“The reality is that our economy does not generate enough jobs that can support a living wage and health benefits anymore.”
“Wal-Mart Bill is No Solution,” Baltimore Sun op-ed, January 12, 2006.
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Unsustainable health care cost growth has forced payers to reexamine goals for hospital payment systems. Employers want simplicity and transparency, with comparative performance data available in the public domain. Insurers favor simplicity but prefer to keep the analysis of comparative performance data and pricing private. Thirty-five pay-for-performance experiments have been devised in the private sector, to reward hospitals for higher quality and move toward more effective payment systems. Definitive results are not yet known, and caveats remain, but early signs are promising. We develop three scenarios for future hospital payment systems and identify policy actions to improve outcomes.
“Hospital Payment Systems: Will Payers Like the Future Better than the Past?” Health Affairs v. 25(1):81-93 (January/February 2006), with Ann O’Leary.
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Health care in America is in a state of crisis. Collectively, we spend a far higher percentage of our GDP on health care than other industrial nations, yet tens of thousands of Americans are dying prematurely each year due to inadequate access to high quality care. Our crisis is rooted in part in how we pay for health care, leaving 45 million Americans without adequate insurance or access to providers, and in what we pay for, getting uneven and low quality — and low clinical value — for our expenditures.
Incremental reforms have failed because they do not alter the incentives that encourage providers to deliver far more services than are clinically necessary, nor do they create sufficient market power for purchasers and patients to effectively demand more clinical value per dollar spent. Creating incentives for patients through larger deductibles will not work either, as most spending occurs long after even high deductibles are met. These problems can only be addressed through a bold, integrated approach that is consistent with our values. Indeed, forward-looking providers, payers, employers and politicians are already showing the way.
“Outline of the New America Vision of the 21st Century Health Care System,” New America Foundation, Issue Brief #1, January, 2006.
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Washington Health Policy Institute Transition Info!!
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