Is cutting 'uncertain' care key to savings?

Article Abstract:

A study of the use of common coronary procedures performed in New York state indicates that the procedures were used inappropriately in only 2.4-4.2% of the cases reviewed. However, procedures that were judged of uncertain appropriateness were performed far more frequently. For example, 38% of angioplasties surveyed were considered to be of uncertain appropriateness. The procedures studied included angioplasties, coronary artery bypasses and coronary angiographies. Health care reformers may focus on reducing the number of marginally appropriate procedures to lower health care costs.

Management, Finance, Health care industry, New York, Medical care, Cost of, Health care costs, New York (State)

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Quality questions: will mechanisms for oversight be overlooked in health reform?

Article Abstract:

The American Medical Peer Review Assn (AMPRA) says that quality assurance criteria should be part of any healthcare reform program. AMPRA is lobbying for: the inclusion of state quality improvement organizations that operate independently of purchasers and providers, uniform clinical databases, a national system of licensing and accreditation, compliance monitoring, penalties for inferior care and a patient appeals process.

Standards, Laws, regulations and rules, Medical care, Health care reform, American Medical Peer Review Association

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How do health plans perform?

Article Abstract:

The National Committee for Quality Assurance reported on a pilot project that studied 21 health maintenance and preferred provider organizations whose performance was measured according to 36 criteria. These included 28 technical aspects of healthcare delivery and 8 questions of patient satisfaction. Many organizations plan to use the data to determine areas that need improvement.

Direct Health and Medical Insurance Carriers, Health Maintenance Organizations, HMO Medical Centers, Preferred Provider Health Plans, Evaluation, Reports, Preferred provider organizations (Medical care), National Committee for Quality Assurance

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