Managed Healthcare Executive - April 2009 - (Page 10) Spending Comparative-effectiveness studies lead to smart spending Wisely Effective Treatments E story | Julie Miller photography | Paul Sirochman conomist Gail Wilensky is troubled by the growth in healthcare expenditures. While many proposed health reforms appear capable of lowering the bar on spending, few address the continuously rising slope. “If we can nd a way to do that,” Wilensky says, “we will make expanding coverage so much easier. We will slow the increase in the uninsured, and we will tend to slow down what the population worries about, which is their share of the premium and their out-ofpocket costs. If we have success in slowing down healthcare costs, then all of these issues will be helped.” The nation spends $6.3 billion per day on healthcare, with recent annual growth rates ranging from 6% to 16%. It’s that constant rise that makes the current system so unsustainable. “Healthcare spending actually slowed last year, dramatically, but probably because of the slowdown in the economy,” Wilensky says. “Unless you begin to change some of the dynamics that drive up healthcare spending, we can’t assume this slower spending rate is going to continue once the economy starts turning around, say in the next 12 to 24 months.” A February report from the Centers for Medicare and Medicaid Services (CMS) projects last year’s growth was just over 6%, which is low compared to rises in recent years, but still well ahead of in ation. To slow the growth, one must recognize its many drivers. The most signi cant—and contentious—driver of all has been the abundant supply of costly healthcare services in the United States coupled with very little constraint on demand, Wilensky says. Managed care has long been criticized for its attempts at constraint, and politicians often weed out such policy provisions because of the unspeakable connotations “rationing” has among the American public. However, common sense would indicate that in order to reduce runaway spending in the fairly well-stocked grocery store of healthcare services, the 10 APRIL 2009
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