Unbiased Analysis of Today's Healthcare Issues

P4P in Ontario

Ontario implemented a physician pay-for-performance (P4P) scheme in 2002.  This P4P framework was a jointly agreed upon by the  Ontario government and the Ontario Medical Association.  The Ontario P4P program is described in Hurley, DeCicca and Buckley (2013) in more detail below: [Ontario’s P4P program] targets performance bonuses on effective preventive services whose rates of provision were […]

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Sustainability of Canadian Health Care System in Doubt?

Canada’s spends far less on health care on health care than the U.S.  According to the CIA World Factbook, in 2010 Canada spent 11.3% of its GDP on health expenditures compared to 17.9% of GDP in the U.S.  Nevertheless, a Society of Actuaries (SOA) report claims that Canada may be in a tenuous fiscal situation.  […]

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P4P and Diabetes Care

In April 2006, Ontario instituted the Diabetes Management Incentive (DMI) that increased payments to physicians that provided high-quality diabetes care. Did the incentive improve payments quality? According to a paper by Kantarevic and Kralj (2012), it turns out that the answer is yes, but the magnitude of the change depends on the type of physician. […]

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Who gets hurt when Americans buy drugs in Canada?

A few years ago, changing federal laws to lower drug prices was a key political issue. Some proposed allowing Medicare to negotiate lower prices from drug manufacturers and others recommended allowing U.S. citizens to import drugs from lower-priced developed countries such as Canada. These policies would certainly reduce drug prices, however, lower prices could also […]

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Why is end-of-life spending so high?

The answer is because using more intensive services does reduce mortality. This is the finding of a recent JAMA paper. After controlling for patient case mix, the authors examine variation in hospital spending in the last year of a patient’s life. The authors note that “Higher-spending hospitals differed in many ways, such as greater use […]

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The Downside of Concentrated Health Care Markets

Many recent healthcare policies aim to consolidate the provision of medical services.  For instance, Accountable Care Organizations consolidate providers with the goal of providing seamless, integrated patient care.  Consolidation can increase efficiency and (potentially) drive down prices.  If a market is highly concentrated, however, problems in a single supplier can lead to shortages.  Consider the […]

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U.S. vs. Canada: Health outcomes and heart disease

This blog has posted frequently on comparisons between the U.S. and Canadian healthcare systems (see here, here, here and here).  Although there are many points of contention, it is clear that the Canadian system is less expensive than the American.  According to the OECD, in 2006 Canada spent $3,678 per person on health care and […]

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Costing Methods

How do hospitals estimate the cost of different inpatient stays?  A paper by Clement et al. (2009) reviews 3 techniques: Microcosting. “With microcosting, a detailed list of each component of a patient’s care is created and costed separately for each facet of a patient’s hospitalization. Given the level of detail, microcosting is generally considered the […]

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Canadian Social Security and Well-Being

Does Social Security work?  By that, I mean does giving elderly individuals a government pension increase their level of income, the amount of goods the can consume, or even their happiness? An NBER working paper by Baker, Gruber and Milligan (2009) tries to answer this question in the Canadian setting. Background Currently, Canadian income transfer […]

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Financial Risk and Medical care: U.S. vs. Canada

In the U.S. a much higher percentage of medical is paid for out of pocket.  Further, there are about 45 million uninsured.  In Canada, the government pays for almost all health care.  The benefits and costs of a centralized, universal health care system have been discussed previously on this blog (see Oct 2, 2007 and […]

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