The U.S. health care system is the most expensive in the world. Yet it is clear that by many measures, Americans are not receiving commensurate value for the health care dollars they spend. Is it possible to simultaneously improve health coverage and quality, while generating savings for health care consumers, employers, government and health care providers? What are the characteristics of a high performance health system? What realistic steps does the private sector need to take, contrasted with government bodies, to move the U.S. toward such a system? What policy changes would be most helpful to the most vulnerable populations – the uninsured, and those facing disparities in care or coverage due to income, race/ethnicity, health or age?
Pay-for-performance programs have been touted by some as a way to improve the overall quality of care provided to patients, while being criticized by others who fear unintended consequences in attempting to change physician behavior. The Medicare Payment Advisory Commission has recommended that pay-for-performance be incorporated into Medicare reimbursement policy in a number of areas. Recent laws, including the Medicare Modernization Act, have mandated pay-for-performance demonstration projects, including one for chronically ill Medicare patients.
The federal government’s responsibility to provide access to health care for the nation’s 41 million Medicare beneficiaries implies another obligation: to spend taxpayer dollars wisely. This means assuring that the $250 billion+ spent for Medicare goes for services that are safe, timely and effective.
A newly launched website known as “Hospital Compare” is the most comprehensive attempt yet by the Centers for Medicare and Medicaid Services (CMS) to display voluntary, self-reported information by hospitals on steps that can be taken to reduce the impact of three major causes of morbidity and mortality – heart attack, heart failure, and pneumonia – in a consumer-friendly format.
Evidence-based medicine offers a win-win proposition: improve the quality and effectiveness of care while at the same time identifying opportunities to reduce waste of valuable health care resources. But what evidence should employers, health care providers and consumers pay attention to? And how should this information be disseminated to those who need it?
Some market-oriented economists have long contended that the best way to get a handle on rising health care costs is to give patients more control over the type of services they consume and the prices they pay for them. There are increasing signs that the market is gravitating in this direction. In the last several years employers have been setting up so-called “consumer-directed” plans, which put more responsibility for selecting the appropriate provider at the right price in the hands of employees—in exchange for potential financial gains.
Medical errors and claims of malpractice are a fact of daily life, according to the Institute of Medicine and other researchers. For doctors, hospitals and other providers, so are rising malpractice premiums, which recent reports suggest may be hurting providers’ ability to administer care in some regions of the country and in some specialties, such as obstetrics.
After years of discussion and debate, both Houses of Congress passed bills providing for Medicare prescription drug coverage in July, 2003. In September 2003, conferees from both the House and Senate resumed their attempt to iron out the differences between the two bills and enact the most extensive expansion of the Medicare program since its inception.