Toward a 21st-Century Health Care System: Recommendations for Health Care Reform

Abstract

The coverage, cost, and quality problems of the U.S. health care system are evident. Sustainable health care reform must go beyond financing expanded access to care to substantially changing the organization and delivery of care. The FRESH-Thinking Project (www.fresh-thinking.org) held a series of workshops during which physicians, health policy experts, health insurance executives, business leaders, hospital administrators, economists, and others who represent diverse perspectives came together. This group agreed that the following 8 recommendations are fundamental to successful reform: 1. Replace the current fee-for-service payment system with a payment system that encourages and rewards innovation in the efficient delivery of quality care. The new payment system should invest in the development of outcome measures to guide payment. 2. Establish a securely funded, independent agency to sponsor and evaluate research on the comparative effectiveness of drugs, devices, and other medical interventions. 3. Simplify and rationalize federal and state laws and regulations to facilitate organizational innovation, support care coordination, and streamline financial and administrative functions. 4. Develop a health information technology infrastructure with national standards of interoperability to promote data exchange. 5. Create a national health database with the participation of all payers, delivery systems, and others who own health care data. Agree on methods to make de-identified information from this database on clinical interventions, patient outcomes, and costs available to researchers. 6. Identify revenue sources, including a cap on the tax exclusion of employer-based health insurance, to subsidize health care coverage with the goal of insuring all Americans. 7. Create state or regional insurance exchanges to pool risk, so that Americans without access to employer-based or other group insurance could obtain a standard benefits package through these exchanges. Employers should also be allowed to participate in these exchanges for their employees' coverage. 8. Create a health coverage board with broad stakeholder representation to determine and periodically update the affordable standard benefit package available through state or regional insurance exchanges.

Do Physicians' Financial Incentives Affect Medical Treatment and Patient Health?

“…1 For instance, see Arrow et al (2009), Ginsburg (2011), and Hackbarth, Reischauer, and Mutti (2008. 2 The care physicians provide has personal financial consequences, as 60 percent are self-employed (Wassenaar and Thran 2003, Table 2) and 85 percent of those in group practices have compensation linked to patient care revenues (Medical Group Management Association 1998, Table 12).…”

“…3 Finally, we investigate the consequences of incremental treatments and technologies for patient health, the crucial outcome for any intervention in health care financing and delivery. † Go to http://dx.doi.org/10.1257/aer.104.4.1320 to visit the article page for additional materials and author disclosure statement(s).1 For instance, see Arrow et al (2009), Ginsburg (2011), and Hackbarth, Reischauer, and Mutti (2008. 2 The care physicians provide has personal financial consequences, as 60 percent are self-employed (Wassenaar and Thran 2003, Table 2) and 85 percent of those in group practices have compensation linked to patient care revenues (Medical Group Management Association 1998, Table 12).…”

Applicability of randomized trials in radiation oncology to standard clinical practice

“…For example, clinical care pathways provide consensus guidelines for the delivery of health services and seek to improve the effectiveness and overall efficiency of health care delivery by improving provider education and reducing unexplained variation in the provision of medical services. [19][20][21][22][23] However, the rationale supporting the creation of appropriate care pathways critically depends on the availability of relevant and high-quality data regarding health care outcomes. Although there have been numerous publications of consensus guidelines for oncology care, our study suggests that the strength of such guidelines may be compromised in a substantial proportion of clinical situations by a lack of available or applicable level I evidence.…”

Health Analytics, Economics and Medicine toward a 21<sup>st</sup> Century Health Care System

“…While the seminal economic principles and models of Arrow [2] and Grossman [3] have laid the foundations of this subfield of economics, we show herein that time is ripe for this subfield to branch out and collaborates with other fields in developing the 21 st century health care system envisioned in [1]. Such collaboration is already evident from the multiple authors of [1] with expertise in diverse fields. We also show that this outreach has the benefit of bringing in new insights and techniques to address the constraints and complexities of the problems and challenges in health economics.…”

“…We began by indicating that the second part of the title was inspired by [1], in which two Nobel laureates in economics, Kenneth Arrow and Daniel McFadden, coauthored with other economists, public health scientists, physicians, hospital administrators, and domain experts from industry and government to delineate in 2009 essential foundations for successful reform of the US health care system. A year later, landmark health care legislation was passed through two federal statutes: the Patient Protection and Affordable Care Act and subsequently amended by the Health Care and Education Reconciliation Act, and had offered new challenges and great opportunities for the three fields in the title.…”