No lack of health care challenges for next president
No lack of health care challenges for next president
Guaranteeing affordable health insurance for all, changing the way doctors and other health care providers are paid, and better organizing and coordinating care delivery are among the top action items that await the next president, according to a report by the Commonwealth Fund Commission on a High Performance Health System.
Other health care priorities for the man or woman who ascends to the highest office include implementing an electronic information system in a reasonable period (e.g., five years), the report says. Members of the commission are a diverse group of leading health policy experts from government, private industry, health care delivery organizations, academia, and professional associations.
"This report outlines how essential it is that we pursue improvements in health care quality and efficiency at the same time as we pursue universal coverage," said commission chair James Mongan, the CEO of Partners HealthCare System. "We cannot and should not hold either of these facets of reform hostage while we wait for the other to happen."
Specific strategies
The report, "A High Performance Health System for the United States: An Ambitious Agenda for the Next President," outlines specific strategies to contain costs and organize the U.S. health care delivery system to address how the system falls short by failing to provide health insurance to everyone, by delivering care that is highly variable in quality, and by promoting inefficient health care spending.
Among the changes called for are:
1. Affordable coverage for all by extending health insurance to all in a way that will allow people to seamlessly get coverage and not risk losing coverage when they change jobs, become widowed, or become ill;
2. Aligned incentives and effective cost control by rewarding doctors and hospitals for providing high-quality, cost-effective care; moving away from a fee-for-service model to one where providers share accountability for the total care of their patients; and addressing the payment disparity between primary and specialty care doctors;
3. Accountable, coordinated care in an organizing health system where doctors, hospitals, and other health care services are linked together, virtually or literally, and it is easy for patients to navigate between their primary care doctor, specialist, and hospital;
4. Aiming higher for quality and efficiency by investing in ways to help all doctors and health care systems practice evidence-based medicine and provide the highest-quality care possible, and ultimately report their quality data to the public, including investing in health information technology such as electronic medical records;
5. Accountable leadership possibly through a national entity that would develop goals for the health care system, set national health care priorities, develop measurements for health system performance, and recommend policies and practices for achieving them.
"There is no question that health care is at the top of the nation's agenda in the presidential election and will be a key issue for the next president," says Commonwealth Fund president Karen Davis. "These recommendations lay out how, in the next five years, we can move closer to a health system that gives all Americans the chance to lead longer, healthier, and more productive lives."
A few weeks earlier, the commission issued a report saying that health insurance reform plans that build on a mix of private and public health insurance, where costs are shared among government, employers, and enrollees, would have the best chance to move the system to high performance and would be the most practical to implement.
The report's authors said affordable, comprehensive health insurance coverage for all Americans is essential to achieving a high-performance health system because coverage helps to ensure access to essential preventive services; improve overall health; cut down on inefficiencies such as duplicate medical tests; reduce administrative costs; and eliminate costly uncompensated care for uninsured and underinsured families.
"If we do health reform right, we can get all Americans covered, improve quality and efficiency, and control skyrocketing health care costs," said report author Sara Collins, Commonwealth Fund assistant vice president.
The report says health reform should:
- provide equitable and comprehensive health insurance to all Americans, regardless of income or health status, in a way that ensure full and equal participation;
- provide a minimum standard benefit floor;
- have premiums, deductibles, and out-of-pocket costs that are affordable relative to family income;
- offer automatic and seamless enrollment;
- provide a choice of health plans or care system so people can keep their current insurance if they so choose;
- reduce administrative costs and keep plans simple to administer, with health risks pooled across broad groups;
- adequate financing with costs shared among federal and state governments, employers, individual households, and other stakeholders.
In the commission's view, both the mixed private-public group insurance with a shared responsibility for financing, and the public insurance reform proposals have the greatest potential to provide everyone with comprehensive and affordable health insurance, achieve greater equity in access to care, realize efficiencies and cost-savings in providing coverage and delivering care, and redirect incentives to improve quality. However, it said, the mixed public-private approach is the more pragmatic one because it allows those who now have employer-based health coverage to retain it, causing far less dislocation initially than asking people to enroll in a new program and minimizing federal budget outlays.
Reasons for universal coverage
"The most important takeaway of this report is that universal coverage is essential to improve access, quality, equity, and efficiency in the U.S. health care system," said Dallas Salisbury, CEO of the Employee Benefit Research Institute and chairman of the commission's coverage workgroup. "However, the design of any health care reform plan will determine whether we are able to achieve the goal of a truly high-performing health system."
Meanwhile, the National Federation of Independent Business (NFIB), an advocate for small business interests, released its "Small Business Principles for Healthcare Reform." NFIB said it supports policy reforms to balance the competing goals of access to quality care, affordability, and predictability and consumer choice. The resulting health system would be:
- Universal. All Americans should have access to quality care and protection against catastrophic costs. A government safety net should enable the neediest to obtain coverage.
- Private. To the greatest extent possible, Americans should receive their health insurance and care through the private sector. Care must be taken to minimize the extent to which governmental safety nets crowd out private insurance and care.
- Affordable. Health care costs to individuals, providers, governments, and businesses must be reasonable, predictable, and controllable.
- Unbiased. Health care and tax laws should not push Americans into employer-provided or government-provided insurance programs and hobble the market for individually purchased policies. Small employers should be treated the same as large employers, who can already pool across state lines. A health care system built on employer mandates or play-or-pay taxes is unacceptable.
- Competitive. Consumers should have many choices among insurers and providers. Policy-makers should work to alleviate the limitations that state boundaries and treatment mandates place on competitiveness.
- Portable. Americans should be able to move throughout the U.S. and change jobs without losing their health insurance.
- Transparent. Information technology should enable all parties to access accurate, user-friendly information on costs, quality, and outcomes. Providers must be able to obtain relatively complete medical histories of patients. At the same time, patients' privacy must be guarded zealously. The private sector must play a vital role in developing the new technologies.
- Efficient. Health care policy should encourage an appropriate level of spending on health care. Laws, regulations, and insurance arrangements should direct health care spending to those goods and services that will maximize health. Adequate risk pools throughout the health care system are vital.
- Evidence-based. The health care system must encourage consumers and providers to accumulate evidence and to use that evidence to improve health. Appropriate treatment choices and better wellness and preventive care should be key outcomes.
- Realistic. Health care reform should proceed as rapidly as possible, but not so quickly that firms and individuals cannot adjust prudently.
"Reform is a delicate balancing act," NFIB said. "Moving too slowly will allow costs to rise too far and too fast. In the process, the health of Americans will suffer, and the financial security of some will be disastrously impacted. But excessive speed is also risky. Thus, we must assure that reform does not allow some Americans to slip through the cracksto lose coverage or see their costs rise too rapidly. Somewhere in between is a seamless transition from the status quo to a more efficient and equitable system."
Download the Commonwealth Fund documents at http://www.commonwealthfund.org. Download the NFIB principles at www.nfib.com.
Guaranteeing affordable health insurance for all, changing the way doctors and other health care providers are paid, and better organizing and coordinating care delivery are among the top action items that await the next president, according to a report by the Commonwealth Fund Commission on a High Performance Health System.Subscribe Now for Access
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