Publications: Issue Brief

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How Can Medicare Lead Delivery System Reform?

November 13, 2009 - In this Commonwealth Fund issue brief, experts argue that the health care system as a whole would do well to emulate top-performing providers that embrace accountability for health care quality, outcomes, and cost. And they say the Medicare program—the nation's largest payer for health care—is the logical place to start.

Issue Brief

Using Insurance Standards and Policy Levers to Build a High Performance Health System

November 6, 2009 - This Commonwealth Fund issue brief examines an unprecedented use of state health insurance regulatory authority to promote health system reform. In Rhode Island, regulators have used this authority to implement a set of standards to promote increased affordability through a series of requirements aimed at strengthening and expanding the state's primary care infrastructure.

Issue Brief

State Hospital Rate-Setting Revisited

October 27, 2009 - In an attempt to control rapid growth in hospital costs, beginning in the mid-1970s seven states implemented rate-setting programs to regulate hospital payments. Although all but two have since been discontinued, these states' experiences offer lessons for policymakers as they continue searching for ways to control rising health care costs.

Issue Brief

Supporting Culture Change: Working Toward Smarter State Nursing Home Regulation

October 9, 2009 - To move toward a new model of nursing home regulation, the states and federal government must strike a balance between the traditional regulatory approach to weed out substandard facilities and a partnership model aimed at promoting high performance. This Commonwealth Fund issue brief highlights the importance of how such a model is structured, as well as the need to adequately train and educate regulatory staff and providers about culture change.

Issue Brief

Out of Options: Why So Many Workers in Small Businesses Lack Affordable Health Insurance, and How Health Care Reform Can Help

September 9, 2009 - Small business owners and employees are among those who stand to benefit the most from provisions in some of the current health reform proposals under consideration by Congress, according to this Commonwealth Fund study.

Issue Brief

North Carolina's ABCD Program: Using Community Care Networks to Improve the Delivery of Childhood Developmental Screening and Referral to Early Intervention Services

August 20, 2009 - North Carolina's Assuring Better Child Health and Development program has quintupled the number of screening tests administered during Medicaid well-child visits to identify young children at risk for developmental disabilities and delays. This Commonwealth Fund issue brief examines the key elements of this program that have resulted in fewer children entering school with unrecognized or untreated developmental problems.

Issue Brief

Paying Medicare Advantage by Competitive Bidding: How Much Competition Is There?

August 12, 2009 - Private health plans that enroll Medicare beneficiaries—known as Medicare Advantage (MA) plans—are being paid $11 billion more in 2009 than it would cost to cover these beneficiaries in regular fee-for-service Medicare. The Obama Administration has proposed eliminating these extra payments to private insurers and instituting a competitive bidding system. This study questions the degree to which firms offering MA plans actually face competition.

Issue Brief

Rite of Passage? Why Young Adults Become Uninsured and How New Policies Can Help, 2009 Update

August 6, 2009 - Young adults between the ages of 19 and 29 represent one of the largest and fastest-growing segments of the U.S. population without health insurance. Often dropped from their parents' policies or from public insurance programs at age 19 or on graduation day, they are left to find insurance on their own while making the often uneasy transition from high school to college or the working world.

Issue Brief

Chronic Burdens: The Persistently High Out-of-Pocket Health Care Expenses Faced by Many Americans with Chronic Conditions

July 23, 2009 - This Commonwealth Fund study shows that nearly 40 percent of nonelderly adults with three or more chronic conditions had out-of-pocket expenses and premiums exceeding 5 percent of income for two consecutive years, compared with 20 percent of people who had a single chronic condition and 14 percent who had no chronic conditions.

Issue Brief

Institute for Quality and Efficiency in Health Care: Germany

July 22, 2009 - The Institute for Quality and Efficiency in Health Care (IQWiG) was established in 2004 to provide Germany's Federal Joint Committee with evidence-based evaluations of the benefits and cost benefits of health services, and functions in an advisory role.

Issue Brief

Comparative Effectiveness Review Within the U.K.'s National Institute for Health and Clinical Excellence

July 22, 2009 - This Commonwealth Fund issue brief examins the U.K.'s National Institute for Health and Clinical Excellence (NICE), which was established to perform three core functions: 1) reduce unwarranted variation in practice across the United Kingdom through the development and dissemination of best practice evidence-based standards; 2) encourage fast diffusion and uniform uptake of high-value medical innovations; and 3) ensure the taxpayers’ money is invested in the National Health Service so that health benefit is maximized.

Issue Brief

Evidence-Based Decision-Making Within Australia's Pharmaceutical Benefits Scheme

July 22, 2009 - This Commonwealth Fund issue brief looks at Australia's Pharmaceutical Benefits Scheme, through which most prescription drugs are subsidized.

Issue Brief

National Authority for Health: France

July 22, 2009 - This Commonwealth Fund issue brief outlines the French National Authority for Health, which was established to assist France's public institutions in optimizing the basket of reimbursable goods and services and to help health care professionals continuously improve their clinical practice.

Issue Brief

Failure to Protect: Why the Individual Insurance Market Is Not a Viable Option for Most U.S. Families

July 21, 2009 - The individual health insurance market is not a viable option for the majority of uninsured adults, according to this new Commonwealth Fund analysis. Seventy-three percent of people who tried to buy insurance on their own in the last three years did not purchase a policy, primarily because premiums were too high.

Issue Brief

How Health Care Reform Can Lower the Costs of Insurance Administration

July 16, 2009 - The United States leads all industrialized countries in the share of national health care expenditures devoted to insurance administration. This issue brief examines the sources of insurance administrative costs in this country, and describes how a private–public approach to health care reform could substantially lower such costs.

Issue Brief