Toward a 21st-century health care system: recommendations for health care reform.
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.
Arrow
Kenneth
K
Department of Economics, Stanford University, Stanford, CA 94305-6072, USA.
Auerbach
Alan
A
Bertko
John
J
Brownlee
Shannon
S
Casalino
Lawrence P
LP
Cooper
Jim
J
Crosson
Francis J
FJ
Enthoven
Alain
A
Falcone
Elizabeth
E
Feldman
Robert C
RC
Fuchs
Victor R
VR
Garber
Alan M
AM
Gold
Marthe R
MR
Goldman
Dana
D
Hadfield
Gillian K
GK
Hall
Mark A
MA
Horwitz
Ralph I
RI
Hooven
Michael
M
Jacobson
Peter D
PD
Jost
Timothy Stoltzfus
TS
Kotlikoff
Lawrence J
LJ
Levin
Jonathan
J
Levine
Sharon
S
Levy
Richard
R
Linscott
Karen
K
Luft
Harold S
HS
Mashal
Robert
R
McFadden
Daniel
D
Mechanic
David
D
Meltzer
David
D
Newhouse
Joseph P
JP
Noll
Roger G
RG
Pietzsch
Jan B
JB
Pizzo
Philip
P
Reischauer
Robert D
RD
Rosenbaum
Sara
S
Sage
William
W
Schaeffer
Leonard D
LD
Sheen
Edward
E
Silber
B Michael
BM
Skinner
Jonathan
J
Shortell
Stephen M
SM
Thier
Samuel O
SO
Tunis
Sean
S
Wulsin
Lucien
L
Yock
Paul
P
Nun
Gabi Bin
GB
Bryan
Stirling
S
Luxenburg
Osnat
O
van de Ven
Wynand P M M
WP
D033161:Government Regulation; D018166:Health Care Reform / Q000191:economics / Q000458:organization & administration*; D006801:Humans; D007349:Insurance, Health, Reimbursement / Q000191:economics; D017749:Total Quality Management / Q000191:economics; D014481:United States; D019472:Universal Health Insurance / Q000191:economics / Q000458:organization & administration*