title: Future of the US healthcare system and the effects on the practice of hand surgery.
abstract: The multitier healthcare system of the USA has several major flaws. High costs and uncertain quality of care indicate that this system is no longer practical. Several improvement initiatives, such as the Oregon Health Plan, Leapfrog, Lean Manufacturing, and Pay-for-Performance have been implemented into the current system. All of these quality improvement models are being experimented in a limited fashion and do not address the biggest problem in the US healthcare, inequality of care. There is now increasing support for a universal health coverage model as an ethically sound and just way to decrease health disparities in the USA. The current quality initiatives as well as an adoption of universal coverage appear to be the best way to improve quality of care, reduce cost, and increase equality in healthcare. These initiatives may have considerable effects on the practice of hand surgery in the near future, and thus, it is important for the field of hand surgery to become more engaged in advocacy and public policy arena. The purpose of this paper is to examine the current problems in the US healthcare system and to evaluate potential solutions that will enhance quality while simultaneously curbing the unchecked increase in healthcare expenditure.
authors.affiliation: Section of Plastic Surgery, University of Michigan Health System, 2130 Taubman Center 1500 E. Medical Center Drive, Ann Arbor, MI 48109-0340, USA.
authors.forename: Allison G
authors.initials: AG
authors.lastname: Pushman
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Chung