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Biomedical subjects

S H Altman

Publications and source records attributed to S H Altman.

At least 19 recordsLinked to original sources
PubMed1996

Health care spending: can the United States control it?

Health care spending in the United States has continued to outpace the growth in national income and the growth in spending in other countries. And yet many Americans are without sufficient health care. Since the failure of national health care reform proposals put forward by the Clinton administration and others, the United States has had to look for other solutions to the problem of how to control spending in this sector. Can the new competitive approach of managed care succeed where other cost control measures of the past have failed? This chapter begins with an examination of the problems facing health care today, outlines recent trends in health care spending, and details reasons why spending is rising so rapidly at this time. The historical context of health care reform proposals and government attempts to control spending are described next and the reasons why some of these plans made no progress are explained. The health care payment systems of other industrialized nations that have seen some success in controlling costs are analyzed. Comparison of these systems with proposed plans for reforming the U.S. system provide insights and lessons for the United States. Finally, the chapter describes managed care and managed competition and makes the argument that managed care has the potential to respond to many of the health care spending problems facing the United States. However, more data on this subject are needed, and the authors call for a national monitoring entity to assess the progress of managed care in meeting the health care needs of the public.

Cost Control↗
PubMed1994

QMHC interview: Stuart H. Altman, Ph.D.. Interview by Marie E. Sinioris.

An internationally recognized authority on health policy, Stuart H. Altman, Ph.D., is a key player in the debate on health care reform and the deliberations of the White House task force on health care policy. QMHC interviewed Dr. Altman to get an inside look at the status of the Administration's much awaited plan to overhaul the health care system. The interview covered a range of topics, including the elements of reform, the prospects for managed care, the implications of a standard benefits package, and the role of quality in the reform debate.

Focus Groups↗
PubMed1992

Shrinking share.

Explore the source record for details and available documents.

Ambulatory Care↗
PubMed1992

The trend in hospital output and labor productivity, 1980-1989.

This paper analyzes changes in hospital labor productivity from 1980 through 1989. Our primary measure is called aggregate productivity, defined as the ratio of admissions (after controlling for the complexity of patients treated) to full-time equivalent employees. To scrutinize changes in aggregate productivity more closely, we also developed two component measures. These are intermediate productivity, which examines the labor necessary to produce a set of patient care services, and the intensity of services. The data show that hospitals clearly became more efficient in producing services during the 1980s. However, these gains were overwhelmed by more services being provided, resulting in a decline in aggregate productivity. The pattern of intensity and productivity changes can be associated with some distinct phases of the Medicare prospective payment system.

Diagnosis-Related Groups↗
PubMed1990

How have PPS changes affected allocation of Medicare spending for hospital care? A case study of New York State.

Complex national factors went into the development of key policies of the federal prospective payment system, and the effects of these policies varied in different parts of the country. One state particularly affected by these changes, and for the most part in a positive way, was New York. This paper focuses on the Medicare PPS policy changes and their impact nationally. An analysis of the experience of New York state, which had been under a stringent hospital cost containment system before PPS, provides a laboratory to understand how key federal policies affected different types of hospitals in that state as well as nationally.

Cost Allocation↗
PubMed1988

Halfway competitive markets and ineffective regulation: the American health care system.

Since the late 1960s the U.S. has attempted to develop a strategy for controlling the rate of growth of health care spending. During the 1970s this strategy relied heavily on various forms of regulation. Some regulatory programs were partially successful in moderating spending increases, but they generated significant opposition--particularly from powerful provider groups, who successfully convinced Congress and the states to dismantle most of the regulatory structure and to substitute various forms of competitive approaches to controlling spending. Some of these competitive strategies have been successful in increasing the efficiency of subsections of our health system. But they too have produced "losers," and the government has been pressured to enter the system to minimize their losses. The net result has been a political stalemate between halfway competitive markets and ineffective regulation. With the rate of health care spending growth near historic levels, it is likely that the 1990s will bring a return to a stronger role for government regulation. But it is unlikely that we are any more willing to tolerate the negative fallout from regulation today than we were in the 1970s, and therefore we predict that the proportion of GNP going to health care will continue to grow throughout the remainder of this century.

Cost Control↗
PubMed1988

What influences a state's approach to Medicaid reform?

Four states--Arizona, California, New York, and Pennsylvania--undertook major Medicare reforms in the early 1980s based on competition, price negotiation, regulation, and diagnosis related groups. To increase our understanding of what led to these reforms, we analyzed data from interviews with representatives of state executive and legislative branches and from providers and others involved in the reforms, and examined published and unpublished information on the reforms. We identified seven factors influencing choice of Medicaid reform: the crisis that triggered reform, the purposes of reform, the locus of the innovation (legislative versus executive), the power and views of key provider groups, state officials' perception of providers and recipients, the scope of the change implemented, and reform as a reflection of past state practices. We discuss these factors extensively.

Arizona↗
PubMed1987

Implementing change: lessons for Medicaid reformers.

Major Medicaid reforms initiated in Arizona, California, and New York in the 1980s form the foundation of this study, which explores issues to consider when implementing change in state Medicaid programs. We prepared case studies of these reforms, describing the innovations and assessing the implementation process in each state. These case studies are used to illustrate broad issues and processes of Medicaid reform. Six lessons emerge from our analysis: Expect reform models to change over time; strive for predictability and continuity in the reform; encourage behavior changes through the use of incentives; use special administrative or political channels to simplify the reform; expect reform models to converge over time; and implementation difficulties can be predicted. These lessons should educate decision makers about how to implement possible future solutions to problems like those seen in Medicaid programs at the start of this decade.

Arizona↗