Improving Health Care Cost Projections for the Medicare Population
Improving Health Care Cost Projections for the Medicare Population

Author: National Research Council

Publisher: National Academies Press

Published: 2010-12-30

Total Pages: 128

ISBN-13: 0309159768

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Developing credible short-term and long-term projections of Medicare health care costs is critical for public- and private-sector policy planning, but faces challenges and uncertainties. There is uncertainty not only in the underlying economic and demographic assumptions used in projection models, but also in what a policy modeler assumes about future changes in the health status of the population and the factors affecting health status , the extent and pace of scientific and technological breakthroughs in medical care, the preferences of the population for particular kinds of care, the likelihood that policy makers will alter current law and regulations, and how each of these factors relates to health care costs for the elderly population. Given the substantial growth in the Medicare population and the continued increases in Medicare, Medicaid, and private health insurance spending, the availability of well-specified models and analyses that can provide useful information on the likely cost implications of health care policy alternatives is essential. It is therefore timely to review the capabilities and limitations of extant health care cost models and to identify areas for research that offer the most promise to improve modeling, not only of current U.S. health care programs, but also of policy alternatives that may be considered in the coming years. The National Research Council conducted a public workshop focusing on areas of research needed to improve health care cost projections for the Medicare population, and on the strengths and weaknesses of competing frameworks for projecting health care expenditures for the elderly. The workshop considered major classes of projection and simulation models that are currently used and the underlying data sources and research inputs for these models. It also explored areas in which additional research and data are needed to inform model development and health care policy analysis more broadly. The workshop, summarized in this volume, drew people from a wide variety of disciplines and perspectives, including federal agencies, academia, and nongovernmental organizations.

Fiscal Therapy
Fiscal Therapy

Author: William G. Gale

Publisher: Oxford University Press

Published: 2019-03-01

Total Pages: 362

ISBN-13: 0190645431

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Keeping the economy strong will require addressing two distinct but related problems. Steadily rising federal debt makes it harder to grow our economy, boost our living standards, respond to wars or recessions, address social needs, and maintain our role as a global leader. At the same time, we have let critical investments lag and left many people behind even as overall prosperity has grown. In Fiscal Therapy, William Gale, a leading authority on how federal tax and budget policy affects the economy, provides a trenchant discussion of the challenges posed by the imbalances between spending and revenue. America is facing a gradual decline as debt accumulates and delay raises the costs of action. But there is hope: fiscal responsibility aligns with both conservative and liberal goals and citizens of all stripes can support the notion of making life better for our children and grandchildren. Gale provides a plan to make the economy and nation stronger, one that controls entitlement spending but preserves and enhances their anti-poverty and social insurance roles, increases public investments on human and physical capital, and raises and reforms taxes to pay for government services in a fair and efficient way. What is needed, he argues, is to balance today's needs against tomorrow's obligations. We face significant fiscal challenges but, if we are wise enough to seize our opportunities, we can strengthen our economy, increase opportunity, reduce inequality, and build better lives for our children and grandchildren. We do not have to kill popular programs or starve government. Indeed, one main goal of fiscal reform is to maintain the vital functions that government provides. We need to act responsibly, pay for the government we want, and shape that government in ways that serve us best.

Competition and the Cost of Medicare's Prescription Drug Program
Competition and the Cost of Medicare's Prescription Drug Program

Author: Anna Cook

Publisher:

Published: 2014-09-03

Total Pages: 48

ISBN-13: 9781457856631

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The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (the Medicare Modernization Act, or MMA) substantially expanded the federal Medicare program by creating the prescription drug benefit known as Part D. In FY 2013, Medicare Part D covered 39 million people. The federal government spent $59 billion net of premiums on Part D in that year; after accounting for certain payments from states under the program, the net federal cost was $50 billion, which represented 10% of net federal spending for Medicare. A combination of broader trends in the prescription drug market and lower-than-expected enrollment in Part D has contributed to much lower spending for the program than projected when the MMA became law in 2003. This report examines the federal budgetary cost and competitive design of Medicare Part D and compares Medicare Part D and Medicaid Fee for Service. Figures and tables. This is a print on demand report.

Health Care Fraud and Abuse
Health Care Fraud and Abuse

Author: Aspen Health Law Center

Publisher:

Published: 1998

Total Pages: 156

ISBN-13:

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Stepped-up efforts to ferret out health care fraud have put every provider on the alert. The HHS, DOJ, state Medicaid Fraud Control Units, even the FBI is on the case -- and providers are in the hot seat! in this timely volume, you'll learn about the types of provider activities that fall under federal fraud and abuse prohibitions as defined in the Medicaid statute and Stark legislation. And you'll discover what goes into an effective corporate compliance program. With a growing number of restrictions, it's critical to know how you can and cannot conduct business and structure your relationships -- and what the consequences will be if you don't comply.

The Healthcare Imperative
The Healthcare Imperative

Author: Institute of Medicine

Publisher: National Academies Press

Published: 2011-01-17

Total Pages: 852

ISBN-13: 0309144337

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The United States has the highest per capita spending on health care of any industrialized nation but continually lags behind other nations in health care outcomes including life expectancy and infant mortality. National health expenditures are projected to exceed $2.5 trillion in 2009. Given healthcare's direct impact on the economy, there is a critical need to control health care spending. According to The Health Imperative: Lowering Costs and Improving Outcomes, the costs of health care have strained the federal budget, and negatively affected state governments, the private sector and individuals. Healthcare expenditures have restricted the ability of state and local governments to fund other priorities and have contributed to slowing growth in wages and jobs in the private sector. Moreover, the number of uninsured has risen from 45.7 million in 2007 to 46.3 million in 2008. The Health Imperative: Lowering Costs and Improving Outcomes identifies a number of factors driving expenditure growth including scientific uncertainty, perverse economic and practice incentives, system fragmentation, lack of patient involvement, and under-investment in population health. Experts discussed key levers for catalyzing transformation of the delivery system. A few included streamlined health insurance regulation, administrative simplification and clarification and quality and consistency in treatment. The book is an excellent guide for policymakers at all levels of government, as well as private sector healthcare workers.

Health-Care Utilization as a Proxy in Disability Determination
Health-Care Utilization as a Proxy in Disability Determination

Author: National Academies of Sciences, Engineering, and Medicine

Publisher: National Academies Press

Published: 2018-04-02

Total Pages: 161

ISBN-13: 030946921X

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The Social Security Administration (SSA) administers two programs that provide benefits based on disability: the Social Security Disability Insurance (SSDI) program and the Supplemental Security Income (SSI) program. This report analyzes health care utilizations as they relate to impairment severity and SSA's definition of disability. Health Care Utilization as a Proxy in Disability Determination identifies types of utilizations that might be good proxies for "listing-level" severity; that is, what represents an impairment, or combination of impairments, that are severe enough to prevent a person from doing any gainful activity, regardless of age, education, or work experience.