The Urban Institute conducts research and writes reports for the Robert Wood Johnson Foundation on key issues related to health insurance coverage and the quality of health care in the United States. These papers are designed to educate policy-makers.
This report provides an overview of performance measurement in U.S. health care, and includes policy recommendations aimed at improving the performance measurement enterprise. Specifically, the report recommends how to develop better measures; when and how to use measures; and how to ensure the validity and comparability of publicly-reported performance measure data.
Experts have projected that as much as a third of U.S. health care spending is unnecessary and wasteful. Of the estimated $765 billion of health care dollars wasted in 2009, a quarter—$210 billion—was spent on the overuse of services, which includes services that are provided more frequently than necessary or services that are higher-cost, but no more beneficial than lower-cost alternatives.
This paper provides a summary of the problem of overuse in the U.S. health care system. The analysis gives an overview of the provision of medically inappropriate and unnecessary services that drive up health care spending without making a positive impact on patients’ health outcomes. It also describes approaches that have already been used to address overuse of health care services and outlines the broader payment reforms needed to minimize incentives to overdiagnose and overtreat.
The Urban Institute is undertaking a comprehensive monitoring and tracking project to analyze trends across 10 diverse states, providing insight into key health reform implementation issues that states nationwide are facing.
There is widespread agreement that the current fee-for-service approach to paying for health care is problematic, but there is a lack of consensus on what should replace it. Medicare is pursuing bundled episode payments, and proponents like Francois de Brantes of the Health Care Incentives Improvement Institute have been laying the groundwork for implementation. But other experts, such as the Urban Institute’s Robert Berenson, worry that the current interest in bundled payments will distract policy-makers from moving more decisively away from fee-for-service. In a new paper, de Brantes and Berenson debate the benefits and drawbacks of bundled payments and global capitation.