Word: modell
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...major problem with American health care today is what policy experts call "perverse incentives." Doctors and hospitals bill insurers for every individual service - every office visit, MRI or hour of operating-room time - a "fee for service" model that drives health-care inflation by rewarding providers who order potentially unnecessary tests, perform potentially unnecessary surgeries and even make mistakes. A hospital readmission caused by avoidable complications just means more billable expenses...
...contrast, Prometheus, funded by a $6 million grant from the Robert Wood Johnson Foundation, calculates compensation for hospitals and doctors based not on the specific treatments a patient receives but on the care a patient should receive "per episode." (Prometheus's calculation model is an open-source program that is already garnering interest from insurers in Minnesota, Pennsylvania and elsewhere...
Doctors are quick to say that much of the 30% of excess health-care spending is on "defensive medicine" - providing extra care in an effort to avoid malpractice liability - but De Brantes counters that the Prometheus model creates budgets based on clinical-practice guidelines that, if followed properly, help protect providers against malpractice claims...
...sites for 37 common surgical procedures. The idea is that if hospitals and doctors are paid out of the same pot, they'll coordinate services to be more efficient and cost-effective. The results could help determine how aggressively the Federal Government will end up pushing the bundled-payment model onto the entire Medicare system...
...delivering health care more efficiently and providing better preventive care - two essential factors for the reduction of overall health-care costs - but providers have been discussing the same factors as long as the idea of health reform has existed. Meanwhile, health-care costs, fueled by the "fee for service" model, are growing some 10% annually. In the end, the only way to get change may be to get real about the fact that, no matter how uncomfortable it makes us, health care and money are inseparable...