Roundtable Discussion Tackles Health Care Reform

Improvements in payment, more data to guide decisions could lead to wiser health spending
By Eric Metcalf
HealthDay Reporter

WEDNESDAY, Oct. 7 (HealthDay News) -- The health care payment system, the role of consumers in responsible health care spending, and the use of comparative-effectiveness research were topics covered in a roundtable discussion with several health economics experts published in the Oct. 8 issue of the New England Journal of Medicine.

In the discussion, Meredith B. Rosenthal, Ph.D., from the Harvard School of Public Health in Boston, puts a high priority on reforming the payment system for health care, as it appears to currently promote more surgeries and days in the hospital. Elliott S. Fisher, M.D., from the Dartmouth Medical School in Lebanon, N.H., discusses how fee-for-service discourages conversations with patients and encourages doctors to shift patients with chronic conditions elsewhere.

Consumer-based approaches, such as medical savings accounts, don't necessarily result in patients making wise decisions on which services to use or not use, Rosenthal notes, and at any rate, the big expenses come from high-cost treatments and critically ill patients, where cost-sharing is not appropriate. In terms of comparative-effectiveness research, information that would allow for even small changes in health care delivery could save billions of dollars, adds Jonathan Gruber, Ph.D., of the Massachusetts Institute of Technology in Cambridge.

"With or without reform, however, I believe we may find the future cost of the health care system to be lower than many have predicted," writes David M. Cutler, Ph.D., of Harvard University in Cambridge, Mass., in an accompanying commentary, citing drying pipelines for pharmaceuticals and medical devices, the use of health information technology, and better targeting of medications to patients who will benefit.

Roundtable
Perspective - Cutler

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