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Variation in Medicare Spending: Some Regions Already Spend at Canadian Level

Variation in Medicare Spending: Some Regions Already Spend at Canadian Level. Overuse of Cardiac Stents. 15% of all stent procedures are appropriate - for acute heart problems (ACS) But, 85% of stents are done for stable heart problems, where no better than simple drugs.

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Variation in Medicare Spending: Some Regions Already Spend at Canadian Level

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  1. Variation in Medicare Spending: Some Regions Already Spend at Canadian Level

  2. Overuse of Cardiac Stents • 15% of all stent procedures are appropriate - for acute heart problems (ACS) • But, 85% of stents are done for stable heart problems, where no better than simple drugs. • Patients treated only with drugs are 11% more likely to eventually need a procedure. • Hence, 62-75% of PCIs are unnecessary, costing $13- 15 billion/year (of the total $20,000 spent on stents).

  3. Quality of Care Slightly Better in Canada Than U.S. A Meta-Analysis of Patients Treated for Same Illnesses (U.S. Studies Included Mostly Insured Patients) Source: Guyatt et al, Open Medicine, April 19, 2007

  4. For-Profit Hospitals’ Death Rates are 2% Higher Source: CMAJ 2002;166:1399

  5. For-Profit Hospitals Cost 19% More Source: CMAJ 2004;170:1817

  6. For-Profit Dialysis Clinics’ Death Rates are 9% Higher Source: JAMA 2002;288:2449

  7. New Bad Ideas from the Private Insurance Industry • Consumer-directed care = skimpy coverage • Individual mandates like Massachusetts (force the uninsured to buy “skimpy coverage”) • Corporate disease management – replace primary care with firms that manage care for patients with diabetes, heart failure, etc. • Let private insurers compete with Medicare or similar program

  8. Walmart’s Plan: Attract Young, Healthy Workers by CDHP + Mandatory Physical Exertion Actual copy of internal memo from VP for Benefits to Walmart’s Board of Diectors, 2005

  9. Individual Mandates • MA law • Proposed in NY and IL • Component of plans by Edwards, Obama and others

  10. Crimes and Punishments in Massachusetts

  11. Corporate Disease Management Programs • No evidence that any disease management program lowers costs. • Fair evidence that non-profit disease management programs led by health professionals improve quality.

  12. Private insurers competing with Medicare • Edwards and Obama proposal • Already policy within the Medicare Advantage program

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