Search Annals: Advanced search

Rapid Responses to:

Medicine and Public Issues: Thomas Bodenheimer High and Rising Health Care Costs. Part 3: The Role of Health Care Providers Ann Intern Med 2005; 142: 996-1002 [Abstract] [Full text] [PDF]

Send comment/rapid response letter

Electronic letters published:

High and Rising Health Care Costs

Paul Griner   (2 July 2005)

Physician's Reimbursement and Rising Health Care Costs

Joel Kovarsky   (30 June 2005)

High and Rising Health Care Costs 2 July 2005
Paul Griner, MD University of Rochester School of Medicine & Dentistry- retired Send rapid response to journal: Re: High and Rising Health Care Costs pfgriner{at}aol.com Paul Griner	In his article describing how health care providers contribute to high and rising health care costs in the United States (1), Bodenheimer notes that the quantity of services is associated with the supply of resources. Strategies to control suppply,such as placing hospitals at risk for increased spending, could be effective in controlloing costs. Such an approach was used successfully in Rochester,New York in the 1980s (2,3). From 1980 to 1989, the nine hospitals in the Rochester area operated under an all payer prospective payments system. This system featured local administration and control and was the first time a group of hospitals in the U.S. had committed to a comprehensive regional financing system. Over the nine years of the experiment, the rate of increase in hospital expenditures in Rochester was well below the national average while the financial position of its hospitals improved, the only hospital region in New York State that showed an operating surplus. A community-wide assessment showed no evidence of a reduction in the quality of care or access to health care. The experiment was terminated when competiton and managed care became the mantra for controlling health care costs. This regional system for hospital payment achieved high quality care at an affordable cost through a balanced combination of self-regulation, cooperation, and competition. These words (regional system, self- regulation, and a balance between cooperation and competition) should serve as key principles for future attempts to improve the health care delivery system in the United States. References: 1. Bodenheimer T. High and Rising Health Care Costs. Part 3: The Role of Health Care Providers. Ann Intern Med. 2005; 142:996-1002 2. Block, JA, Regenstreif, DI, Griner, PF. A Community Hospital Payment Experiment Outperforms National Experience. The Hospital Experimental Payment Program in Rochester, NY. JAMA. 1987, 257: 1093-7 3. Hall WJ, Griner PF. Cost-effective Health Care: The Rochester Experience. Health Affairs, 1993, Spring: 58-69 Conflict of Interest: None declared
Physician's Reimbursement and Rising Health Care Costs 30 June 2005
Joel Kovarsky, M.D. Send rapid response to journal: Re: Physician's Reimbursement and Rising Health Care Costs jsk{at}gamewood.net Joel Kovarsky	The authors state, on p. 997, that the 'ratio of average physician income to average employee compensation is 5.5 in the United States compared to 1.5 in the United Kingdom...". On the surface it raises eyebrows, but there are a couple of concerns I have. 1. Other authors have commented that mean physician incomes are virtually meaningless in the USA. Without a specialty breakdown, what good are these figures? 2. What are we to do, index the incomes in all professions and industries to average ratios for industrialized nations? That is a bit cynical, but if physicians are to be singled-out for such indexing, please outline the reasons. 3. What are the average costs of a medical education in these other nations? What other social safety nets are provided to citizens (including physicians). These are just a few things that cross my mind. It is one thing to throw around numbers. I just have trouble knowing what they mean. Regards. Joel Kovarsky M.D., 800 Memorial Drive, Suite B, Danville, VA 24541 USA Conflict of Interest: None declared