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Practice Guidelines: Can They Save Money? Should They?

Published online by Cambridge University Press:  01 January 2021

Mark V. Pauly
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Extract

To achieve lower medical spending with as little reduction as possible in good outcomes, practitioners and policy makers alike have been experimenting with the use of practice guidelines. These guidelines both recommend certain types of therapies and proscribe others in the treatment of patients with particular conditions. This paper explores the question of whether guidelines which do reduce total resource costs of medical care to a population will (1) be feasible and (2) produce “acceptable” results. The definition of acceptable is part of the policy problem, so it will be left open for a while, but the question of which outcomes match with which levels of resource cost will form the positive basis for the normative judgment of “acceptability.”

Type
Article
Information
Journal of Law, Medicine & Ethics , Volume 23 , Issue 1 , Spring 1995 , pp. 65 - 74
Copyright
Copyright © American Society of Law, Medicine and Ethics 1995

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References

Shapiro, D.W. et al., “Containing Costs While Improving Quality of Care: The Role of Profiling and Practice Guidelines,” Annual Review of Public Health, 14 (1993): 219–41.CrossRefGoogle Scholar
Tannenbaum, S.J., “What Physicians Know,” N. Engl. J. Med., 329 (1993): 1268–70.CrossRefGoogle Scholar
Id.Google Scholar
Phelps, C.E., “The Methodologic Foundations of Studies of the Appropriateness of Medical Care,” N. Engl. J. Med., 329 (1993): 1244.CrossRefGoogle Scholar
Warner, K.E. Luce, B.R., Cost-Benefit and Cost-Effectiveness Analysis in Health Care: Principles, Practice, and Potential (Ann Arbor: University of Michigan Press, 1982).Google Scholar
LaBelle, R.J. Hurley, J.E., “Implications of Basing Health-Care Resource Allocations on Cost-Utility Analysis in the Presence of Externalities,” Journal of Health Economics, 11 (1992): 259–77.CrossRefGoogle Scholar
Chassin, M.R. et al., The Appropriateness of Use of Selected Medical and Surgical Procedures and Its Relationship to Geographic Variation in Use (Ann Arbor: Health Administration Press, 1989).Google Scholar
Schwartz, W.B. Mendelson, D.N., “The Effects of Aging and Population Growth on Health Care Costs,” Health Affairs, 12 (1993): 119–25.Google Scholar
Wennberg, J.E. Gittelsohn, A.M., “Variations in Medical Care Among Small Areas,” Scientific American, 246 (1982): 120–34.Google Scholar
Becker, G.S., “Crime and Punishment: An Economics Approach,” Journal of Political Economy, 78 (1968): 169–217.CrossRefGoogle Scholar
Eddy, P., Summary: “Designing a Fair and Reasonable Basic Benefit Plan Using Clinical Guidelines,” in California Public Employees' Retirement System, Health Benefits Advisory Council (Sacramento: CalPERS, 1992).Google Scholar
Greco, P.J. Eisenberg, J.M., Editorial: “Changing Physicians' Practices,” N. Engl. J. Med., 329 (1993): 1271.CrossRefGoogle Scholar
Davis, D.A. et al., “Evidence for the Effectiveness of CME: A Review of 50 Randomized Controlled Trials,” JAMA, 268 (1992): 1111–17.CrossRefGoogle Scholar
Eisenberg, J.M. Foster, N.E., “Using Clinical Guidelines: Impact on Public Policy, Clinical Policy, and Individual Care Decisions,” Journal of Quality Improvement, 19 (1993): 384–88.Google Scholar
Ray, S.G. et al., “Impact of the Recommendations of the British Pacing and Electrophysiology Group on Pacemaker Prescription and on the Immediate Costs of Pacing, in the Northern Region,” British Heart Journal, 68 (1992): 531–34.Google Scholar
Webb, L.Z. et al., “The Impact of Status Asthmaticus Practice Guidelines on Patient Outcome and Physician Behavior,” Quality Review Bulletin, Dec. (1992): 471–76.CrossRefGoogle Scholar
Rosenberg, J. Greenberg, M.K., “Practice Parameters: Strategies for Survival in the Nineties,” Neurology, 42 (1992): 1110–15.CrossRefGoogle Scholar
Lamas, G.A. et al., “Do the Results of Randomized Clinical Trials of Cardiovascular Drugs Influence Medical Practice?,” N. Engl. J. Med., 327 (1992): 241–74.CrossRefGoogle Scholar
Lomas, J. et al., “Opinion Leaders vs. Audit and Feedback to Implement Practice Guidelines: Delivery After Previous Cesarean Section,” JAMA, 265 (1991): 2202–07.CrossRefGoogle Scholar
Naylor, C.D. Hollenberg, A.A., “Practice Guidelines and Professional Authority in a Universal Health Insurance System,” Social Science in Medicine, 31 (1990): 1327–36.CrossRefGoogle Scholar
Kosecoff, J. et al., “Effects of the National Institutes of Health Consensus Development Program on Physicians Practice,” JAMA, 261 (1989): 2101–06.Google Scholar
Weingarten, S.R. et al., “Practice Guidelines and Reminders to Reduce Duration of Hospital Stay for Patients with Chest Pain,” Annals of Internal Medicine, 120 (1994): 257–63; Mulley, A.G., “The Role of Decision Analysis in the Transition of Research Findings into Clinical Practice,” in Gelijns, A.C., ed., Medical Innovation at the Crossroads, Volume 1: Modern Methods of Clinical Investigation (Washington, D.C.: National Academy Press, 1990), pp. 78-87; and Eagle, K.A. et al., “Lengths of Stay in the Intensive Care Unit: Effect of Practice Guidelines and Feedback,” JAMA, 264 (1990): 992-97.CrossRefGoogle Scholar
See Lomas, et al., supra note 19.Google Scholar
See Shapiro, et al., supra note 1.Google Scholar
Wennberg, J.E. et al., “Changes in Tonsillectomy Rates Associated with Feedback and Review,” Pediatrics 59 (1977): 821–26.Google Scholar
Mugford, M. Banfield, P. O'Hanlon, M., “Effects of Feedback of Information on Clinical Practice: A Review,” British Medical Journal, 3003 (1991): 398–402.CrossRefGoogle Scholar
Grimshaw, J.M. Russell, I.T., “Effect of Clinical Guidelines on Medical Practice: A Systematic Review of Rigorous Evaluations,” Lancet, 342 (1993): 1317–22.CrossRefGoogle Scholar
Kassirer, J.P. et al. “Decision Analysis: A Progress Report,” N. Engl. J. Med., 106 (1993): 275–91.Google Scholar
Audet, M. Greenfield, S. Field, M., “Medical Practice Guidelines: Current Activities and Future Directions,” Annals of Internal Medicine, 113 (1990): 709–14.CrossRefGoogle Scholar
See Wennberg, Gittelsohn, , supra note 9.Google Scholar
Pauly, M.V., “What is Unnecessary Surgery?,” Milbank Quarterly, 57 (1979): 95–117.CrossRefGoogle Scholar
Brook, R.H., The BAND/UCLA Appropriateness Method (Rockville: AHCPR, 1994).Google Scholar
U.S. Congress, Congressional Budget Office, “Managed Competition and Its Potential to Reduce Spending,” A CBO Study (Washington, D.C.: U.S. Government Printing Office, May 1993).Google Scholar
See Mulley, , supra note 22.Google Scholar
See Wennberg, Gittelsohn, , supra note 9.Google Scholar
Lichter, P.R., “Demystifying the Peer Review Process,” Ophthalmology, 100 (1993): 1749–59.CrossRefGoogle Scholar
Sui, A.L. et al., “Inappropriate Use of Hospitals in a Randomized Trial of Health Insurance Plans,” N. Engl. J. Med., 315 (1986): 1259–66.Google Scholar
See Schwartz, Mendelson, , supra note 8.Google Scholar
See Brook, , supra note 32.Google Scholar
See Shapiro, et al., supra note 1.Google Scholar
Shapiro, et al. (id.) appear to assert that “alternatives that are more effective, yet also are more expensive,” can be subject to “guidelines which can help control volume without sacrificing quality,” but they do not offer an explanation of how this can be done.Google Scholar
Carpenter, C. Nash, D.B. Johnson, N., “Evaluating the Cost Containment Potential of Clinical Guidelines,” Quarterly Review Bulletin, 19 (1993): 119–23.CrossRefGoogle Scholar
Id., p. 122.Google Scholar
See Phelps, , supra note 4.Google Scholar