Health Care Reform 2009

Payment Reform for Safety-Net Institutions — Improving Quality and Outcomes

C. Jason Wang, M.D., Ph.D., Kathleen N. Conroy, M.D., and Barry Zuckerman, M.D.

In the U.S. health care system today, many hospitals have the market power to raise the prices of their services without showing evidence of improvements in the quality of care.¹ In an effort to realign incentives, health care reformers are now proposing to link provider payments to quality of care and health outcomes. (more…)

Controlling U.S. Health Care Spending — Separating Promising from Unpromising Approaches

Peter S. Hussey, Ph.D., Christine Eibner, Ph.D., M. Susan Ridgely, J.D., and Elizabeth A. McGlynn, Ph.D.

High U.S. health care spending has been characterized not only as a barrier to affordable insurance but also as the preeminent long-term threat to the economy and the competitiveness of American business. (more…)

Health Care Reform in Perspective

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…)

Primary Care and Accountable Care — Two Essential Elements of Delivery-System Reform

Diane R. Rittenhouse, M.D., M.P.H., Stephen M. Shortell, Ph.D., M.P.H., M.B.A., and Elliott S. Fisher, M.D., M.P.H.

With discussions about U.S. health care reform focused heavily on insurance reforms, relatively little attention has been paid to the delivery-system reforms that will be required to improve the quality and coordination of health care and slow the growth of spending. (more…)

Lost in Transmission — FDA Drug Information That Never Reaches Clinicians

Lisa M. Schwartz, M.D., and Steven Woloshin, M.D.

The 2009 federal stimulus package included $1.1 billion to support comparative-effectiveness research about medical treatments. (more…)

Comparative Effectiveness — Thinking beyond Medication A versus Medication B

Kevin G. Volpp, M.D., Ph.D., and Anup Das

The American Recovery and Reinvestment Act of 2009 (ARRA), the stimulus package signed into law by President Barack Obama on February 17, 2009, directs $1.1 billion to support “the development and dissemination of research assessing the comparative effectiveness of health care treatments and strategies, including through efforts that . . . (more…)

Getting to the Real Issues in Health Care Reform

Paul B. Ginsburg, Ph.D.

No issue has dominated the health care reform debate as much as whether the U.S. government should offer a health insurance plan to compete with private insurers — the so-called public option. Congress has discussed two approaches to the public option, one of which would have the public plan pay providers at rates close to Medicare rates (more…)

Doctors as the Key to Health Care Reform

Arnold S. Relman, M.D.

Experts agree that sustainable health care reform requires reining in rising costs, but few people understand that the control of medical expenditures is largely in the hands of the medical profession. Doctors, in consultation with their patients (more…)

Poor Substitutes — Why Cooperatives and Triggers Can’t Achieve the Goals of a Public Option

Jacob S. Hacker, Ph.D.

According to a recent survey, a majority of U.S. physicians support health care reform that includes a new national public health insurance plan, which would compete with private plans.¹ Polls have shown that a substantial majority of Americans support the public option as well.  (more…)

Medicaid and National Health Care Reform

Sara Rosenbaum, J.D.

Defined by a history of both achievement and controversy, Medicaid has once again become central to the U.S. health policy debate, this time figuring as a key to national health care reform. Since its creation, Medicaid has repeatedly been called on to compensate for the shortcomings of a market-based health insurance system that excludes the poor and the sick. (more…)

Use of Electronic Health Records in U.S. Hospitals

Ashish K. Jha, M.D., M.P.H., Catherine M. DesRoches, Dr.Ph., Eric G. Campbell, Ph.D., Karen Donelan, Sc.D., Sowmya R. Rao, Ph.D., Timothy G. Ferris, M.D., M.P.H., Alexandra Shields, Ph.D., Sara Rosenbaum, J.D., and David Blumenthal, M.D., M.P.P.

This national survey showed that less than 2% of U.S. hospitals have a comprehensive system of electronic health records across all clinical units. (more…)

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Narrowly Clearing the Next Hurdle — Passage of the House Reform Bill

John K. Iglehart

With Democrats wielding their sizable majority to fend off strong Republican opposition and survive the defection of 39 members of their own party, the U.S. House of Representatives voted 220 to 215 to approve health care reform legislation after a day of contentious debate. On November 7, as midnight drew near, 219 House Democrats and 1 Republican (Representative Anh “Joseph” Cao of Louisiana) approved a measure that would extend insurance coverage to virtually all Americans by 2013. The 1990-page bill would also restructure private insurance, bolster primary care, and make countless other policy changes (more…)