Bending the health cost curve: the promise and peril of the Independent Payment Advisory Board.

Ann Marie Marciarille, J Bradford DeLong
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Abstract

Underlying today's and the future's health-care reform debate is a consensus that America's health-care financing system is in a slow-moving but deep crisis: care appears substandard in comparison with other advanced industrial countries, and relative costs are exploding beyond all reasonable measures. The Obama Administration's Patient Protection and Affordable Care Act (ACA) attempts to grapple with both of these problems. One of ACA's key instrumentalities is the Independent Payment Advisory Board-the IPAB, designed to discover and authorize ways to reduce the rate of growth of Medicare and other categories of health spending. The IPAB is a peril. Expert boards to perform regulatory tasks in the interest of efficiency and social goals always run a high risk of being captured by the industry they are supposed to regulate. Even should it succeed at its task of reducing the rate of growth of Medicare spending, who is to say that the reductions will not come at a heavy cost in reduced quantity and effectiveness of medical care? But the IPAB also has promise. The need for a better process than our current specialist-driven one to assign value to the medical services provided by Medicare is great. The bellwether status of Medicare payment systems means that commercial insurance consumers and payors would also benefit mightily from bringing more coherent, technocratic, and cost-effectiveness oriented logic to this process. And the current system of relative Medicare reimbursement rates is, in the judgment of many, currently well out of whack. We quail when we consider the magnitude of the tasks the IPAB faces--even its initial task. Nevertheless, we remain optimistic that this administrative agency will manage to bend the long-run healthcare cost curve and moderate future price increases.

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弯曲医疗成本曲线:独立支付咨询委员会的希望与危险。
当前和未来医疗改革辩论的基础是一种共识,即美国的医疗融资体系正处于一场缓慢但深刻的危机之中:与其他发达工业国家相比,医疗服务似乎不达标,相对成本正在爆炸式增长,超出了所有合理的衡量标准。奥巴马政府的《患者保护和平价医疗法案》(ACA)试图解决这两个问题。ACA的主要工具之一是独立支付咨询委员会(IPAB),旨在发现和授权降低医疗保险和其他医疗支出增长速度的方法。IPAB是一种危险。为了效率和社会目标而执行监管任务的专家委员会总是冒着被他们应该监管的行业俘获的高风险。即使它成功地降低了医疗保险支出的增长率,谁敢说这种削减不会以医疗服务的数量和效率下降为代价呢?但IPAB也有希望。我们迫切需要一个比目前由专家驱动的流程更好的流程来为医疗保险提供的医疗服务赋值。医疗保险支付系统的领头羊地位意味着商业保险消费者和付款人也将从在这一过程中引入更连贯、技术官僚和以成本效益为导向的逻辑中受益匪浅。而且,在很多人看来,现行的相对医疗保险报销率体系目前已经严重失调。当我们考虑到IPAB面临的任务的规模——甚至是它的初始任务——时,我们会感到害怕。尽管如此,我们仍然乐观地认为,这个行政机构将设法扭转长期的医疗保健成本曲线,并缓和未来的价格上涨。
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