Conrad, Whitehouse Call for GAO Health Reform Study
Survey to Focus on Best Practices that Improve Quality and Lower Costs
Washington, D.C. - With health care reform among Americans' highest priorities for the next Congress, Senate Budget Committee Chairman Kent Conrad (D-ND) and U.S. Senator Sheldon Whitehouse (D-RI) have asked the Government Accountability Office (GAO) to study best practices used by states, hospitals, and other countries to reduce health care costs and improve quality.
This year, Americans will spend $2.4 trillion on health care, and are expected to spend $4.3 trillion by 2017. In the next decade, health care spending is projected to consume 20 percent of gross domestic product. Medicare's liability alone is estimated at $36 trillion.
"If we as a society fail to control health care costs, there will be a detrimental effect on our nation's economy and standard of living," the Senators wrote. "To improve value in health care spending, we must balance our need to control costs with the need to maintain quality of care."
In many states, efforts are underway to generate savings through simple improvements in the quality of health care delivery. Michigan's Keystone Project, which sought to reduce hospital-acquired infections and other complications in intensive care units (ICUs), saved 1,578 lives and over $165 million in a 15-month span between March 2004 and June 2005. In a similar project spearheaded by the Rhode Island Quality Institute, an organization Whitehouse founded, infections in patients with catheters decreased 36 percent from the first quarter of 2006 to the fourth quarter, and 11 out of 23 participating ICUs had zero infections for 12 months.
The Senators' letter asks GAO to identify best practices in health care delivery and to determine the extent to which they could be applied nationwide.
The full text of the letter follows:
November 20, 2008
The Honorable Gene Dodaro
Acting Comptroller General of the United States
United States Government Accountability Office
441 G Street, N.W.
Washington, D.C. 20548-0002
Dear Mr. Dodaro:
We write to request that GAO conduct a study on health care reform.
Rising health care spending represent the central long-term fiscal challenge facing the United States. Health care spending by both public and private payers has been growing faster than the economy-about 2.5 percent more per year since the 1960s. There is no reason to expect these high growth rates to abate, as health care spending is projected to encompass 20 percent of GDP in just 10 years.
Concerns about health care spending might be less prominent if it was clear that this spending was producing commensurate gains in health outcomes. However, substantial evidence suggests that much of this spending is not cost effective and in many cases does not improve outcomes. If we as a society fail to control health care costs, there will be a detrimental effect on our nation's economy and standard of living. To improve value in health care spending, we must balance our need to control costs with the need to maintain quality of care.
To achieve better value for the dollars spent, we need solutions that work in both the private and public sectors. We need a greater focus on improving health outcomes and on increasing prevention and wellness. We need to reduce unnecessary utilization of health care and increase efficiencies in the system, both without reducing quality. We need to revise incentives that reward quantity instead of quality and efficiency. We need to study the development and diffusion of health care technology and discourage defensive medicine. We need to find ways to provide better information to both consumers and providers of care and thoroughly explore all potential areas of reducing health care expenditures.
Health care reform will not be easy, but it is a priority. As we examine the significant fiscal challenges facing this country, health care reform will continue to be a key component. There are many examples of successes in addressing some of the problems listed above. In preparation for congressional action on health reform, it would be helpful to understand how these "best practices," whether from the states, integrated delivery systems, or other countries, can be applied to the system as a whole.
Accordingly, we request that GAO conduct a study that includes:
1) an identification of best practices utilized by states, integrated delivery systems, or other countries to reduce costs and improve quality; and
2) an examination of the extent to which these best practices can be applied on a systemwide basis in the U.S.
We thank you for your attention to this matter.
KENT CONRAD, Chairman, Senate Budget Committee
SHELDON WHITEHOUSE, U.S. Senator
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