title: The impact of global budgets on pharmaceutical spending and utilization: early experience from the alternative quality contract.
abstract: In 2009, Blue Cross Blue Shield of Massachusetts implemented a global budget-based payment system, the Alternative Quality Contract (AQC), in which provider groups assumed accountability for spending. We investigate the impact of global budgets on the utilization of prescription drugs and related expenditures. Our analyses indicate no statistically significant evidence that the AQC reduced the use of drugs. Although the impact may change over time, early evidence suggests that it is premature to conclude that global budget systems may reduce access to medications.
authors.affiliation: Harvard Medical School, Boston, MA, USA afendulis@hcp.med.harvard.edu.
authors.forename: Christopher C
authors.initials: CC
authors.lastname: Afendulis
authors.affiliation: University of Michigan Health System, Ann Arbor, USA.
authors.forename: A Mark
authors.initials: AM
authors.lastname: Fendrick
authors.affiliation: Harvard Medical School, Boston, MA, USA.
authors.forename: Zirui
authors.initials: Z
authors.lastname: Song
authors.affiliation: Harvard Medical School, Boston, MA, USA.
authors.forename: Bruce E
authors.initials: BE
authors.lastname: Landon
authors.affiliation: Blue Cross Blue Shield of Massachusetts, Boston, USA.
authors.forename: Dana Gelb
authors.initials: DG
authors.lastname: Safran
authors.affiliation: Brandeis University, Boston, MA, USA.
authors.forename: Robert E
authors.initials: RE
authors.lastname: Mechanic
authors.affiliation: Harvard Medical School, Boston, MA, USA.
authors.forename: Michael E
authors.initials: ME
authors.lastname: Chernew
mesh_terms: D054598:Blue Cross Blue Shield Insurance Plans / Q000191:economics*; D002017:Budgets; D003363:Cost Control; D005260:Female; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008404:Massachusetts; D018803:Models, Economic; D004364:Pharmaceutical Preparations / Q000191:economics*; D019984:Quality Indicators, Health Care / Q000191:economics; D011787:Quality of Health Care / Q000191:economics / Q000706:statistics & numerical data; D012052:Reimbursement, Incentive
chemical_list: D004364:Pharmaceutical Preparations
keywords: bundled payment; global budgeting; health insurance; pharmaceutical spending