lessons from abroad: international efforts to improve quality, reduce costs and increase...
TRANSCRIPT
Lessons From Abroad:
International Efforts to Improve Quality, Reduce Costs and Increase Transparency
Robert S. Galvin, MDBipartisan Congressional
Health Policy Conference
January 13, 2007
2 Robert S. Galvin
Bipartisan Congressional Health Policy Conference
January 13, 2007
Lessons From AbroadWhere The U.S. Is Different
• Much Larger, More Heterogeneous Population
• Health System Much Less Centralized…By Design(?)
- Federal vs. State vs. Private Sector
• No Consensus On How To Control Costs
• Very Medical Innovation-Technology “Friendly”Where The U.S. Is Most Similar
• Common Belief: Driving Value vs. Cost Containment
3 Robert S. Galvin
Bipartisan Congressional Health Policy Conference
January 13, 2007
U.S. Has Been Improving Quality…Slowly
4 Robert S. Galvin
Bipartisan Congressional Health Policy Conference
January 13, 2007
Strategic Framework Board - 2003
Professional Organizations
Care Delivery Teams
PATHWAY #2
Goals
Purpose
Results(Performance)
Improvement
Consumers
Purchasers
PatientsMotivation
PATHWAY #1
Selection + Payment
Hospital Death Rate (RAMR)
Columbia Presbyterian 3.93*
Lenox Hill 2.26
NYU Hospitals Center 1.95
Weil Cornell – NYP 0.95*
Surgeon RAMR
State Total 2.25
Smith, C 4.15
The Power Of Transparency
6 Robert S. Galvin
Bipartisan Congressional Health Policy Conference
January 13, 2007
Payment and Improvement
“Current Payment
Systems . . . Are at Best
Neutral and at Worst
Negative Towards Quality”
MedPAC 2004 (2004)Institute of Medicine (2001)
“If I keep getting better, Dr Galvin,I’m going to improve myself
right out of business”
Glen Hackbarth
“Purchasers should…Remove
Barriers that…Impede Quality
Improvement
And Build In Stronger Incentives
For Quality Enhancement”
Immutable &
Desirable
AgeingTechnology
Unhealthy LifestylesMalpracticeEnd of Life Care
Cultural
System of
Care
UninsuredAdministrative CostsHigh Prices/Specialist IncomesWaste and Quality ShortfallsLack of Accountability/Transparency
Health Costs: Lots of Opportunity, Little Focus