From Commonwealth Fund Issue Brief, December 2009, "Why Health Reform Will
Bend the Cost Curve" p. 10
"Explaining the Differences with Other Estimates"
.
"The common assessments of CBO and the CMS Office of the Actuary are not
surprising. Those groups rely largely on peer-reviewed studies using
carefully controlled comparison groups (either randomized trials or the
natural equivalent) for their evidence. for every study that shows savings
from baseline, there is another study that does not.
"There is however, a less formal, but no less important, literature that
sees the world very differently. Business scholars, including Michael
Porter and Elizabeth Teisberg, and Clay Christenson, Jerome Grossman, and
Jason Hwang, all note the enormous inefficiency in health care relative to
other industries: excessive administrative spending, wasted time and money,
and resources spent passing along costs, not reducing them. They highlight
the enormous potential for productivity improvement that reform can drive if
it makes health care operate more like other industries.
"Experiences of health care practitioners reach a similar conclusion.
Physicians on the front line, including Guy Clifton, Arthur Garson, Atul
Gawande, and Arnold Relman, see waste, know it exists, and have a common
view about why it exists-misaligned incentives being the major driver. They
present a story of care that could be better and cheaper, but operates in a
system that discourages it. This story is echoed in journalistic accounts
of health care.
"A number of case studies provide support for the potential of reform. The
experience of Geisinger Health System, Health Partners, Denver Health, and
others all illustrate that health can be improved and costs lowered. ..
These case studies are often in the published literature but lack the
careful comparison groups that make the results compelling to the most
skeptical reviewers. Thus, their results are not given as much emphasis as
they otherwise might.
While evidence (sic?) regarding appropriate evidence standards differs, the
situation we analyze is one where there are essentially no clinical trials
and where effects of large policy changes may differ substantially from
effects of small trials. In such a situation, it is imperative to cast a
wider net than traditional evidence standards. Our decision to be more
inclusive in the use of evidence is the primary reason why our results
differ from those of CBO and the CMS Office of the Actuary."
Am I allowed to cry?
Cheers,
Joe
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