By NextBestFitBudgets adjust automatically for population, age, and volume
Each year's budget is recalculated for population growth, aging, and unexpected volume, so demand growth doesn't produce queues.
Budgets follow population and age.
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Budgets adjust automatically for population, age, and volume
Concrete changes if chosen
What would actually have to change in law, agencies, payment rules, or systems.
- Adjust budgets for population, age, and volume
Effects
Each effect has its own page: the evidence, the case that it is or isn't a real cost, and whom it affects.
What it fixes
- Fixed budgets can ration care
Recalculating hospital budgets for population growth, aging, and unexpected volume reduces slowdowns and treats growing areas fairly.
- Longer waits if demand grows faster than capacity
Adjusting budgets for changing demand helps prevent demand growth from producing queues.
What it creates or worsens
- Raises spending or loosens control over it
Increasing budgets in response to demand weakens cost control.
- Depends on uncertain evidence or judgments
Recalculating budgets using demand formulas can lead to disputes over those formulas.
Who's affected
Who gains
- People with ongoing or specialist care needs
- Fixed budgets can ration care: Hospitals may slow elective procedures when demand exceeds fixed budgets.
- Longer waits if demand grows faster than capacity: They need specialists and procedures most often.
- People with employer coverage
- Longer waits if demand grows faster than capacity: They are seen fastest today and would share one queue with everyone.
Who loses
- Taxpayers and public budgets
- Fixed budgets can ration care: Global budgets cap spending.
- Raises spending or loosens control over it: Public budgets pay the added spending.
Where it has been tried
- Maryland: Global budgets adjust for demographics and market shifts.Sources: CMS Innovation Center / RTI (2023)