Health Care Reform Center

From the Publishers of the New England Journal of Medicine

Risking Big Changes with Small Reforms

NEJM • February 3, 2010

Stuart M. Butler, Ph.D.

As the prospects for health care reform ebb and flow by the day, one school of thought holds that making modest adjustments rather than enacting large-scale reform could help to avert controversy and command more broad support. Perhaps — but seemingly modest changes could also unleash huge pressures that would profoundly alter the system’s future structure and function. Since perceptive lawmakers and congressional staff members recognize this fact, there may well be bitter debate over the enactment of certain apparently modest elements of a smaller reform package submitted to Congress. (more…)

Giving Teeth to Comparative-Effectiveness Research — The Oregon Experience

NEJM • February 3, 2010

Somnath Saha, M.D., M.P.H., Darren D. Coffman, M.S., and Ariel K. Smits, M.D., M.P.H.

Experts believe that comparative-effectiveness research (CER) can substantially reduce future health care spending and improve the quality of care.1,2 Their analyses indicate that CER can control costs if its results are used to inform coverage, payment, and cost-sharing policies that provide incentives for appropriate and cost-effective care.1,2 But the proposed approach to CER in the United States would constrain these uses of the research, to avoid any implication that health care will be rationed. Though the word elicits fear and opposition, “rationing” is simply the equitable, or rational, distribution of resources; it involves delivering health care services according to clinical need and effectiveness, rather than wealth or geographic location. (more…)

Medicare and Medical Technology — The Growing Demand for Relevant Outcomes

NEJM • January 20, 2010

Peter J. Neumann, Sc.D., and Sean R. Tunis, M.D.

In deciding whether to pay for new medical technologies, the Centers for Medicare and Medicaid Services (CMS) is becoming more specific about its requirements for evidence of improved health outcomes in the Medicare population. In our view, this is a positive and overdue step, but one whose rationale and likely consequences must be better understood by the medical community, policymakers, and the public. Expansions of access to health insurance under the health care reform legislation pending in Congress — and resulting financial pressures — would almost certainly intensify the emphasis on more relevant and robust evidence. (more…)

Launching HITECH

NEJM • December 30, 2009

David Blumenthal, M.D., M.P.P.

Information is the lifeblood of modern medicine. Health information technology (HIT) is destined to be its circulatory system. Without that system, neither individual physicians nor health care institutions can perform at their best or deliver the highest-quality care, any more than an Olympian could excel with a failing heart. Yet the proportion of U.S. health care professionals and hospitals that have begun the transition to electronic health information systems is remarkably small.1,2 (more…)

Washington Update

Press Ahead or Scale Back? The Reform Effort after the GOP Victory in Massachusetts

John K. Iglehart
For almost a century, U.S. presidents have tried and failed to enact comprehensive health care reform featuring expanded coverage.1 In a development never imagined by most Democrats, President Barack Obama’s name may be added to this list because his party lost its filibuster-proof 60-vote Senate majority on January 19, thereby imperiling its ambitious [...]

Read More Articles By JK Iglehart

International Perspectives

Communal Responsibility for Health Care -- The Example of Benefit Assessment in Germany

Peter T. Sawicki, M.D., Ph.D.
Many German observers are bewildered over the U.S. health care reform debate.

Benefit Assessment in Germany

To the Editor: In his Perspective article, Sawicki (Nov. 12 issue)1 portrays Germany as a land of milk and honey, thanks to the efforts and actions of the Institute for Quality and Efficiency in Health Care

Read More International Perspectives

What Physicians and Patients Are Saying

The American Public and the Next Phase of the Health Care Reform Debate

Robert J. Blendon, Sc.D., and John M. Benson, M.A.
Congressional leaders and President Barack Obama are moving ahead to develop a single piece of major health care legislation, which will be debated, voted on by both houses of Congress, and, if enacted, sent to the President for his approval and signature. Previous research suggests that public [...]

Read More Surveys

Cost of Health Care and Reform

“Play-or-Pay” Insurance Reforms for Employers — Confusion and Inequity

December 30, 2009

Bradley Herring, Ph.D., and Mark V. Pauly, Ph.D.

One prominent feature of the current health care reform bills is a “play-or-pay” rule for employers: workers must receive part of their compensation in the form of employer-sponsored health insurance, or the company’s payroll will be subjected to a tax penalty. (more…)

Comparative Effectiveness

Comparative Effectiveness and Health Care Spending — Implications for Reform

January 6, 2010

Milton C. Weinstein, Ph.D., and Jonathan A. Skinner, Ph.D.

In this Sounding Board article, the authors argue that health care costs can be reduced without a negative effect on quality by reducing spending on interventions that are not cost-effective.

See free full text at NEJM.org.

New Delivery System

Cottage Industry to Postindustrial Care — The Revolution in Health Care Delivery

January 20, 2010

Stephen J. Swensen, M.D., M.M.M., Gregg S. Meyer, M.D., Eugene C. Nelson, D.Sc., M.P.H., Gordon C. Hunt, Jr., M.D., M.B.A., David B. Pryor, M.D., Jed I. Weissberg, M.D., Gary S. Kaplan, M.D., Jennifer Daley, M.D., Gary R. Yates, M.D., Mark R. Chassin, M.D., M.P.P., M.P.H., Brent C. James, M.D., M.Stat., and Donald M. Berwick, M.D., M.P.P.

U.S. health care is broken. Although other industries have transformed themselves using tools such as standardization of value-generating processes, performance measurement, and transparent reporting of quality, the application of these tools to health care is controversial, evoking fears of “cookbook medicine,” loss of professional autonomy, a misinformed focus on the wrong care, or a loss of individual attention and the personal touch in care delivery. (more…)

Universal Coverage

Avoiding Side Effects in Implementing Health Insurance Reform

January 27, 2010

Mark V. Pauly, Ph.D.

All U.S. health insurance reform proposals currently being discussed now include changes in the way insurers treat some people with above-average health risks. In most states, insurers who sell policies directly to individuals now charge premiums based to some extent on characteristics thought to predict the risk of high-cost conditions; insurers also exclude some or all preexisting conditions from coverage and simply refuse to cover some people. (more…)

Primary Care

Patient-Centered Medical Homes in Ontario

January 6, 2010

Walter W. Rosser, M.D., Jack M. Colwill, M.D., Jan Kasperski, R.N., M.H.Sc., and Lynn Wilson, M.D.

As the United States debates health care reform, the concept of “patient-centered medical homes” is receiving increasing attention.1 Many experts believe that medical homes with multidisciplinary teams and financial incentives for providing comprehensive care will lead to improvements in health, increase efficiency, and reduce costs of care while making practice more attractive for primary care physicians. (more…)

The FDA

Tobacco Control and Free Speech — An American Dilemma

January 13, 2010

Ronald Bayer, Ph.D., and Matthew Kelly, M.P.H.

On June 22, 2009, President Barack Obama signed the Family Smoking Prevention and Tobacco Control Act. This landmark legislation, which passed the House by a vote of 307 to 97 and the Senate 79 to 17, grants the Food and Drug Administration (FDA) extensive authority to regulate tobacco products. (more…)

Medicare and Medicaid

Ending End-of-Life Phobia — A Prescription for Enlightened Health Care Reform

December 16, 2009

Benjamin W. Corn, M.D.

Reform is coming to U.S. health care. A sense of urgency regarding the redesign of policies prevailed well before Barack Obama was elected president under the banner of change. A debate is now raging over a wide span of topics, including prescription plans, physician reimbursement, and solutions for the medical liability problem. (more…)

Medicare and Medicaid

The Effect of Medicare Part D on Drug and Medical Spending

July 2, 2009

Yuting Zhang, Ph.D., Julie M. Donohue, Ph.D., Judith R. Lave, Ph.D., Gerald O’Donnell, M.S., and Joseph P. Newhouse, Ph.D.

This study examined expenditures on drugs and other medical services before and after the implementation of Medicare Part D. For patients who had no drug coverage before Part D, the increase in drug spending after the implementation of Part D was approximately offset by a decrease in other medical spending. Improved access to medications may achieve savings in nonpharmacy costs because of better control of chronic illness.

See free full text at NEJM.org.

Politics of Health Care Reform

Implementation and Enforcement of Health Care Reform — Federal versus State Government

December 30, 2009

Timothy S. Jost, J.D.

Health care reform lurches forward. The House and Senate have both passed reform bills. How well reform works in practice, however, will depend on one key difference between the two bills that has received far too little attention — how their provisions will be implemented and enforced. (more…)

Health Information Technology

Accelerating the Use of Electronic Health Records in Physician Practices

January 20, 2010

Steven Shea, M.D., and George Hripcsak, M.D.

North Shore Hospital System on Long Island in New York recently announced that it will pay an incentive of up to $40,000 to each physician in its network who adopts its electronic health record (EHR) — paying 50% of the cost to physicians who install an EHR that communicates with the hospital and 85% of the cost if the physician also shares de-identified data on the quality of care.1 (more…)

Public Plan

Health Care Reform in Perspective

October 14, 2009

Arnold M. Epstein, M.D., Henry J. Aaron, Ph.D, Katherine Baicker, Ph.D, Jacob S. Hacker, Ph.D, and Mark V. Pauly, Ph.D

President Barack Obama has placed U.S. health care reform at the top of his domestic agenda, and months of legislative work on the issue have resulted in five bills — three in the House of Representatives and two in the Senate — that proponents believe will move the country in the direction of universal coverage, a fairer insurance system, and slower escalation of health care costs. (more…)

Weekly Forums

Forum: What role should physicians have in controlling medical costs?

December 23, 2009

See what other readers have to say about Dr. Brody’s Perspective article and submit a comment to our weekly forum.

Washington Update: Iglehart

Press Ahead or Scale Back? The Reform Effort after the GOP Victory in Massachusetts

January 27, 2010

John K. Iglehart

For almost a century, U.S. presidents have tried and failed to enact comprehensive health care reform featuring expanded coverage.1 In a development never imagined by most Democrats, President Barack Obama’s name may be added to this list because his party lost its filibuster-proof 60-vote Senate majority on January 19, thereby imperiling its ambitious reform package. (more…)

International Perspectives

Communal Responsibility for Health Care — The Example of Benefit Assessment in Germany


Peter T. Sawicki, M.D., Ph.D.

Many German observers are bewildered over the U.S. health care reform debate. (more…)