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Toward a 21st-century health care system: recommendations for health care reform.

Abstract：

: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.

journal_name

Ann Intern Med

journal_title

Annals of internal medicine

authors

Arrow K,Auerbach A,Bertko J,Brownlee S,Casalino LP,Cooper J,Crosson FJ,Enthoven A,Falcone E,Feldman RC,Fuchs VR,Garber AM,Gold MR,Goldman D,Hadfield GK,Hall MA,Horwitz RI,Hooven M,Jacobson PD,Jost TS,Kotlikoff LJ

doi

10.7326/0003-4819-150-7-200904070-00115

subject

Has Abstract

pub_date

2009-04-07 00:00:00

pages

493-5

issue

eissn

0003-4819

issn

1539-3704

pii

0000605-200904070-00115

journal_volume

150

pub_type

杂志文章

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Toward a 21st-century health care system: recommendations for health care reform.