To Reform Medicare, Reform Incentives and Organization

Alain C. Enthoven's paper, To Reform Medicare, Reform Incentives And Organization, explains how the principles of cost-responsible consumer choice among competing health-insurance plans, sometimes called "managed competition," can both improve quality and reduce cost in the federal government's Medicare program

Health Care in California and National Health Reform

CED believes that the U.S. employer-based health insurance system is failing -- and the recently enacted health reform, the Patient Protection and Affordable Care Act (PPACA), will not reverse that dynamic. Fewer American workers have insurance now than did ten years ago; and fewer American firms are offering health insurance now than did then. Many people do without care because they are not covered, or fear -- with justification -- that one illness or the loss of a job will cost them their coverage. The competitiveness of American firms is threatened by the cost of health insurance. Public budgets at every level of government are eroded by the costs of health care, including costs that previously were paid by employers. Although the new law will create pathways to private coverage for some people who are not insured by their employers, and many others will be made eligible for Medicaid, the clear intent is to maintain employer coverage for as many as possible -- and there is precious little in the law to improve this core structure of the U.S. healthcare system. We have proposed a fundamental restructuring of the health-care system to address this crisis. With the nation having focused on this issue, we have worked to learn what the health-care system of California can teach us about national reform, and how national reform might affect California

Regulatory and Nonregulatory Strategies for Controlling Health Care Costs

To date, three generic types of policy responses to the problem of rising health expenditures have been proposed. One is to increase greatly the share of medical costs that is paid by the patient so that consumers will have much more incentive to economize on medical services. A second is to leave intact the incentives for increasing expenditures in the fee-for-service, cost reimbursement, third-party intermediary system, but to impose economic and technical regulation on providers in an attempt to prevent the incentives from producing their natural effect. The third is to restructure the delivery and payments system in a manner that alters the basic financial incentives facing providers so that they find it in their interest to provide good quality but cost-effective care. The main thesis of this paper is that spending on health services cannot be effectively controlled in the present political context without the use of a policy of the third type

Delivery System Reform Tracking: A Framework for Understanding Change

Proposes a framework for tracking progress on delivery system reforms such as patient-centered medical homes and accountable care organizations by assessing structures, capabilities, incentives, and outcomes. Outlines challenges for data collection

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