RESUMO
(1) Through the Choosing Wisely initiative, medical specialty societies identified non-indicated cardiac testing in low-risk patients and short-interval dual-energy X-ray absorptiometry (DXA) or bone density testing as low-value care. (2) Nationally, 13 percent of low-risk Medicare beneficiaries received non-indicated cardiac tests, and 10 percent of DXAs reimbursed by Medicare were administered at inappropriately short intervals. There is significant geographic variation in the provision of these services. (2) Carefully designed policy and payment changes will likely prove most effective in reducing low-value care.
Assuntos
Prática Clínica Baseada em Evidências/economia , Seguro Saúde/economia , Medicare/economia , Procedimentos Desnecessários/economia , Procedimentos Desnecessários/estatística & dados numéricos , Absorciometria de Fóton/economia , Absorciometria de Fóton/estatística & dados numéricos , Densidade Óssea , Redução de Custos , Tomada de Decisões , Técnicas de Diagnóstico Cardiovascular/economia , Técnicas de Diagnóstico Cardiovascular/estatística & dados numéricos , Eletrocardiografia/economia , Eletrocardiografia/estatística & dados numéricos , Humanos , Medição de Risco , Sociedades Médicas , Fatores de Tempo , Estados UnidosRESUMO
Key findings. (1) Substantial geographic variation exists in Medicare costs, but to determine the source and extent of this variation requires proper accounting for population health differences. (2) While physician practice patterns likely affect Medicare geographic cost variations, population health explains at least 75 to 85 percent of the variationsmore than previously estimated. (3) Policy strategies should consider the magnitude of the impact of beneficiary health status on Medicare costs in order to address geographic variation.
Assuntos
Custos de Cuidados de Saúde , Nível de Saúde , Disparidades em Assistência à Saúde/economia , Medicare/economia , Características de Residência , Grupos Diagnósticos Relacionados/economia , Serviços de Saúde/economia , Serviços de Saúde/estatística & dados numéricos , Humanos , Padrões de Prática Médica/estatística & dados numéricos , Assistência Terminal/economia , Estados UnidosRESUMO
Key findings. (1) Value-based insurance design (VBID) improves medication adherence by 1 to 3 percent in the first year after implementation; (2) Improvements in adherence were sustained and amplified in the second year post-implementation, ranging from 2 to 5 percent; (3) Adherence improvements varied according to VBID participants' baseline adherence, with greatest improvements evident in those with poorer baseline adherence
Assuntos
Custo Compartilhado de Seguro/economia , Custo Compartilhado de Seguro/métodos , Dedutíveis e Cosseguros/economia , Seguro Saúde/economia , Adesão à Medicação , Cooperação do Paciente , Custos de Medicamentos/tendências , Previsões , Humanos , Benefícios do Seguro/economia , Seguro Saúde/tendências , Estados UnidosRESUMO
Key findings. (1) Health care spending, both public and private, accounted for more than 20 percent of family income for families in the lowest-income quintile, but no more than 16 percent for families in any other income quintile. (2) The Affordable Care Act should reduce, but is unlikely to completely eliminate, some of this inequity through its heavy reliance on federal funding for the Medicaid expansion and income-related subsidies for private insurance.
