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Comparative effectiveness research holds out the tantalizing prospect of making it easier for patients and their doctors to choose the best treatment, thus improving quality. At the same time, it could also justify denying or reducing payment for a host of treatments or procedures that may be clinically ineffective or unworthy of their high price.
No matter who wins the White House and control of Congress in November, health reform legislation will likely be a front-burner issue for both House and Senate in 2009. The debates about reform, and the behind-the-scenes meetings, of 1993 and 1994 produced a wealth of knowledge on what should be done differently the next time Congress takes up this issue. What derailed health reform in 1994? What tactical and strategic decisions, in areas such as timing and content, affected the outcome? What part did outside groups play? How should the issue be approached differently the next time around? What are the appropriate roles for congressional and executive branch leadership in getting reform done? This briefing, cosponsored with the Robert Wood Johnson Foundation, addressed these and related questions.
Many of today’s reporters are too young to remember the last time Congress vigorously debated health coverage for all – 1993 and 94. For other reporters, that period feels “like yesterday.” Whichever camp a person is in, that debate produced a wealth of knowledge on what should be done differently the next time Congress takes up national health reform, a time that could be coming soon after the next election.
There is mounting evidence that the U.S. system is often financially inefficient and delivers poor quality. There is also research suggesting that having so many people without insurance can adversely affect the quality of care for everyone, even those with insurance. A new report by The Commonwealth Fund sets forth principles for providing universal coverage in ways that could promote a high performance health care system. Several states are already trying to reform their health care systems.
As presidential candidates of both major parties woo the American public, particularly in early caucus and primary states, they are gravitating toward a common public concern: the U.S. health care system. Potential voters are well aware of rising premiums and higher out of pocket costs to families, the impact of high health care costs on America’s economic competitiveness and on federal and state budgets, and the ever-growing number of uninsured – now nearly 45 million. A Kaiser Family Foundation poll released in March shows that health care ranks as the second most important issue that the public would like discussed by presidential candidates for the 2008 election.
There is mounting research highlighting poor quality of care and inefficient spending in our health care system. At the same time, diagnostic and treatment options proliferate at an accelerating pace.
Providing health insurance coverage to the 46 million Americans without it has been receiving more attention in recent months. Several polls have shown rising public interest in the topic. Coverage is fast becoming an issue in the 2008 presidential campaign, for both Democrats and Republicans. President Bush offered an uninsured proposal in his January State of the Union address. Bills dealing with the uninsured have been introduced by members of Congress from both parties. A number of states have also laid out ambitious coverage plans.
As the nation’s largest payer for health care services, the Medicare program has a major effect on payments to providers. Its ability to align incentives through pay-for-performance will have implications for the health delivery system at large. A recent Institute of Medicine report made recommendations for implementation of “P4P” under Medicare.
The growing complexity of our health care system, and time demands on providers, can cause patients’ non-obvious needs to get lost in the shuffle. Sometimes, the result can be less-than-optimal care. In response, providers are trying to be more responsive to patients’ cultural traditions, family situations, personal preferences and values. Some have tagged this movement “patient-centered care.”
Polls consistently show that addressing problems in our health care system remains a top concern for most Americans. But while major health care reform efforts have stalled in Washington, many states are attempting to address the rising number of uninsured on their own. This briefing focused on such efforts in three states – Massachusetts, Vermont and Utah.
A new assessment by The Commonwealth Fund finds that deficiencies in the nation’s health care system cost 100,000 to 150,000 lives and $50 to $100 billion annually. The scorecard compares national averages for the U.S. to national and international benchmarks for 37 indicators. The U.S. received a composite score of 66 out of 100. On one quality measure, mortality, the U.S. ranked 14th out of 19 countries.
The Medicare Savings Programs provide assistance with premiums — and in some instances, cost sharing requirements — to Medicare beneficiaries of limited income and resources who do not qualify for full Medicaid benefits. Medicare Part B premiums currently amount to over $1,000 annually — which can be a large sum for some beneficiaries.
In today’s health care system it is clear that there needs to be a multidisciplinary approach toward improving quality. Nurses are on the front lines of implementing this quality improvement. By using the highest quality measurements and optimizing the delivery of care, those outside the nursing community would understand the importance of their role in quality performance.
On April 4, the Massachusetts legislature approved a plan that requires all adults to purchase health insurance by July 2007, or face a fine. The plan is projected to expand coverage to 95 percent of the state’s uninsured residents over the next three years.
The enactment of the Patient Safety and Quality Improvement Act last year sets the stage for health care providers to be able to report medical errors confidentially to designated entities known as “Patient Safety Organizations” (PSOs).
The U.S. isn’t alone in efforts to improve the quality of health care. Other countries as well are coming up with new ways to measure quality, working to improve patient safety, and experimenting with financial incentives to encourage physicians to meet or exceed quality targets.
The enactment of the Patient Safety and Quality Improvement Act last year sets the stage for health care providers to be able to report medical errors confidentially to designated entities known as “Patient Safety Organizations” (PSOs).