TY - CHAP M1 - Book, Section TI - Painful Versus Painless Cost Control A1 - Bodenheimer, Thomas A1 - Grumbach, Kevin PY - 2020 T2 - Understanding Health Policy: A Clinical Approach, 8e AB - Dr. Joshua Worthy is chief of neurology at a large group model health maintenance organization (HMO) and serves as the physician representative to the HMO’s executive committee. The federal government has just taken the unprecedented step of imposing mandatory cost controls. The HMO’s budget for the coming year will be frozen at the current year’s level. In past years, the annual growth in the HMO’s budget has averaged 8%.The HMO’s CEO begins the committee meeting by groaning, “These cuts are draconian! To meet these new budget limits we’ll have to cut staff and ration life-saving technologies. Patients will suffer.” A consumer member responds, “We all know there’s fat in the system. Why, in the newspaper just the other day there was an article about how rates of back surgery in our city are twice the national average. And if we’re going to talk about cuts, maybe we should start by looking at your salary and the number of administrators working here. I’m not so sure patients have to suffer just because we’re adopting the kind of reasonable spending limits that they have in most countries.”Dr. Worthy remains silent for much of the meeting. He wonders to himself, “Is the CEO right? Is cost containment inevitably a painful process that will deprive our patients of valuable health services? Or, could we be doing a better job with the resources we’re already spending? Is there a way that our HMO could implement these cost controls in a relatively painless fashion as far as our patients’ health is concerned?” Interpreting Dr. Worthy’s silence as an indication of great wisdom and judgment, the committee assigns him to chair the HMO’s task force charged with developing a cost-control strategy to meet the new budgetary realities. SN - PB - McGraw Hill CY - New York, NY Y2 - 2024/10/16 UR - accesspharmacy.mhmedical.com/content.aspx?aid=1171158609 ER -