Click here to access the conference issue brief, papers and presentations.

The Twelfth Princeton Conference: How Will the States Pay For Health Care?

The Twelfth Annual Princeton Conference focused on how the states will pay for health care. The financial challenges were outlined by Uwe Reinhardt and participants discussed how future partnerships could evolve between the federal government and the states. Highlights including detailed discussions of how states are addressing persistent problems in health care access, quality and cost. Key Congressional staff and the Executive Director of the National Governors Association gave the perspective of Congress and the Governors on potential Medicaid cuts. This is a time of great uncertainty and challenge for the states. Stuart Altman observed that "Americans do not solve problems, they solve crises." As we move from problem to crisis, the states as laboratories may hold the key to progress.

Click here to access the conference materials and presentations. Click here to access the conference issue brief. A webcast of the meeting, including transcripts and speaker presentations can be viewed through Kaisernetwork.org, by clicking here.

Specialty Hospitals, Ambulatory Surgery Centers, and General Hospitals: Charting a Wise Public Policy

The number of specialty hospitals tripled between 1990 and March 2003, and the number of ambulatory surgery centers (ASCs) doubled between 1991 and 2001. These specialty providers focus their efforts on specific medical procedures and are thus often referred to as "focused factories." Because of their specialization, they claim that they can perform higher quality medical procedures at lower cost than general hospitals. Some focused factories have demonstrated impressive clinical results.

However, general hospitals are claiming foul! They contend that specialty facilities cater only to the most profitable patients, draining revenue away from community hospitals that need those patients to cross subsidize care for the poor and uninsured as well as other unprofitable services that specialty hospitals don't have to provide.

Complicating the issue is the fact that most of these specialty centers are at least partially owned by physicians who can financially benefit from referring or not referring patients to their own facilities.

Mired in controversy, the federal government has instituted an 18-month moratorium on payments for physician services in cases where physicians have an ownership interest in new specialty hospitals - a policy that effectively halts the development of any new specialty facilities.

The Council on Health Care Economics and Policy met on September 10, 2004 in the rotunda of the Ronald Reagan International Trade Center, Washington, DC to discuss the moratorium and the future course of public policy.

The agenda included, among others, Regina Herzlinger, perhaps the nation's leading proponent of focused factories and market-driven health care; Congressman Fortney "Pete" Stark the author of the Stark physician self-referral laws; Charles "Chip Kahn" the president of the Federation of American Hospitals; John Rex-Waller the President of National Surgical Hospitals; Thomas Mallon, the president of Regent Surgical Health; and Mark Miller, the executive director of The Medical Payment Advisory Commission (MedPAC) which has been charged by congress to study and report on these issues prior to the end of the moratorium.

The web site presently includes copies of the papers and most of the presentations that were prepared for the conference. A complete transcript of the conference proceedings will be posted prior to October 1, 2004.

Click here to access the conference materials and presentations. A complete transcript of the conference proceedings can be accessed by Clicking here.

The Eleventh Princeton Conference: Managing Cost and Quality Through the Health Care Delivery System

The Council held its 11th Princeton Conference on May 20-21, 2004 at the headquarters of The Robert Wood Johson Foundation and on the campus of Princeton University. The conference was entitled, "Managing Cost and Qualilty Through the Health Care Delivery System."

Health care spending in the U.S. continues to increase at over twice the rate of general inflation, while, at the same time, deficiencies in quality of care become more apparent. Latest research shows that adults receive approximately half of recommended care for their medical conditions. In response, employers, insurers, and providers have been trying to implement changes in the delivery system to ameliorate cost increases and to improve quality. Many have focused on chronically ill populations, implementing disease and care management programs and structuring the reimbursement system to pay for performance. Some have tried to make consumers more cost and quality conscious through a variety of consumer driven health plans.

The Council brought together experts from industry, government, and academia to examine these strategies. Industry experts included, among others, Leonard Schaeffer, James Mongan, Christobel Selecky, and Robert Stone. Government representatives included Tom Scully, Stuart Guterman, and Melanie Brown-Woofter. From Academia, Alain Enthoven, Sandra Foote, David Blumenthal, Meredith Rosenthal, and a number of other prominent researchers participated in the conference. Speakers assessed the promise of these delivery system changes and the future impact they might have on the cost and quality of health care.

Click here to access the conference materials and presentations. A webcast of the meeting, including transcripts and speaker presentations can be viewed through Kaisernetwork.org, by clicking here.

Health Insurance Expansions 2004: Examining the Options

The Council convened a conference in Washington, DC on November 3, 2003 to discuss the new health insurance proposals and their possible impact on the health care system. The number of uninsured Americans swelled to 43.6 million last year, an increase of 2.4 million or 5.8%. That number exceeds the total population of 24 states plus the District of Columbia. Reminiscent of 1991, the salience of this issue has burst upon the political agenda and has focused attention on the health insurance proposals of the presidential candidates.

Click here to access the conference materials and presentations including a issue brief. A webcast of the meeting, including transcripts and speaker presentations can be viewed through Kaisernetwork.org, by clicking here.

The Tenth Princeton Conference: Regional Disparities in Health Spending: Implications for the Private Market and Medicare

On May 15-16, 2003, the Council held the 10th annual Princeton Conference entitled Regional Disparities in Health Spending: Implications for the Private Market and Medicare. The conference was held at the headquarters of the Robert Wood Johnson Foundation and on the campus of Princeton University.

Researchers have long known that there are large variations in health care spending and utilization within and across many regions of the country. Although some regions consistently spend more, the increased spending is not associated with better health outcomes. Policy makers have estimated that Medicare costs could be reduced by 30%, without negatively impacting quality, if spending in high cost regions was reduced to the level existing in low cost regions. Yet, little has been done with this knowledge, because there is no consensus about the causes of variation or about effective policies to reduce it.

The Council assembled leading national experts in this area to discuss the problem. Headlining the conference was the father of "small area variations," Jack Wennberg, and members of his group from Dartmouth College. Although researchers focused on the need to reduce practice variation, many politicians and public policy makers were focused on a different aspect of the problem; the fact that low spending, mostly rural areas, receive less from Medicare than high spending areas. Speakers addressed the possible causes of variation, and efforts by both the private and public sectors to reduce variation in order to increase the quality of health care and to potentially lower cost.

Click here to access the conference materials and presentations. A webcast of the meeting, including transcripts and speaker presentations can be viewed through Kaisernetwork.org, by clicking here.

Medical Malpractice in Crisis: Health Care Policy Options

On March 3, 2003, the Council looked at the critical issue of medical malpractice through the lens of health policy and our health care system. Medical malpractice has emerged as a top issue on the health policy agenda. From striking surgeons in West Virginia to a severe shortage of obstetricians in several areas, rising malpractice premiums have become a key concern. President Bush recently renewed his call for caps on awards, and Congress and many states are considering the issue. The opening speaker, Dr. William Sage of Columbia Law School, is the leading expert on this topic. He placed the issue in the context of an evolving health system that is markedly different than what we confronted in past malpractice crises. Other sessions featured Ken Thorpe from Emory University and Robert Hunter, Insurance Director of the Consumer Federation of America, who presented their conclusions on the forces that underlie the current growth in premiums.
The conference also examined the goals of the malpractice system and proposals for reform. Michelle Mello of the Harvard School of Public Health examined the relationship between malpractice liability and error prevention, and John Horty, a leading health care lawyer from Horty, Springer & Mattern, address the unique concerns facing hospitals. The program ended with a presentation by Philip Howard, chair of Common Good, a leading proponent of reforming our medical justice system.

Click here to access the conference materials and presentations and a background paper prepared by Council research associate, Brian P. Rosman. A webcast of the meeting, including transcripts and speaker presentations can be viewed through Kaisernetwork.org, by clicking here.

Council Examines Restructuring Medicaid

On September 20, 2002, the Council held its Fall conference on the topic "Reimagining Medicaid: The Evolving Federal Role in Medicaid." The Medicaid program is the nation's largest public health insurance program, surpassing Medicare in both the total number of people served and total dollars spent. Declining state and federal revenues, rising health care costs, and increased utilization has led to what many have termed a fiscal crisis. Legislation is pending to increase the flow of federal dollars to the states. In addition, a recent GAO report has called into question whether the new federal waiver policy violates Congressional intent.

The conference began with presentations that detailed the fiscal and programmatic challenges facing the states and federal government, and examined the role of waivers in Medicaid. Next, Centers for Medicare and Medicaid Services (CMS) Administrator Tom Scully presented his views on Medicaid. This was followed by a panel of innovative state officials who discussed challenges and solutions from the states' point of view. The final panel of experts in both state and federal health policy presented their thoughts on major systemic changes that reconceptualize the current institutional arrangements between the federal government and the states.

Click here to access the conference materials and presentations, including the Policy Brief/Meeting Summary and a background paper prepared by Council research associate, Michael Doonan, Ph.D. A webcast of the meeting, including transcripts and speaker presentations can be viewed through Kaisernetwork.org, by clicking here.

New Publication:

The Council is pleased to announce the publication of
“Policies for an Aging Society: Confronting the Economic and Political Challenges”
One in eight Americans today is over the age of 65, and the proportion will increase dramatically in the future. The aging of the population has begun to drive tax and budget decisions and the federal policy agenda, as policy makers and voters look ahead to enormous demands on the health and income security programs.
In the book, based on papers presented at the Council's 1999 Landsowne Conference, Council Chair Stuart H. Altman and Council Project Director David Shactman have gathered experts in public and health policy, economics, law, and management to identify the salient issues and explore realistic options. From positions ranging from liberal to conservative, the contributors take a wide view of the philosophical, economic, and programmatic aspects of the social protection programs for elderly Americans. They ask broad questions and propose integrated conceptions of how our society can best provide for the needs of its aging population.

Learn more, or order the book directly from the publisher, Johns Hopkins University Press
Order the book from Amazon.com

Council Contact Info

Questions or comments about this web site? Contact Pat Aloise, at aloise@brandeis.edu