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Dartmouth Researchers Outline Options for Health System Overhaul

By Mary Agnes Carey, CQ HealthBeat Associate Editor

DECEMBER 18, 2008 -- Health care coverage and quality could be improved by reducing the oversupply of health care services in high spending regions of the country, promoting organized systems of care and giving patients more information about the full range of treatment options available, according to a new Dartmouth Atlas white paper.

In addition, the Dartmouth researchers recommend that the Medicare program should promote the training of more primary care physicians and provide greater funding to programs that teach coordinated, community-based care for chronic illness. Medical effectiveness research must create a system for continuous evaluation of new clinical theories and technologies, and greater focus should be placed on organized systems of care that provide better medical treatment at less cost.

"Most analyses of coverage reform predict that we will spend more as a nation on health care once the uninsured gain coverage and begin consuming more care," the paper's lead authors, John E. Wennberg and Shannon Brownlee, said in a news release. "But we predict that covering everyone will have a much smaller impact on the trend in health care costs, provided that capacity is not increased." Other co-authors of the paper, released by the Dartmouth Institute for Health Policy and Clinical Practice, are Elliott S. Fisher, Jonathan S. Skinner and James N. Weinstein.

Separately Thursday, the Congressional Budget Office (CBO) released a set of cost estimates that detail the fiscal challenges that await lawmakers and incoming president Barack Obama as they contemplate major changes to the nation's health care system. Democrats and Obama have linked overhauling health care to a broader economic revival.

CBO Director Peter R. Orszag--who has been nominated to head the Office of Management and Budget in the incoming Obama administration--has previously pointed to Dartmouth studies showing that lower cost areas in the United States, such as the upper Midwest and Northwest, have quality of care at least as good as that of more expensive "interventionist" parts of the country in which far more health care resources are used. Orszag has testified on Capitol Hill that Wennberg's work offers the nation a way out of the fiscal crisis it faces because of unsustainable health care spending increases, in that it suggests spending growth can be cut without sacrificing quality.

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