Health Care Reform and Cost Control
White House Office of Management and Budget, Washington, DC, USA.New England Journal of Medicine (Impact Factor: 55.87). 08/2010; 363(7):601-3. DOI: 10.1056/NEJMp1006571
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- "Health systems around the world are undergoing revolutions, evolutions or reforms (Rosenberg, 2012; Orszag and Emanuel, 2010; Braithwaite et al., 2015). In the USA, for example, the 2010 introduction of The Patient Protection and Affordable Care Act was purported to herald changes to every aspect of healthcare (Huntington et al., 2011). "
ABSTRACT: Purpose – Health systems are changing at variable rates. Periods of significant change can create new challenges or amplify existing barriers to accreditation program credibility and reliability. The purpose of this paper is to examine, during the transition to a new Australian accreditation scheme and standards, challenges to health service accreditation survey reliability, the salience of the issues and strategies to manage threats to survey reliability. Design/methodology/approach – Across 2013-2014, a two-phase, multi-method study was conducted, involving five research activities (two questionnaire surveys and three group discussions). This paper reports data from the transcribed group discussions involving 100 participants, which was subject to content and thematic analysis. Participants were accreditation survey coordinators employed by the Australian Council on Healthcare Standards. Findings – Six significant issues influencing survey reliability were reported: accreditation program governance and philosophy; accrediting agency management of the accreditation process, including the program’s framework; survey coordinators; survey team dynamics; individual surveyors; and healthcare organizations’ approach to accreditation. A change in governance arrangements promoted reliability with an independent authority and a new set of standards, endorsed by Federal and State governments. However, potential reliability threats were introduced by having multiple accrediting agencies approved to survey against the new national standards. Challenges that existed prior to the reformed system remain. Originality/value – Capturing lessons and challenges from healthcare reforms is necessary if improvements are to be realized. The study provides practical and theoretical strategies to promote reliability in accreditation programs.
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- "In addition, USA healthcare reform, which aims to provide broader health access for millions of uninsured persons, will undoubtedly attract international health worker emigration due to the increased demand for services. Though the USA healthcare reform enacts certain cost-control measures and is estimated to only have a negligible impact on health expenditures as a percentage of GDP, savings projected do not change the fact that additional healthcare workers will be needed for the millions of additional people that are targeted to gain access to the healthcare system  . Such demand will impose yet additional challenges on resource-poor countries. "
ABSTRACT: Global public health is threatened by an imbalance in health worker migration from resource-poor countries to developed countries. This "brain drain" results in health workforce shortages, health system weakening, and economic loss and waste, threatening the well-being of vulnerable populations and effectiveness of global health interventions. Current structural imbalances in resource allocation and global incentive structures have resulted in 57 countries identified by WHO as having a "critical shortage" of health workers. Yet current efforts to strengthen domestic health systems have fallen short in addressing this issue. Instead, global solutions should focus on sustainable forms of equitable resource sharing. This can be accomplished by adoption of mandatory global resource and staff-sharing programs in conjunction with implementation of state-based health services corps.
- "Hospitalizations constitute one of the most expensive sources of medical expenditures in the U.S. health care system while modern rates of preventable hospitalizations due to chronic illness are increasing. Close to 20% of Medicare beneficiaries are being re-admitted to hospitals within 30 days of discharge due in part to expedited discharges and inadequate or no transition of care between the discharge physician and patient's primary care provider (Orszag & Emanuel 2010). Orszag and his colleagues note: " More than half of these readmitted patients have not seen their physician between discharge and readmission, and a recent study suggests that better coordination of care can reduce readmission rates for major chronic illness. "