medical Costs Buying Prescription Drugs You Against the Healthcare System Medicare Taking Charge of Your Healthcare Future Consumer Assistance Programs and State Departments of Insurance
The United States has the highest per capita spending on health care of any industrialized nation but continually lags behind other nations in health care outcomes including life expectancy and infant mortality. National health expenditures are projected to exceed $2.5 trillion in 2009. Given healthcare's direct impact on the economy, there is a critical need to control health care spending. According to The Health Imperative: Lowering Costs and Improving Outcomes, the costs of health care have strained the federal budget, and negatively affected state governments, the private sector and individuals. Healthcare expenditures have restricted the ability of state and local governments to fund other priorities and have contributed to slowing growth in wages and jobs in the private sector. Moreover, the number of uninsured has risen from 45.7 million in 2007 to 46.3 million in 2008. The Health Imperative: Lowering Costs and Improving Outcomes identifies a number of factors driving expenditure growth including scientific uncertainty, perverse economic and practice incentives, system fragmentation, lack of patient involvement, and under-investment in population health. Experts discussed key levers for catalyzing transformation of the delivery system. A few included streamlined health insurance regulation, administrative simplification and clarification and quality and consistency in treatment. The book is an excellent guide for policymakers at all levels of government, as well as private sector healthcare workers.
Drawing on the work of the Roundtable on Evidence-Based Medicine, the 2007 IOM Annual Meeting assessed some of the rapidly occurring changes in health care related to new diagnostic and treatment tools, emerging genetic insights, the developments in information technology, and healthcare costs, and discussed the need for a stronger focus on evidence to ensure that the promise of scientific discovery and technological innovation is efficiently captured to provide the right care for the right patient at the right time. As new discoveries continue to expand the universe of medical interventions, treatments, and methods of care, the need for a more systematic approach to evidence development and application becomes increasingly critical. Without better information about the effectiveness of different treatment options, the resulting uncertainty can lead to the delivery of services that may be unnecessary, unproven, or even harmful. Improving the evidence-base for medicine holds great potential to increase the quality and efficiency of medical care. The Annual Meeting, held on October 8, 2007, brought together many of the nation's leading authorities on various aspects of the issues - both challenges and opportunities - to present their perspectives and engage in discussion with the IOM membership.
The direct-to-consumer business model has transformed how people seek out goods and services from music to mortgages. So what happens now that the revolution has come for healthcare? While consumers have begun to insist on healthcare that is as convenient and personalized as nearly every other good or service they purchase, most healthcare provider organizations, physicians, and insurance companies remain woefully unprepared to meet this demand. Choice Matters is the healthcare sector's guide to understanding and delivering the brand of consumer-centered care that is an imperative for the Zocdoc age. Drawing on the authors' diverse backgrounds in medicine, business, and public policy, this practically-oriented resource offers an on-the-ground introduction for clinicians and managers to better understand: Â- The differences between healthcare and other consumer-driven markets Â- What factors are most important for consumers in seeking care providers Â- How consumers make decisions about healthcare Â- The system-wide effects of increased consumer choice in healthcare Â- The important distinction between patients and consumers By celebrating the possibilities inherent to consumer-centered healthcare, Choice Matters offers a refreshing, empirically informed take on how healthcare in the United States can flourish, not wither, in the new economy.
In this book the authors explore the state of the art on efficiency measurement in health systems and international experts offer insights into the pitfalls and potential associated with various measurement techniques. The authors show that: - The core idea of efficiency is easy to understand in principle - maximizing valued outputs relative to inputs, but is often difficult to make operational in real-life situations - There have been numerous advances in data collection and availability, as well as innovative methodological approaches that give valuable insights into how efficiently health care is delivered - Our simple analytical framework can facilitate the development and interpretation of efficiency indicators.
America's legislators have found themselves floundering for an economically tenable solution to the healthcare crisis. Consumer driven health plans (CDHPs) represent a proposed solution based on America's constitutional, liberal roots. The success of the consumer driven health movement relies on the anticipated benefits of better informed healthcare consumer choices and increased associated responsibility. CDHPs--with lower monthly premiums and higher deductibles than traditional plans--should incentivize enrollees to become better-informed, prudent consumers of healthcare by searching the Internet for the cheapest and best providers, insurance plans, and medications. In turn, healthcare costs should decrease and quality of care should increase as providers compete for patients. Potential enrollees' competency to make informed decisions regarding the following five tasks critical to CDHPs were assessed: 1) enrolling in CDHPs, 2) becoming better symptom-based medical decision-makers, 3) learning about preventing and managing common chronic conditions, 4) locating high quality healthcare providers, and 5) curbing spending on medications. Twenty volunteers (10 English-speaking, 10 Spanish-speaking)--all without health insurance, from varying sociodemographic backgrounds--participated in observational usability testing using screen capture software, Morae 2.0. The average Flesch-Kincaid reading level and consistency of information presented on four popular health Infomediaries was also assessed. The results suggest most potential CDHP enrollees don't have the adequate skill sets or online tools to effectively and safely make the informed decisions associated with plan usage. The Infomediaries provided fairly consistent information, but had a mean Flesch-Kincaid grade level of 10.1, well above the recommended sixth to eighth grade level. Most participants used search engines' sponsored links that led to poor quality websites. No participants used the government-produced healthfinder.gov. Home computer access (p=.01) and increased years of education (p=.02) had statistically significant positive effects on performance of the tasks. Age, gender, and primary language were not significant. The renovation of healthfinder.gov, health infomediary websites, a free educational program based in public libraries, and a call for greater responsibility by search engines with regard to sponsored links should result in a more just system that is likely to result in delivery of better quality healthcare in America and greater respect for patient autonomy.
America's health care system has become too complex and costly to continue business as usual. Best Care at Lower Cost explains that inefficiencies, an overwhelming amount of data, and other economic and quality barriers hinder progress in improving health and threaten the nation's economic stability and global competitiveness. According to this report, the knowledge and tools exist to put the health system on the right course to achieve continuous improvement and better quality care at a lower cost. The costs of the system's current inefficiency underscore the urgent need for a systemwide transformation. About 30 percent of health spending in 2009-roughly $750 billion-was wasted on unnecessary services, excessive administrative costs, fraud, and other problems. Moreover, inefficiencies cause needless suffering. By one estimate, roughly 75,000 deaths might have been averted in 2005 if every state had delivered care at the quality level of the best performing state. This report states that the way health care providers currently train, practice, and learn new information cannot keep pace with the flood of research discoveries and technological advances. About 75 million Americans have more than one chronic condition, requiring coordination among multiple specialists and therapies, which can increase the potential for miscommunication, misdiagnosis, potentially conflicting interventions, and dangerous drug interactions. Best Care at Lower Cost emphasizes that a better use of data is a critical element of a continuously improving health system, such as mobile technologies and electronic health records that offer significant potential to capture and share health data better. In order for this to occur, the National Coordinator for Health Information Technology, IT developers, and standard-setting organizations should ensure that these systems are robust and interoperable. Clinicians and care organizations should fully adopt these technologies, and patients should be encouraged to use tools, such as personal health information portals, to actively engage in their care. This book is a call to action that will guide health care providers; administrators; caregivers; policy makers; health professionals; federal, state, and local government agencies; private and public health organizations; and educational institutions.