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This document contains two slides (pages 317 and 318) from a KPCB presentation titled 'USA Inc. | What Might a Turnaround Expert Consider?'. The slides analyze US healthcare inefficiencies, comparing 2007 US health indicators (obesity, infant mortality, etc.) against OECD medians to show the US ranking poorly. It also argues for 'Comparative Effectiveness' research to improve Medicare and Medicaid efficiency, noting that Medicare is currently legally precluded from considering costs in coverage decisions. The document bears the Bates stamp HOUSE_OVERSIGHT_021000.
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Key Quotes (3)
"Note that by law, Medicare is effectively precluded from considering costs when making coverage decisions."Source
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Quote #1
"Without rigorous data about comparative effectiveness, according to the CBO: Treatment decisions often depend on anecdotal evidence, conjecture, and the experience/judgment of involved physicians."Source
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Quote #2
"USA Falls Behind OECD Averages in Many Other Health Indicators"Source
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Quote #3
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Complete text extracted from the document (1,975 characters)
Restructure Medicare & Medicaid: In Addition to Life Expectancy, USA Falls Behind OECD Averages in Many Other Health Indicators
2007 Health Indicators USA OECD Median USA Ranking (1 = Best, 30 = Worst) RED = Below Average
Obesity (% of total population) 34 15 30
Infant Mortality (per 1,000 live births) 7 4 27
Infant Mortality (per 1,000 live births) 7 4 27
Medical Resources Available (per 1,000 population)
Total Hospital Beds 3 6 25
Practicing Physicians 2 3 22
Doctors' Consultations per Year 4 6 19
MRI Machines* (per million population) 26 9 1
Total Hospital Beds 3 6 25
Practicing Physicians 2 3 22
Doctors' Consultations per Year 4 6 19
MRI Machines* (per million population) 26 9 1
Cause of Death (per 100,000 population)
Heart Attack 216 178 22
Respiratory Diseases 60 45 21
Diabetes 20 12 20
Cancer 158 159 14
Stroke 33 45 8
Heart Attack 216 178 22
Respiratory Diseases 60 45 21
Diabetes 20 12 20
Cancer 158 159 14
Stroke 33 45 8
KPCB www.kpcb.com Note: *MRI is Magnetic Resonance Imaging. Source: OECD.
USA Inc. | What Might a Turnaround Expert Consider? 317
USA Inc. | What Might a Turnaround Expert Consider? 317
Restructure Medicare & Medicaid: Effectiveness Research Could Improve Efficiency (i.e., Outputs Track Inputs)
• Comparative Effectiveness evaluates different options for treating a condition for a specific set of patients¹
– Either relative benefits and risks of various treatment options (technology assessment, evidence-based medicine), or
– Both clinical effectiveness and relative cost (cost-benefit analysis).
– Either relative benefits and risks of various treatment options (technology assessment, evidence-based medicine), or
– Both clinical effectiveness and relative cost (cost-benefit analysis).
• Without rigorous data about comparative effectiveness, according to the CBO:
– Treatment decisions often depend on anecdotal evidence, conjecture, and the experience/judgment of involved physicians.
– Treatments and types of care vary widely from one area of the country to another.
– Treatment decisions often depend on anecdotal evidence, conjecture, and the experience/judgment of involved physicians.
– Treatments and types of care vary widely from one area of the country to another.
• To affect healthcare spending meaningfully, comparative effectiveness must alter doctor and patient behavior, potentially through reimbursement scheme changes, the CBO notes.
• Note that by law, Medicare is effectively precluded from considering costs when making coverage decisions.
KPCB www.kpcb.com Source: "Research on the Comparative Effectiveness of Medical Treatments", A CBO Paper, December 2007.
USA Inc. | What Might a Turnaround Expert Consider? 318
USA Inc. | What Might a Turnaround Expert Consider? 318
HOUSE_OVERSIGHT_021000
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