The role of the NIH in nurturing clinician-scientists.

(MedPAC) involves comparing costs with payment rates — an approach that does not identify services whose utilization is increasing because prices are set too high. Japan has taken a different approach in responding to high rates of utilization, by monitoring specific services whose use grows substantially, rather than lumping all physician procedures together. In the United States, line-item revisions could replace the SGR and guide revisions of the resource-based relative-value scale, DRGs, and Ambulatory Payment Classification rates. One reason for the success of this policy in Japan is the country’s system of setting rates for all payers. Unless other U.S. payers implemented the same approach as Medicare, Medicare beneficiaries could have problems with access to the services whose reimbursement rates were reduced. Although Japan’s evaluation of volume in determining prices is instructive, the United States may want to develop its own approach to determining whether a volume increase is appropriate or inappropriate for a particular procedure. Creating a high-performing health system entails challenges that are being addressed by other countries. Incorporation of international evidence-based policy initiatives might enhance U.S. costcontainment efforts. Germany’s bundled payments and Japan’s payment adjustments are two of the many options that are translatable and relevant to the U.S context.