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Harold S. Luft
Journal Articles

Economic Incentives to Promote Innovation in Healthcare Delivery

Harold Luft
Clinical Orthpaedics and Related Research, 2009 October 1, 2009

Economics influences how medical care is delivered, organized, and progresses. Fee-for-service payment encourages delivery of services. Fee-for-individual-service, however, offers no incentives for clinicians to efficiently organize the care their patients need. Global capitation provides such incentives; it works well in highly integrated practices but not for independent practitioners. The failures of utilization management in the 1990s demonstrated the need for a third alternative to better align incentives, such as bundling payment for an episode of care.

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Journal Articles

Medicare’s Policy Not To Pay For Treating Hospital-Acquired Conditions: The Impact

McNair PD, Harold Luft, Bindman AB
Health Affairs, 2009 September 1, 2009

In 2008 Medicare stopped reimbursing hospitals for treating eight avoidable hospital-acquired conditions. Using 2006 California data, we modeled the financial impact of this policy on six such conditions. Hospital-acquired conditions were present in 0.11 percent of acute inpatient Medicare discharges; only 3 percent of these were affected by the policy. Payment reductions were negligible (0.001 percent, or $0.1 million-equivalent to $1.1 million nationwide) and are unlikely to encourage providers to improve quality.

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Policy Briefs

Beyond the Public Plan: Pathway to Control Costs & Transform the Delivery System

Harold Luft
Berkeley Center on Health, Economic & Family Security, 2009 July 1, 2009

The current focus of the health reform debate is rightfully beginning to shift to the need to transform the delivery system to contain the long run growth in costs. Although much of the debate still focuses on the role of a public plan, this ignores the need for fundamental change. None of the options on the table will transform the delivery system. If passed, the best the current proposals could do is to expand enrollment and perhaps contain federal costs, but on its own the public plan will be unable to make the delivery system more efficient.

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Journal Articles

Toward a 21st-Century Health Care System: Recommendations for Health Care Reform

Kenneth J. Arrow, Auerbach A, Bertko J, Brownlee S, Casalino LP, Cooper J, Crosson J, Alain C. Enthoven, Falcone E, Feldman RC, Victor R. Fuchs, Alan M. Garber, Gold MR, Goldman D, Hadfield GK, Hall MA, Horwitz RI, Hooven M, Jacobson PD, Stoltzfus Jost T, Kotlikoff LJ, Levin J, Levine S, Levy R, Linscott K, Harold S. Luft, Marshal R, McFadden D, Mechanic D, Meltzer D, Newhouse JP, Noll RG, Pietzsch JB, Pizzo P, Reischauer RD, Rosenbaum S, Sage W, Schaeffer LD, Sheen E, Siilber BM, Skinner J, Stephen M. Shortell, Thier SO, Sean R. Tunis, Wulsin L, Yock P, Nun GB, Stirling Bryan, Luxenburg O, van de Ven PMM
Annals of Internal Medicine, 2009 April 7, 2009

The coverage, cost, and quality problems of the U.S. health care system are evident. Sustainable health care reform must go beyond financing expanded access to care to substantially changing the organization and delivery of care. The FRESH-Thinking Project held a series of workshops during which physicians, health policy experts, health insurance executives, business leaders, hospital administrators, economists, and others who represent diverse perspectives came together.

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