Health care spending growth: how different is the United States from the rest of the OECD?
ABSTRACT This paper compares the long-term (1970-2002) rates of real growth in health spending per capita in the United States and a group of high-income countries in the Organization for Economic Cooperation and Development (OECD). Real health spending growth is decomposed into population aging, overall economic growth, and excess growth. Although rates of aging and overall economic growth were similar, annual excess growth was much higher in the United States (2.0 percent) versus the OECD countries studied (1.1 percent). That difference, which is of an economically important magnitude, suggests that country-specific institutional factors might contribute to long-term health spending trends.
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ABSTRACT: Ambient and pervasive technologies provide several ways to assist people with special needs in smart environments. However, the system's complexity and the size of the contextual information of these environments lead to several difficulties in deploying and providing the assistance services. A service provision mechanism which is aware of the environment context can simplify the deployment of assistance services on environment devices, by taking care of the decision processes. Moreover, the integration of the interaction modalities in the decision processes of such mechanisms allows deliveries of services to users based on their capabilities and preferences. In this paper, we present a context-aware service provision system for smart environment, which takes into account a whole set of contextual information: user profiles, device profiles, software profiles and environment topology. In regards to our previous work, this paper focuses on the modeling of the user interaction capabilities, built around the notion of interaction modalities. We also detail the integration of the model to the service provision reasoning process, as well as its implementation. Finally, we demonstrate the functionalities of this system through technical validations and scenarios carried out in a real smart apartment.Journal of Ambient Intelligence and Smart Environments 01/2013; 5(1):47-64. · 1.30 Impact Factor
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ABSTRACT: Some believe that a substantial amount of US health care is unnecessary, suggesting that it would be possible to control costs without rationing effective services. The views of primary care physicians-the frontline of health care delivery-are not known. Between June and December 2009, we conducted a nationally representative mail survey of US primary care physicians (general internal medicine and family practice) randomly selected from the American Medical Association Physician Masterfile (response rate, 70%; n=627). Forty-two percent of US primary care physicians believe that patients in their own practice are receiving too much care; only 6% said they were receiving too little. The most important factors physicians identified as leading them to practice more aggressively were malpractice concerns (76%), clinical performance measures (52%), and inadequate time to spend with patients (40%). Physicians also believe that financial incentives encourage aggressive practice: 62% said diagnostic testing would be reduced if it did not generate revenue for medical subspecialists (39% for primary care physicians). Almost all physicians (95%) believe that physicians vary in what they would do for identical patients; 76% are interested in learning how aggressive or conservative their own practice style is compared with that of other physicians in their community. Many US primary care physicians believe that their own patients are receiving too much medical care. Malpractice reform, realignment of financial incentives, and more time with patients could remove pressure on physicians to do more than they feel is needed. Physicians are interested in feedback on their practice style, suggesting they may be receptive to change. clinicaltrials.gov Identifier: NCT00853918.Archives of internal medicine 09/2011; 171(17):1582-5. · 11.46 Impact Factor
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ABSTRACT: Facing escalating health care expenditures, the governments of countries with national health insurance programs are trying to control or even to reduce health care utilization. Little research has examined the effects of decreased health care utilization on health outcomes. Applying a natural experiment design to the Taiwan population between 2000 and 2004, which includes the 2003 SARS epidemic when an average 20% decline in health care utilization occurred, this study examines the association between a decline in health care utilization and health outcomes measured by cause-specific mortality rates. We analyse the monthly mortality rates caused by infectious diseases, cancer, diabetes mellitus, nervous system diseases, cerebrovascular diseases, heart and other vascular diseases, respiratory system diseases, digestive system diseases, genitourinary system diseases and accidents. Models control for age, sex, month and year effects. Results show the heterogeneous effect of reduced health care utilization on health outcomes. Patients with diabetes mellitus or cerebrovascular diseases are vulnerable to short-term reductions in health care; compared with the non-SARS period, mortality caused by diabetes mellitus and cerebrovascular diseases significantly increased during the SARS epidemic by 8.4% and 6.2%, respectively. No significant change in mortality rates caused by the other diseases or accidents is found. This study suggests that governments of countries where health care utilization and spending are similar to or inferior to those in Taiwan should carefully evaluate the impact of policies that attempt to reduce health care utilization. Furthermore, when an area encounters an epidemic, governments should be aware of the negative consequences of voluntary restraints on access to health care that accompany decreases in utilization.Health Policy and Planning 01/2012; 27(7):590-9. · 2.65 Impact Factor