Health Care Reform

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Program Manager
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MPP

Neesha Joseph is Program Manager for the Stanford Center on the Demography and Economics of Health and Aging (CDEHA) and the Stanford Center on Advancing Decision Making in Aging (CADMA). In this capacity she oversees center operations, including coordinating pilot projects and center conferences and activities. She also conducts policy research on health care topics, such as the impact of age on innovation in health research, the cost and disease management implications of patient comorbidity in Medicare populations, and the impact of of health care reform on physician human capital.

She brings with her experience in health research and management. Previously Neesha worked as a Research Analyst specializing in health economics at the Milken Institute, where she was involved with various aging initiatives. She received a master's degree in public policy from the USC Price School of Public Policy, and her areas of interest include health economics and international development.

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ABSTRACT

Health-care reform could generate major new opportunities to strengthen the central role of neonatology in improving child health in the United States. However, without considerable caution, such reform also could destabilize many of the policies that have facilitated neonatology's most important contributions. This article anticipates the policy issues of greatest consequence for neonatology, including the public's misperception of neonatology's costs and impact on outcomes, the danger of adult-focused cost-containment policies, the potential to improve health services for women, and the generational politics of health-care reform. Neonatologists could provide essential technical guidance and a coherent political voice in shaping the nature and scope of health-care reform.

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Publication Type
Journal Articles
Publication Date
Journal Publisher
NeoReviews
Authors
Paul H. Wise
Paul Wise
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A collection of core faculty Victor Fuchs' articles on actions needed for meaningful health care reform in the United States.

  • Eliminating "Waste" in Health Care
  • Four Health Care Reforms for 2009
  • Cost Shifting Does Not Reduce the Cost of Health Care.
  • The Proposed Government Health Insurance Company - No Substitute for Real Reform
  • Reforming US Health Care - Key Considerations for the New Administration.
  • Health Reform: Getting The Essentials Right
  • Health Care Reform - Why So Much Talk and So Little Action?
  • Three "Inconvenient Truths" about Health Care
  • The Perfect Storm of Overutilization
  • Who Really Pays for Health Care? The Myth of "Shared Responsibility".
  • What Are The Prospects For Enduring Comprehensive Health Care Reform?
  • Essential Elements of a Technology and Outcomes Assessment Initiative
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Publication Type
Working Papers
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Journal Publisher
SIEPR
Authors
Victor Fuchs
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Magnetic resonance imaging (MRI) is a technology frequently used to evaluate low back pain, despite evidence that challenges the usefulness of routine MRI and the surgical interventions it may trigger. We analyze the relationship between MRI supply and care for fee-for-service Medicare patients with low back pain. We find that increases in MRI supply are related to higher use of both low back MRI and surgery. This is worrisome, and careful attention should be paid to assessing the outcomes for patients.

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Journal Articles
Publication Date
Journal Publisher
Health Affairs
Authors
Baras JD
Laurence C. Baker
Laurence Baker
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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.

To control health care costs, I propose a publicly chartered major risk pool, or MRP, that
will allow plans to pool risk, thereby eliminating the need for wasteful underwriting and
selective marketing costs. Participation in the MRP by both providers and insurers is
voluntary. It can be combined with any public option in an exchange implemented at the
federal or state level; it can even work without a public option. After a brief transition
period, the MRP requires no federal funds and will not be “on budget.” By allowing private plans to play a role in a transformed insurance and delivery system, the MRP can be politically attractive to a broader constituency than any of the current proposals.

The MRP addresses a key component of comprehensive health reform: restructuring the
delivery system. It is not a simple reinsurance pool that reimburses health plans for high costclaims. Instead, it creates a reformed payment system for both inpatient care and outpatient chronic care that will encourage efficiency and quality. The MRP will cover inpatient and similar short but expensive episodes, as well as chronic illness management. Its new payment approaches will achieve the efficiency goals promised by proposals for hospital medical staff-focused Accountable Care Organizations, but in an organizationally more plausible manner. Hospitals and physicians who focus on inpatient care and voluntarily form Care Delivery Teams will receive bundled episode-based payments, but the MRP will pay providers regardless of whether they belong to a Care Delivery Team, although at less attractive rates. Providers in these teams can use their bargaining power to charge the primary insurers more than the MRP pays. The MRP’s payments for monthly chronic illness management will give health plans and primary care physicians the incentives, flexibility, and information to more effectively compensate clinicians for the care they deliver and coordinate. By being publicly chartered, but independent of Congress, and by allowing options for all players, the MRP will be able to sidestep the ability of special interests to block change.

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Publication Type
Policy Briefs
Publication Date
Journal Publisher
Berkeley Center on Health, Economic & Family Security
Authors
Harold S. Luft
Harold Luft
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As pressure builds on the White House and Congress to deliver on their promise of health care reform, the idea of a government health insurance company to compete with for-profit and not-for-profit private companies is gaining political momentum. Advocates claim that this new company would be more efficient, honest, and successful in forcing lower reimbursement rates on physicians and hospitals. However, a close look at how the present health care system functions, what its major problems are, and what reforms are needed to solve them suggests that this new idea is not the answer. The three major problems of the current U.S. system are that 45 million to 50 million people have no health insurance, the cost of care is high and rapidly increasing, and there are gross lapses in the quality of care. There is no reason to think that a government insurance company would make a significant dent in any one of these problems, let alone all three. To do that would require real reform in the financing, organization, and delivery of care.

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Publication Type
Journal Articles
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Journal Publisher
New England Journal of Medicine
Authors
Victor Fuchs
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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. This group agreed that the following 8 recommendations are fundamental to successful reform:

  1. Replace the current fee-for-service payment system with a payment system that encourages and rewards innovation in the efficient delivery of quality care. The new payment system should invest in the development of outcome measures to guide payment.
  2. Establish a securely funded, independent agency to sponsor and evaluate research on the comparative effectiveness of drugs, devices, and other medical interventions.
  3. Simplify and rationalize federal and state laws and regulations to facilitate organizational innovation, support care coordination, and streamline financial and administrative functions.
  4. Develop a health information technology infrastructure with national standards of interoperability to promote data exchange.
  5. Create a national health database with the participation of all payers, delivery systems, and others who own health care data. Agree on methods to make deidentified information from this database on clinical interventions, patient outcomes, and costs available to researchers.
  6. Identify revenue sources, including a cap on the tax exclusion of employer-based health insurance, to subsidize health care coverage with the goal of insuring all Americans.
  7. Create state or regional insurance exchanges to pool risk, so that Americans without access to employer-based or other group insurance could obtain a standard benefits package through these exchanges. Employers should also be allowed to participate in these exchanges for their employees' coverage.
  8. Create a health coverage board with broad stakeholder representation to determine and periodically update the affordable standard benefit package available through state or regional insurance exchanges.
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Journal Articles
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Journal Publisher
Annals of Internal Medicine
Authors
Kenneth J. Arrow
Auerbach A
Bertko J
Brownlee S
Casalino LP
Cooper J
Crosson J
Alain C. Enthoven
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
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
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Objectives From 1994 to the year 2000 the government of Puerto Rico implemented a health care reform which included the mandatory enrollment of the entire Medicaid eligible population under Medicaid managed care (MMC) plans. This study assessed the effect of MMC on the use, initiation, utilization, and adequacy of prenatal care services over the reform period.

Methods Using the vital records of all infants born alive in Puerto Rico from the year 1995-2000, a series of bivariate and multivariate analyses were conducted to assess the effect of insurance status (traditional Medicaid, MMC, private insurance and uninsured) on prenatal care utilization patterns. In order to assess the potential influence of selection bias in generating the health insurance assignments, propensity scores (PS) were estimated and entered into the multivariate regressions.

Results MMC had a generally positive effect on the frequency and adequacy of prenatal care when compared with the experience of women covered by traditional Medicaid. However, the PS analyses suggested that self-selection may have generated part of the observed beneficial effects. Also, MMC reduced but did not eliminate the gap in the amount and adequacy of prenatal care received by pregnant women covered by Medicaid when compared to their counterparts covered by private insurance.

Conclusions The Puerto Rico Health Reform to implement MMC for pregnant women was associated with a general improvement in prenatal care utilization. However, continued progress will be necessary for women covered by Medicaid to reach prenatal care utilization levels experienced by privately insured women.

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Publication Type
Journal Articles
Publication Date
Journal Publisher
Maternal and Child Health Journal
Authors
HA Marin
R Ramirez
Paul H. Wise
Paul H. Wise
Y Sanchez
R Torres
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Fuchs argues that health reform must encompass the Four Cs in order to succeed: coverage, cost control, coordinated care and choice. While details are certainly important, Fuchs writes, Congress and the Obama Administration must remember that "God is in the essentials." Without the essentials, no reform plan can succeed.

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Publication Type
Journal Articles
Publication Date
Journal Publisher
Health Affairs
Authors
Victor R. Fuchs
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