PUP 4931r Lecture Notes - Lecture 57: Budget Constraint, Marginal Utility, Marginal Cost
16 May 2018
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Department
Course
Professor
Problems with Home Care
Not cost-minimizing
Utilization & cost results poor
Not effective
Few outcome benefits, very high cost per benefit
Goals Unclear:
Goal nominally is avoiding nursing home entry
But most patients face little risk of nursing home entry.
Do face other risks
So patient specific goals left vague
Case manager must work them out
Do own prioritizing
Constraints
Budget caps not binding for most patients
Cap binds only on highest cost patients
Or limits new patients
No cost-effectiveness limit set on low risk patients with little potential to
benefit
Spending may exceed potential to benefit
Even if home care is 100% effective
No accountability or rewards
Few rewards for successful or unsuccessful outcomes
Payets do’t rise for avoiding ER or hospital or nursing home or
ADL decline
Nor do they fall if outcomes consistently under achieved
Reform Agenda: Improve Agency
Clarify goals
Focus on patient specific outcome goals
Improve information
Acknowledge false positives in selection
Create incentives for efficiency, effectiveness
Impose budget constraint binding on every patient
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