DOCSLIB.ORG

Reducing Administrative Costs in U.S. Health Care

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Reducing Administrative Costs in U.S. Health Care POLICY PROPOSAL 2020-09 | MARCH 2020 Reducing Administrative Costs in U.S. Health Care David M. Cutler MISSION STATEMENT The Hamilton Project seeks to advance America’s promise of opportunity, prosperity, and growth. We believe that today’s increasingly competitive global economy demands public policy ideas commensurate with the challenges of the 21st Century. The Project’s economic strategy reflects a judgment that long-term prosperity is best achieved by fostering economic growth and broad participation in that growth, by enhancing individual economic security, and by embracing a role for effective government in making needed public investments. Our strategy calls for combining public investment, a secure social safety net, and fiscal discipline. In that framework, the Project puts forward innovative proposals from leading economic thinkers — based on credible evidence and experience, not ideology or doctrine — to introduce new and effective policy options into the national debate. The Project is named after Alexander Hamilton, the nation’s first Treasury Secretary, who laid the foundation for the modern American economy. Hamilton stood for sound fiscal policy, believed that broad-based opportunity for advancement would drive American economic growth, and recognized that “prudent aids and encouragements on the part of government” are necessary to enhance and guide market forces. The guiding principles of the Project remain consistent with these views. Reducing Administrative Costs in U.S. Health Care David M. Cutler Harvard University MARCH 2020 This policy proposal is a proposal from the author(s). As emphasized in The Hamilton Project’s original strategy paper, the Project was designed in part to provide a forum for leading thinkers across the nation to put forward innovative and potentially important economic policy ideas that share the Project’s broad goals of promoting economic growth, broad-based participation in growth, and economic security. The author(s) are invited to express their own ideas in policy papers, whether or not the Project’s staff or advisory council agrees with the specific proposals. This policy paper is offered in that spirit. The Hamilton Project • Brookings 1 Abstract Administrative costs account for one-quarter to one-third of health-care spending in the United States. This share is far greater than in other countries and exceeds all estimates of the amount necessary to perform the functions of health-care administration. This paper considers how administrative costs in health care could be reduced. The particular focus is on administrative costs where coordination among parties is required to achieve savings: (a) claims submission and adjudication, (b) prior authorization determinations, and (c) quality measurement and reporting. Underlying each of these areas is the need for data exchange among and between payers and providers. Examples from other industries show the importance of three key actions in reducing administrative costs: (a) developing uniform rules about information exchange, (b) using technology instead of manual processes, and (c) having payers and providers pay the additional costs when they choose to use nonstandard processes. Establishing a health-care automated clearinghouse (ACH) is a key step in claims simplification; it would be modeled after the one in banking and could be operated at modest expense. Prior authorization could also be simplified, especially if prices are attached to payers that require additional information. Simplifying quality reporting involves furthering existing processes to develop uniform quality measures, and ensuring that payers that prefer to use separate measures pay the cost of doing so. Data interoperability is central to these areas, with recent legislation providing a foundation for interoperability. The overall amount that might be saved with progress in these areas is about $50 billion annually, or about $150 per person per year. It would also result in greater satisfaction for both patients and providers. 2 Reducing Administrative Costs in U.S. Health Care Table of Contents ABSTRACT 2 INTRODUCTION 4 THE CHALLENGE 10 THE PROPOSAL 12 QUESTIONS AND CONCERNS 19 CONCLUSION 20 AUTHOR AND ACKNOWLEDGMENTS 21 ENDNOTES 22 REFERENCES 23 The Hamilton Project • Brookings 3 Introduction dministrative costs are estimated to account for one- procedures on both the provider and payer side, submitting quarter to one-third of the total U.S. spending on bills and appropriate documentation, addressing denied health (Woolhandler, Campbell, and Himmelstein claims, and remitting payment. Other administrative costs A2003; Yong, Saunders, and Olsen 2010). This is twice what include marketing and enrollment (payer), credentialing costs the country spends on caring for cardiovascular disease and (payer and provider), and the costs of quality measurement three times what it spends caring for cancer (Cutler, Wikler, and assessment (both payer and provider). At the claim level, and Basch 2012). Every study that has looked at the situation Tseng et al. (2018) estimated that provider administrative has determined that administrative costs are higher than costs in the United States range from $20 for a primary care they need to be in order to deliver effective health care. This visit to $215 for an inpatient surgical procedure (figure 1). By proposal considers how those costs could be lowered. comparison, the reimbursement for a routine visit in Ontario, Canada—which must cover both clinical and administrative Administrative costs are defined as the nonclinical costs of costs—is about $34 (Ontario Ministry of Health 2019).1 running a medical system. The label “administrative cost” encompasses several different activities (see box 1). On Some amount of administrative expense is necessary. In a the patient end, there are costs associated with submitting system of private health insurance, some marketing and bills for payments and choosing health plans. While these enrollment costs are unavoidable. Similarly, bills have to be costs typically do not involve money transfer, they are submitted and payments transacted, neither of which are costs nonetheless. The biggest financial component of costless. Nevertheless, the United States spends more on administrative costs is billing- and insurance-related (BIR) administrative costs than comparable multi-payer systems expenditures. This includes the costs of a provider verifying pay. A number of studies have attempted to estimate “excess” that a patient is eligible for services, prior authorization administrative costs—generally defined as costs above the FIGURE 1. Administrative Costs per Claim at a Major Academic Health System Inpatient surgery Ambulatory surgery General inpatient stay Emergency department visit Primary care visit 0 50 100 150 200 250 Administrative costs per claim (dollars) Source: Tseng et al. 2018. 4 Reducing Administrative Costs in U.S. Health Care BOX 1. The Cost of Health-Care Administration There are many components of administrative costs in health care. The figure shows the major categories. The largest component is termed billing- and insurance-related (BIR) costs and includes the costs of claims management, clinical documentation and coding, and prior authorization. Other administrative costs are associated with sales and marketing, quality measurement, and credentialing. The policies considered here are directed largely, but not exclusively, at BIR costs (e.g., quality assessment is not a BIR cost but is addressed). The rough magnitude of BIR and non-BIR administrative expenses in 2018 are presented in box figure 1. BOX FIGURE 1. Estimates of Administrative Expenses Setting Administrative costs Non-BIR administrative expenses (billions of dollars) BIR expense Hospitals 101 148 BIR expenses • Filing and managing claims • Prior authorization Non-BIR expenses Physicians and 94 100 • General business overhead (HR, legal) clinics • Quality measurement and assessment • Updating EMRs • Credentialing costs Other providers 57 60 • Customer service BIR expenses • Managing claims • Prior authorization Non-BIR expenses Private payers 104 48 • General business overhead • Customer service, including marketing and enrollment • Excise taxes and prots • Quality assurance • Credentialing costs All expenses Public programs 52 • Claims payment • Quality measurement Source: Altarum 2018; Kahn et al. 2005; Yong, Saunders, and Olsen 2010. Note: BIR refers to billing- and insurance-related expenses. EHR refers to electronic health records. Other providers include pharmacies, labs, and skilled nursing, long-term care, and rehabilitation facilities. Costs are in billions of dollars. level of a comparable European country. Estimates suggest part of which is due to administration.” Insurers, in turn, that one-half to two-thirds of BIR administrative costs are pass these prices and their own administrative costs along excessive (Jiwani et al. 2014; Shrank, Rogstad, and Parekh to insuring businesses, who respond by raising employee 2019; Woolhandler and Himmelstein 2017; Yong, Saunders, premiums or reducing what they pay workers. Policyholders and Olsen 2010). and taxpayers (in the case of the public medical system) ultimately pay for high administrative expense. Administrative costs are baked into the health-care cost structure (Cutler and Ly 2011; Pozen and Cutler 2010). The In addition to its burden on individuals, administrative costs money that providers spend on administration is passed along affect the medical system
Load more

Recommended publications
  • April 16, 2021 1 Address: Phone: (614)
    BRUCE A. WEINBERG Address: Phone: (614) 292-5642 Department of Economics Fax: (614) 292-3906 Ohio State University E-Mail: [email protected] 410 Arps Hall Web: www.bruceweinberg.net 1945 North High Street Columbus, Ohio 43210 Education: University of Chicago, Ph.D., Economics, 1996. University of Chicago, B. A., with Honors, Economics, 1991. Professional Positions: Ohio State University, Department of Economics. - Joan N. Huber Faculty Fellow in recognition of outstanding scholarship. 2015. - Professor, October 2010-. - Associate Professor, October 2001-September 2010. - Assistant Professor, October 1996-September 2001. - Director of Undergraduate Studies, 2007-2012. - John Glenn School of Public Affairs 2007-. - Faculty Associate, Battelle Center; Center for Higher Education Excellence; Center for Human Resource Research; Criminal Justice Research Center; Center for Urban and Regional Analysis (and Oversight Committee Member); Initiative in Population Research; Mershon Center. National Bureau of Economic Research - Research Associate, 2010- - Faculty Research Fellow, 2005-2010. - Visiting Scholar 2004-2005. Visiting Scholar. Princeton University, Industrial Relations Section and Department of Economics, 2012-13. Visiting Scholar, Federal Reserve Bank of Cleveland, 2009-2010. Taubman Center, Harvard University, Visiting Scholar, 2004-2005. Institute for the Study of Labor (IZA), Bonn, Research Fellow, 2002-. Hoover Institution, National Fellow, 2000-2001. Extended Visits: Hebrew University; IZA; LSE; Maastricht University. Teaching Experience: Undergraduate Microeconomics (Honors Principles, Intermediate, Calculus-Based Intermediate, and MBA), Ohio State University. Undergraduate and Graduate Labor Economics, Ohio State University. Undergraduate Research. Ohio State University. April 16, 2021 1 Fellowships and Grants National Institutes of Health. National Institute of General Medical Sciences. PI. “Invisible Collaborators: Underrepresentation, Research Networks, and Outcomes of Biomedical Researchers.” $869,402.
    [Show full text]
  • David M. Cutler Edward L. Glaeser Jesse M. Shapiro Working Paper
    NBER WORKING PAPER SERIES WHY HAVE AMERICANS BECOME MORE OBESE? David M. Cutler Edward L. Glaeser Jesse M. Shapiro Working Paper 9446 http://www.nber.org/papers/w9446 NATIONAL BUREAU OF ECONOMIC RESEARCH 1050 Massachusetts Avenue Cambridge, MA 02138 January 2003 We are grateful to Melissa Eccleston, Daniel Michalow, and Vladimir Novakovski, for research assistance, and to the National Institutes on Aging for research support. We thank Gary Becker, Darius Lakdawalla, Tomas Philipson, and seminar participants at Ohio State University and the University of Chicago for helpful comments. The views expressed herein are those of the authors and not necessarily those of the National Bureau of Economic Research. ©2003 by David M. Cutler, Edward L. Glaeser, and Jesse M. Shapiro. All rights reserved. Short sections of text not to exceed two paragraphs, may be quoted without explicit permission provided that full credit including notice, is given to the source. Why Have Americans Become More Obese? David M. Cutler, Edward L. Glaeser, and Jesse M. Shapiro NBER Working Paper No. 9446 January 2003 JEL No. I1, O3, D1 ABSTRACT Americans have become considerably more obese over the past 25 years. This increase is primarily the result of consuming more calories. The increase in food consumption is itself the result of technological innovations which made it possible for food to be mass prepared far from the point of consumption, and consumed with lower time costs of preparation and cleaning. Price changes are normally beneficial, but may not be if people have self-control problems. This applies to some, but not most, of the population.
    [Show full text]
  • 2018 Annual Report Alfred P
    2018 Annual Report Alfred P. Sloan Foundation $ 2018 Annual Report Contents Preface II Mission Statement III From the President IV The Year in Discovery VI About the Grants Listing 1 2018 Grants by Program 2 2018 Financial Review 101 Audited Financial Statements and Schedules 103 Board of Trustees 133 Officers and Staff 134 Index of 2018 Grant Recipients 135 Cover: The Sloan Foundation Telescope at Apache Point Observatory, New Mexico as it appeared in May 1998, when it achieved first light as the primary instrument of the Sloan Digital Sky Survey. An early set of images is shown superimposed on the sky behind it. (CREDIT: DAN LONG, APACHE POINT OBSERVATORY) I Alfred P. Sloan Foundation $ 2018 Annual Report Preface The ALFRED P. SLOAN FOUNDATION administers a private fund for the benefit of the public. It accordingly recognizes the responsibility of making periodic reports to the public on the management of this fund. The Foundation therefore submits this public report for the year 2018. II Alfred P. Sloan Foundation $ 2018 Annual Report Mission Statement The ALFRED P. SLOAN FOUNDATION makes grants primarily to support original research and education related to science, technology, engineering, mathematics, and economics. The Foundation believes that these fields—and the scholars and practitioners who work in them—are chief drivers of the nation’s health and prosperity. The Foundation also believes that a reasoned, systematic understanding of the forces of nature and society, when applied inventively and wisely, can lead to a better world for all. III Alfred P. Sloan Foundation $ 2018 Annual Report From the President ADAM F.
    [Show full text]
  • The Challenge of Reforming the US Health Care System
    Wanting It All: The Challenge of Reforming the U.S. Health Care System Wanting It All: The Challenge of Reforming the U.S. Health Care System ©2007 Federal Reserve Bank of Boston. All rights reserved. edited by No part of this book may be reproduced in any form by any electronic or mechanical means (including photocopying, recording, or information storage and retrieval) without permission in writing from the publisher. Jane Sneddon Little This edited volume is based on a conference held in June 2005 by the Federal Reserve Bank of Boston. Conference Series No. 50 Cover illustrations by Art Glazer. This book was set in Sabon by Sztrecska Publishing and was printed and bound in the United States of America. Federal Reserve Bank of Boston Boston, Massachusetts vi Contents Comments on Enthoven’s “The U.S. Experience 119 Contents with Managed Care and Managed Competition” Michael E. Chernew Comments on Enthoven’s “The U.S. Experience 127 with Managed Care and Managed Competition” Sherry A. M. Glied 5 How the U.S. Health Care System Affects U.S. Labor 135 Markets The U.S. Health Care System and Labor Markets 137 Brigitte C. Madrian Acknowledgments ix Comments on Madrian’s “The U.S. Health Care System 165 1 Introduction 1 and Labor Markets” Reforming the U.S. Health Care System: Where There’s 3 Henry S. Farber a Will, There Could be a Way Employer-Funded Health Care and Labor Markets: 173 Jane Sneddon Little and Teresa Foy Romano An Insider’s View 2 Understanding the Political Challenge 27 Robert S.
    [Show full text]
  • Employment Other Affiliations
    David M. Cutler Department of Economics Harvard University 230 Littauer Center - 1805 Cambridge Street Cambridge, MA 02138 Phone: (617) 496-5216 [email protected] Employment 2014-: Harvard College Professor, Harvard University 2005-: Otto Eckstein Professor of Applied Economics, Department of Economics and Kennedy School of Government, Harvard University 2003-2008: Social Sciences Dean, Faculty of Arts and Sciences, Harvard University 1997-2005: Professor of Economics, Department of Economics and Kennedy School of Government, Harvard University 1995-1997: John L. Loeb Associate Professor of Social Sciences, Harvard University 1993: On leave as Senior Staff Economist, Council of Economic Advisers and Director, National Economic Council 1991-1995: Assistant Professor of Economics, Harvard University Other Affiliations Member, Institute of Medicine Scientific Advisory Board, Alliance for Aging Research Scientific Advisory Board, Fidelity Investments Academic and Policy Advisory Board, Kyruss, Incorporated Consultant, Mathematica Policy Research, Inc. Research Associate, National Bureau of Economic Research, Aging, Health Care, Public Economics, and Productivity programs Fellow, Employee Benefit Research Institute Member, National Academy of Social Insurance Member, Institute for Research on Poverty Senior Fellow, Center for American Progress Board Member, Center for Healthcare Transparency David M. Cutler June 2016 Public Service 2013-: Health Policy Commission, Commonwealth of Massachusetts 2006-2013: Group Insurance Commission, Commonwealth
    [Show full text]
  • Chandra CV May 5, 2021
    Amitabh Chandra 79 JFK Street Harvard Kennedy School of Government Harvard University Cambridge, Massachusetts 02138 email: [email protected] Citizenship United States India (overseas citizen) Degrees, Chronological MA Honorary Degree, Harvard University, 2009 Ph.D Economics, University of Kentucky, 2000 Dissertation: Labor Market Dropouts and the Racial Wage Gap, 1940-1990 MS Economics, University of Kentucky, 1999 BA Economics, University of Kentucky, 1996 Employment July 2020 - present John H. Makin Visiting Scholar American Enterprise Institute July 2018 - present: Henry and Allison McCance Family Professor of Business Administration Faculty Chair, MS/MBA Program in the Life-Sciences Harvard Business School July 2015 – present Ethel Zimmerman Wiener Professor of Public Policy Harvard Kennedy School of Government April 2009 – present Professor and Director of Health Policy Research Harvard Kennedy School of Government October 2009 – present Research Associate National Bureau of Economic Research (NBER) July 2012 - present Panel of Health Advisors Congressional Budget Office ! May 6, 21, p. 1/14 Previous Positions July 2012 - 2014 Visiting Scholar American Enterprise Institute January 2011 - 2012 Special Commissioner Massachusetts Commission on Provider Price Reform December 2011 - 2019 Chair Editor and Editor Review of Economics and Statistics April 2011 - 2016 Consultant Microsoft Research April 2008 - 2015 Associate Editor American Economic Journal: Applied July 2008 - 2012 Co-Editor Journal of Human Resources July 2005
    [Show full text]
  • The Impact of the Health Care Law on the Economy, Employers, and the Workforce
    THE IMPACT OF THE HEALTH CARE LAW ON THE ECONOMY, EMPLOYERS, AND THE WORKFORCE HEARING BEFORE THE COMMITTEE ON EDUCATION AND THE WORKFORCE U.S. HOUSE OF REPRESENTATIVES ONE HUNDRED TWELFTH CONGRESS FIRST SESSION HEARING HELD IN WASHINGTON, DC, FEBRUARY 9, 2011 Serial No. 112–2 Printed for the use of the Committee on Education and the Workforce ( Available via the World Wide Web: http://www.gpoaccess.gov/congress/house/education/index.html or Committee address: http://edworkforce.house.gov U.S. GOVERNMENT PRINTING OFFICE 64–228 PDF WASHINGTON : 2011 For sale by the Superintendent of Documents, U.S. Government Printing Office Internet: bookstore.gpo.gov Phone: toll free (866) 512–1800; DC area (202) 512–1800 Fax: (202) 512–2104 Mail: Stop IDCC, Washington, DC 20402–0001 COMMITTEE ON EDUCATION AND THE WORKFORCE JOHN KLINE, Minnesota, Chairman Thomas E. Petri, Wisconsin George Miller, California, Howard P. ‘‘Buck’’ McKeon, California Senior Democratic Member Judy Biggert, Illinois Dale E. Kildee, Michigan Todd Russell Platts, Pennsylvania Donald M. Payne, New Jersey Joe Wilson, South Carolina Robert E. Andrews, New Jersey Virginia Foxx, North Carolina Robert C. ‘‘Bobby’’ Scott, Virginia Duncan Hunter, California Lynn C. Woolsey, California David P. Roe, Tennessee Rube´n Hinojosa, Texas Glenn Thompson, Pennsylvania Carolyn McCarthy, New York Tim Walberg, Michigan John F. Tierney, Massachusetts Scott DesJarlais, Tennessee Dennis J. Kucinich, Ohio Richard L. Hanna, New York David Wu, Oregon Todd Rokita, Indiana Rush D. Holt, New Jersey Larry Bucshon, Indiana Susan A. Davis, California Trey Gowdy, South Carolina Rau´ l M. Grijalva, Arizona Lou Barletta, Pennsylvania Timothy H.
    [Show full text]
  • David M. Cutler Department of Economics Harvard University 226
    David M. Cutler Department of Economics Harvard University 226 Littauer Center - 1805 Cambridge Street Cambridge, MA 02138 Phone: (617) 496-5216 [email protected] Website Employment 2005-: Otto Eckstein Professor of Applied Economics, Department of Economics and Kennedy School of Government, Harvard University 2014-2019: Harvard College Professor, Harvard University 2003-2008: Social Sciences Dean, Faculty of Arts and Sciences, Harvard University 1997-2005: Professor of Economics, Department of Economics and Kennedy School of Government, Harvard University 1995-1997: John L. Loeb Associate Professor of Social Sciences, Harvard University 1993: On leave as Senior Staff Economist, Council of Economic Advisers and Director, National Economic Council 1991-1995: Assistant Professor of Economics, Harvard University Other Affiliations Academic and Policy Advisory Board, Kyruss, Incorporated National Advisory Board, Firefly Board Member, Center for Healthcare Transparency Consultant, Mathematica Policy Research, Inc. Consultant, Mercer Health & Benefits, LLC Fellow, Employee Benefit Research Institute Litigation. Retained by counsel for plaintiffs to provide expert services in pending litigation involving opioid pharmaceuticals. Member, Institute for Research on Poverty Member, Institute of Medicine Member, National Academy of Social Insurance Research Associate, National Bureau of Economic Research, Aging, Health Care, Public Economics, and Productivity programs Scientific Advisory Board, Alliance for Aging Research Scientific Advisory Board,
    [Show full text]
  • Liebman.Cv .April2018.Pdf
    April 2018 JEFFREY B. LIEBMAN Address: John F. Kennedy School of Government Harvard University 79 JFK Street Cambridge, MA 02138 telephone: (617) 495-8518 email: [email protected] web: https://sites.hks.harvard.edu/jeffreyliebman/ Current Positions: Malcolm Wiener Professor of Public Policy, Kennedy School of Government, Harvard University, 2006-present. Director, Taubman Center for State and Local Government, 2015-present. Director, Rappaport Institute for Greater Boston, 2015-present. Founder and Director, Harvard Kennedy School Government Performance Lab, 20ll-present. Research Associate, National Bureau of Economic Research, 2005-present. Co-organizer, NBER Working Group on Social Security. Associate Director, NBER Retirement Research Center and NBER Disability Research Center, 2011-2015. Previous Positions: Acting Deputy Director, Office of Management and Budget, 2010. Executive Associate Director and Chief Economist, Office of Management and Budget, 2009. Special Assistant to the President for Economic Policy, White House National Economic Council, 1998-1999. Assistant Professor of Public Policy, Kennedy School of Government, Harvard University, 1996-2001. Associate Professor of Public Policy, Kennedy School of Government, Harvard University, 2001-2005. Professor of Public Policy, Kennedy School of Government, Harvard University, 2005-2006. Faculty Research Fellow, National Bureau of Economic Research, 1996-2005. Harvard Kennedy School Area Chair for Social Policy, 2005-2007. Director, Harvard University Multidisciplinary Program in Inequality and Social Policy, 2005-2007. Education: Ph.D., Economics, 1996 Harvard University B.A. magna cum laude, distinction in Economics and Political Science, 1989 Yale University Honors and Fellowships: Elected to National Academy of Social Insurance, 2002. NBER Center for Aging, Demography Research Fellow, 2001-2002. Alfred P.
    [Show full text]
  • Residential Segregation in General Equilibrium
    ECONOMIC GROWTH CENTER YALE UNIVERSITY P.O. Box 208269 New Haven, CT 06520-8269 http://www.econ.yale.edu/~egcenter/ CENTER DISCUSSION PAPER NO. 885 RESIDENTIAL SEGREGATION IN GENERAL EQUILIBRIUM Patrick Bayer Yale University Robert McMillan University of Toronto and Kim Rueben Public Policy Institute of California May 2004 Notes: Center Discussion Papers are preliminary materials circulated to stimulate discussions and critical comments. We would like to thank Fernando Ferreira for outstanding research assistance. Thanks also to Pedro Cerdan and Jackie Chou for help on assembling the data. We are grateful to Pat Bajari, Steve Berry, Dennis Epple, Tom Nechyba, Holger Sieg and Chris Timmins for many valuable discussions, and to Joe Altonji, Gregory Besharov, Maureen Cropper, David Cutler, James Heckman, Vernon Henderson, Phil Leslie, Costas Meghir, Robert Moffitt, Michael Riordan, Steve Ross, Kerry Smith, Jon Sonstelie, Chris Taber, Chris Udry, and Jacob Vigdor for additional valuable comments. We also thank conference participants at the AEA, ERC, IRP, NBER, PET, SITE, and SIEPR, and seminar participants at Brown, Chicago, Chicago-GSB, Colorado, Columbia, Duke, Johns Hopkins, Northwestern, NYU, PPIC, Stanford, Toronto, UC Berkeley, UC Irvine, UCLA, and Yale for useful suggestions. This research was conducted at the California Census Research Data Center; our thanks to the CCRDC, and to Ritch Milby in particular. We gratefully acknowledge financial support for this project provided by the National Science Foundation under grant SES-0137289
    [Show full text]
  • JAMA Forum — the Future of Health Care Becomes Clearer: the Obama
    Home The JAMA Forum Contact Us About Us Subscribe to JAMA Forum — The Future of Health Care Becomes news@JAMA Clearer: The Obama Approach Wins Enter your email BY DAV ID CUTLER, PHD on NOV EM BER 7, 2012 address to subscribe to The 2012 Presidential this blog and receive race was the most notifications of new important election for posts by email. health care the country Join 1,423 other has ever experienced. followers In no other election has the repeal of a single law loomed as large as Romney’s promise to Sign me up! rescind the Affordable Care Act (ACA). Only RSS rarely have different approaches for health care been so starkly From JAMA painted. Voters had no difficulty knowing Medical News David Cutler, PhD where the candidates Media Coverage stood on health care, JAMA Report Video and they voted for the President’s approach. Audio Summaries The important question is what this will mean going forward. In reality, there Other News are 2 health care discussions. The election’s outcome will affect each. Curing Drug-Resistant The Affordable Care Act Tuberculosis In Kids Takes Creativity The election will have a major effect on the ACA. The ACA always had 3 major hurdles to pass, and it has now passed all of them. First, it had to Post-Transplant and Off become law. It did so after protracted debate and by a thin margin. Second, Drugs, HIV Patients Are the US Supreme Court had to decide that it was constitutional. That happened Apparently Virus-Free in June, again by a hair.
    [Show full text]
  • The Importance of Medical Care for Life Expectancy Gains
    NBER WORKING PAPER SERIES TWO HUNDRED YEARS OF HEALTH AND MEDICAL CARE: THE IMPORTANCE OF MEDICAL CARE FOR LIFE EXPECTANCY GAINS Maryaline Catillon David Cutler Thomas Getzen Working Paper 25330 http://www.nber.org/papers/w25330 NATIONAL BUREAU OF ECONOMIC RESEARCH 1050 Massachusetts Avenue Cambridge, MA 02138 December 2018 We are grateful to Marcella Alsan, George Clark, Claudia Goldin, Marcis Kempe, and Charles Roehrig for helpful conversations and data leads. Maryaline Catillon gratefully acknowledges support by the National Institute on Aging of the National Institutes of Health under Award Number R24AG048059 to the National Bureau of Economic Research. David Cutler gratefully acknowledges support by R37AG047312 from the National Institute of Aging. Tom Getzen gratefully acknowledges support by the Society of Actuaries grant on Modeling Long Run Medical Cost Trends. The content of this article is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health, the NBER, or the Society of Actuaries. The views expressed herein are those of the authors and do not necessarily reflect the views of the National Bureau of Economic Research. At least one co-author has disclosed a financial relationship of potential relevance for this research. Further information is available online at http://www.nber.org/papers/w25330.ack NBER working papers are circulated for discussion and comment purposes. They have not been peer-reviewed or been subject to the review by the NBER Board of Directors that accompanies official NBER publications. © 2018 by Maryaline Catillon, David Cutler, and Thomas Getzen. All rights reserved. Short sections of text, not to exceed two paragraphs, may be quoted without explicit permission provided that full credit, including © notice, is given to the source.
    [Show full text]