{"version":1,"type":"rich","provider_name":"Libsyn","provider_url":"https:\/\/www.libsyn.com","height":300,"width":600,"title":"A Costly Paradox: More Spending, No Better Health. - Dr. Elliott Fisher","description":"Is more healthcare always better healthcare? Dr. Elliott Fisher has spent decades uncovering why high-spending regions fail to deliver better care or longer lives \u2014 and what this means for patients and policymakers. In this episode of Healthcare Reframed, Fisher shares the inside story of how one 1973 paper shook the medical world, why towns with the same people and same hospitals have 10\u00d7 differences in surgery rates, and what it really takes to align incentives so care becomes safer, kinder, and more affordable. \ud83e\uddd0 You\u2019ll learn Why spending more often leads to worse outcomes How the idea of Accountable Care Organizations (ACOs) was born (literally by \u201cstopping the presses\u201d) Why the U.S. wastes 20\u201330% of healthcare dollars on unnecessary care The \u201cballoon problem\u201d of squeezing costs in one area only to see them pop up elsewhere The most important leadership question: \u201cWhat do you stand for?\u201d Whether you\u2019re a policymaker, healthcare worker, or a patient trying to understand why medical bills keep rising, this conversation will change how you see the system. \ud83d\udcd6 Chapters 00:00 \u2013 Introduction to Healthcare Spending and Outcomes 01:03 \u2013 Elliott Fisher\u2019s Background and Early Insights 05:28 \u2013 Personal Motivations and Family Influence 08:33 \u2013 Early Research on Variations in Medical Practice 12:21 \u2013 Challenges and Skepticism in the Medical Community 13:22 \u2013 Shared Decision-Making and Patient Preferences 16:47 \u2013 Physician\u2013Patient Interaction in the Early 1980s 19:01 \u2013 Treatment Decisions and Patient Advocacy 21:28 \u2013 Choosing Wisely and Understanding Risks 23:05 \u2013 The Value of Time in Diagnosis 24:05 \u2013 Global Spread and Impact of Variation Research 25:16 \u2013 From Research to the Dartmouth Atlas 27:50 \u2013 Why the Research Was Unique & National Impact 29:38 \u2013 Four Decades of Progress in Healthcare 31:47 \u2013 Spending, Outcomes, & Hospital Utilization 37:04 \u2013 Policymaker Reactions and Political Context 38:41 \u2013 Development of Accountable Care Organizations (ACOs) 44:56 \u2013 Effectiveness and Challenges of ACOs 48:47 \u2013 Insurance Trends & High-Deductible Plans 52:12 \u2013 Reflections & the Need for All-Payer Models 54:31 \u2013 Quality Improvements & Remaining Gaps 56:08 \u2013 Case Study: Intermountain Healthcare\u2019s Success 58:19 \u2013 Pathways to Reform & Leadership 60:38 \u2013 Barriers to Change in Health Systems 62:40 \u2013 Hospital vs. Physician Roles in Care Delivery 63:37 \u2013 Medical Pricing & Systemic Reform 69:10 \u2013 Regulatory Models & Public Utility Commissions 69:44 \u2013 Financialization of Healthcare & Consequences 72:57 \u2013 Oversight & Competition in Healthcare Markets 74:12 \u2013 Controversies Around Competition & Choice 77:13 \u2013 Purpose & Leverage Points for Improvement 81:20 \u2013 Empathy, Compassion & the Future 82:14 \u2013 Measuring Success in Healthcare Reform ","author_name":"Healthcare Reframed","author_url":"https:\/\/www.healthcarereframed.org","html":"