The study, published in the journal Health Affairs, examined how other high-income countries that use a fee-for-service model regulate health care costs.

Although the United States has the highest health care prices in the world, the specific mechanisms commonly used by other countries to set and update prices are often overlooked. In most countries with universal health insurance, physicians are paid on a fee-for-service basis, yet health care prices there are lower than in the U.S. To lower health care spending, American policymakers have focused on eliminating fee-for-service reimbursement, which provides an incentive for performing additional services rather than setting up price negotiations to address the main factor that drives health care spending.

U.S. policy makers emphasize the need to reduce the volume of care that the system provides, but prior research shows that U.S. health care expenditures are higher than in other countries because of the price, not the volume, of services.

The researchers compared policies in France, Germany and Japan where payers and physicians engage in structured fee negotiations and standardized prices in systems where fee-for-service is the main model of outpatient physician reimbursement. They interviewed 37 stakeholders and health policy experts in those three countries to understand the process for creating physician fee schedules and updates, to learn about recent policy changes in physician payment and to identify the remaining challenges in the use of fee-for-service payment to physicians.

“The parties involved, the frequency of fee schedule updates and the scope of the negotiations vary, but all three countries attempt to balance the interests of payers with those of physician associations,” said lead author Michael K. Gusmano, lead study author and a professor at the Rutgers School of Public Health and research scholar at The Hastings Center.

Expanding public insurance and creating universal health care coverage for U.S. residents have been popular — even more so during the COVID-19 pandemic. However, addressing the price of health care is crucial for making universal coverage affordable.

The use of fee-for-service physician payment does create issues, but marking fee-for-service as the major cause of high health care spending in the United States is problematic, especially as countries with lower prices and expenditures use fee-for-service systems, while also providing universal health care to its residents. France, Germany and Japan limit the incomes of physicians by standardizing and adjusting the fees they are paid while using a variety of approaches to limit the volume of services provided.

According to Gusmano — who is also a member of the Rutgers Institute for Health, Health Care Policy and Aging Research and Rutgers Global Health Institute — regardless of whether the United States will pursue fundamental policy changes such as Medicare for All or incremental expansion of the Affordable Care Act, both would require that policy makers address health care prices.

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Materials provided by Rutgers University. Original written by Michelle Edelstein. Note: Content may be edited for style and length.

“Ice deforms as it melts,” said physical oceanographer Claudia Cenedese, who has worked with Hester on the project. “It makes these very weird shapes, especially on the bottom, like the way the wind shapes a mountain on a longer time scale.”

At the 73rd Annual Meeting of the American Physical Society’s Division of Fluid Dynamics, Hester presented results from his group’s experiments aimed at understanding how melting alters the face-changing boundary of a shrinking iceberg — and how those alterations in turn affect the melting.

The dynamics of iceberg melt is missing from most climate models, Cendese said. Including them could help with prediction: icebergs pump fresh water from ice sheets into oceans, boosting communities of living organisms. Icebergs are the dominant source of freshwater in the fjords of Greenland — and a significant contributor to freshwater loss in Antarctica. Icebergs play a critical role in the climate, Cenedese said, and shouldn’t be neglected in models. The physics of melting ice is well understood, and some models simulate it accurately, she said. Others don’t. “But what you can’t do in those simulations is change the shape of the ice.”

Icebergs form with a wide range of shapes and sizes, Hester said, and distinct thermodynamic processes affect different surfaces. The base, submerged in water, doesn’t melt in the same way as the side. “And each face doesn’t melt uniformly,” added Cenedese.

Hester conducted his experiments by submerging a dyed block of ice in a flume with a controlled flow of water passing by, and watching it melt. He and his colleagues found that the side facing a current melts faster than sides that run parallel to flow. By combining experimental and numerical approaches, Hester and his collaborators charted the relative influences of factors like relative water velocity and aspect ratio, or the proportion of height to width on a side. Not surprisingly, they found that the bottom had the slowest melt rate.

Cenedese said Hester’s project brings together collaborators from a range of disciplines and countries, and that a diverse collaboration was needed for such an interdisciplinary project. “Working in isolation isn’t as productive in this case.”

Other studies discussed at the conference focused on ice formation, rather than melting. During a session on particle-laden flows, engineer Jiarong Hong from the St. Anthony Falls Laboratory at the University of Minnesota, in Minneapolis, discussed results from experiments showing how turbulence influences both the speed and distribution of snow as it falls and settles. The findings could also help scientists better understand precipitation, Hong said.

Another project, presented by physicist Chao Sun from Tsinghua University in China and his group during a session on convection and buoyancy-driven flows, focused on ice formation in lakes.

Working on a grant from the Natural Science Foundation of China with Ziqi Wang from Tsinghua University, Enrico Calzavarini from the University of Lille in France, and Federico Toschi from Eindhoven University of Technology in the Netherlands, Sun showed how the formation of ice on a lake is closely tied to the fluid dynamics of the water beneath.

A lake may possess layers of water of differing densities and temperatures. “The water density anomalies can induce elaborate fluid dynamics beneath a moving ice front and can drastically change system behaviors,” said Sun. “This has often been ignored in previous studies.”

Sun’s group combined physical experiments, numerical simulations, and theoretical models to investigate the connection between the ice and (turbulent) convective flows. They identified four distinct regimes of different flow dynamics, each of which interacts with other layers and the ice in its own ways. Even with that complexity, though, the group developed an accurate theoretical model that could be used in future studies.

“It made a fair prediction of ice layer thickness and of icing time,” said Sun.

Since the formation and melting of ice plays such a critical role in the climate, he said, a better understanding of the fluid dynamics behind the process could help researchers identify and study accurately the markers of a warming world. “The time for ice to form and melt, for example, could potentially provide an indicator of climate change.”

About the size of a small pickup truck, Sentinel-6 Michael Freilich will extend a nearly 30-year continuous dataset on sea level collected by an ongoing collaboration of U.S. and European satellites while enhancing weather forecasts and providing detailed information on large-scale ocean currents to support ship navigation near coastlines.

“The Earth is changing, and this satellite will help deepen our understanding of how,” said Karen St. Germain, director of NASA’s Earth Science Division. “The changing Earth processes are affecting sea level globally, but the impact on local communities varies widely. International collaboration is critical to both understanding these changes and informing coastal communities around the world.”

After arriving in orbit, the spacecraft separated from the rocket’s second stage and unfolded its twin sets of solar arrays. Ground controllers successfully acquired the satellite’s signal, and initial telemetry reports showed the spacecraft in good health. Sentinel-6 Michael Freilich will now undergo a series of exhaustive checks and calibrations before it starts collecting science data in a few months’ time.

Continuing the Legacy

The spacecraft is named in honor of Michael Freilich, the former director of NASA’s Earth Science Division, who was a leading figure in advancing ocean observations from space. Freilich passed away Aug. 5, 2020. His close family and friends attended the launch of the satellite that now carries his name.

“Michael was a tireless force in Earth sciences. Climate change and sea level rise know no national borders, and he championed international collaboration to confront the challenge,” said ESA (European Space Agency) Director of Earth Observation Programmes Josef Aschbacher. “It’s fitting that a satellite in his name will continue the ‘gold standard’ of sea level measurements for the next half-decade. This European-U.S. cooperation is exemplary and will pave the way for more cooperation opportunities in Earth observation.”

“Mike helped ensure NASA was a steadfast partner with scientists and space agencies worldwide, and his love of oceanography and Earth science helped us improve understanding of our beautiful planet,” added Thomas Zurbuchen, NASA associate administrator for science at the agency’s headquarters. “This satellite so graciously named for him by our European partners will carry out the critical work Mike so believed in — adding to a legacy of crucial data about our oceans and paying it forward for the benefit of future generations.”

A joint U.S.-European satellite built to monitor global sea levels lifted off on a SpaceX Falcon 9 rocket from Space Launch Complex 4E at Vandenberg Air Force Base in California Saturday at 9:17 a.m. PST (12:17 p.m. EST).

About the size of a small pickup truck, Sentinel-6 Michael Freilich will extend a nearly 30-year continuous dataset on sea level collected by an ongoing collaboration of U.S. and European satellites while enhancing weather forecasts and providing detailed information on large-scale ocean currents to support ship navigation near coastlines.

The ocean-observing Sentinel-6 Michael Freilich satellite launched from Vandenberg Air Force Base in California aboard a SpaceX Falcon 9 rocket on Nov. 21, 2020 at 12:17 p.m. EST (9:17 a.m. PST, 5:17 p.m. UTC). Credit: NASA-JPL/Caltech

“The Earth is changing, and this satellite will help deepen our understanding of how,” said Karen St. Germain, director of NASA’s Earth Science Division. “The changing Earth processes are affecting sea level globally, but the impact on local communities varies widely. International collaboration is critical to both understanding these changes and informing coastal communities around the world.”

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After arriving in orbit, the spacecraft separated from the rocket’s second stage and unfolded its twin sets of solar arrays. Ground controllers successfully acquired the satellite’s signal, and initial telemetry reports showed the spacecraft in good health. Sentinel-6 Michael Freilich will now undergo a series of exhaustive checks and calibrations before it starts collecting science data in a few months’ time.

Continuing the Legacy

The spacecraft is named in honor of Michael Freilich, the former director of NASA’s Earth Science Division, who was a leading figure in advancing ocean observations from space. Freilich passed away Aug. 5, 2020. His close family and friends attended the launch of the satellite that now carries his name.

“Michael was a tireless force in Earth sciences. Climate change and sea level rise know no national borders, and he championed international collaboration to confront the challenge,” said ESA (European Space Agency) Director of Earth Observation Programmes Josef Aschbacher. “It’s fitting that a satellite in his name will continue the ‘gold standard’ of sea level measurements for the next half-decade. This European-U.S. cooperation is exemplary and will pave the way for more cooperation opportunities in Earth observation.”

“Mike helped ensure NASA was a steadfast partner with scientists and space agencies worldwide, and his love of oceanography and Earth science helped us improve understanding of our beautiful planet,” added Thomas Zurbuchen, NASA associate administrator for science at the agency’s headquarters. “This satellite so graciously named for him by our European partners will carry out the critical work Mike so believed in — adding to a legacy of crucial data about our oceans and paying it forward for the benefit of future generations.”

Sentinel-6 Michael Freilich will continue the sea level record that began in 1992 with the TOPEX/Poseidon satellite and continued with Jason-1 (2001), OSTM/Jason-2 (2008), and eventually Jason-3, which has been observing the oceans since 2016. Together, these satellites have provided a nearly 30-year record ofprecise measurements of sea level height while tracking the rate at which our oceans are rising in response to our warming climate. Sentinel-6 Michael Freilich will pass the baton to its twin, Sentinel-6B, in 2025, extending the current climate record at least another 10 years between the two satellites.

Global Science Impact

This latest mission marks the first international involvement in Copernicus, the European Union’s Earth Observation Programme. Along with measuring sea levels for almost the entire globe, Sentinel-6 Michael Freilich’s suite of scientific instruments will also make atmospheric measurements that can be used to complement climate models and help meteorologists make better weather forecasts.

“NASA is but one of several partners involved in Sentinel-6 Michael Freilich, but this satellite speaks to the very core of our mission,” said NASA Administrator Jim Bridenstine. “Whether 800 miles above Earth with this remarkable spacecraft or traveling to Mars to look for signs of life, whether providing farmers with agricultural data or aiding first responders with our Disasters program, we are tirelessly committed not just to learning and exploring, but to having an impact where it’s needed.”

The initial orbit of Sentinel-6 Michael Freilich is about 12.5 miles (20.1 kilometers) lower than its ultimate operational orbit of 830 miles (1,336 kilometers). In less than a month, the satellite will receive commands to raise its orbit, trailing Jason-3 by about 30 seconds. Mission scientists and engineers will then spend about a year cross-calibrating data collected by the two satellites to ensure the continuity of sea level measurements from one satellite to the next. Sentinel-6 Michael Freilich will then take over as the primary sea level satellite and Jason-3 will provide a supporting role until the end of its mission.

“This mission is the very essence of partnership, precision, and incredible long-term focus,” said Michael Watkins, director of NASA’s Jet Propulsion Laboratory in Southern California, which manages the mission. “Sentinel-6 Michael Freilich not only provides a critical measurement,it is essential for continuing this historic multi-decadal sea level record.”

Sentinel-6 Michael Freilich and Sentinel-6B compose the Sentinel-6/Jason-CS (Continuity of Service) mission developed in partnership with ESA. ESA is developing the new Sentinel family of missions to support the operational needs of the Copernicus program, managed by the European Commission. Other partners include the European Organisation for the Exploitation of Meteorological Satellites (EUMETSAT), and National Oceanic and Atmospheric Administration, with funding support from the European Commission and technical support from France’s National Centre for Space Studies.

“The data from this satellite, which is so critical for climate monitoring and weather forecasting, will be of unprecedented accuracy,” said EUMETSAT Director-General Alain Ratier. “These data, which can only be obtained by measurements from space, will bring a wide range of benefits to people around the globe, from safer ocean travel to more precise prediction of hurricane paths, from greater understanding of sea level rise to more accurate seasonal weather forecasts, and so much more.”

JPL, a division of Caltech in Pasadena, California, is contributing three science instruments to each Sentinel-6 satellite: the Advanced Microwave Radiometer for Climate, the Global Navigation Satellite System — Radio Occultation, and the Laser Retroreflector Array. NASA is also contributing launch services, ground systems supporting operation of the NASA science instruments, the science data processors for two of these instruments, and support for the U.S. component of the international Ocean Surface Topography Science Team. The launch is managed by NASA’s Launch Services Program, based at the agency’s Kennedy Space Center in Florida.

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