HEALTHCARE IN THE UNITED STATES AND INDIAAXIA COLLEGENICOLE CAMPONOVEMEBER 21, 2010
Health Care in the United States is described as the “cottage industry” it has been fragmented at the national, state, community and practice levels. There is not one single entity or set of policies guiding the health care system; Furthermore, this fragile primary care system is on the verge of collapse according to the Commonwealth Fund Commission. (A. Shih, 2008) The fragmentation of our delivery system is a fundamental contributor to the poor overall performance of the U.S. health care system. In our fragmented system: * patients and families navigate unassisted across different providers and care settings, fostering frustrating and dangerous patient experiences; * poor communication and lack of clear accountability for a patient among multiple providers lead to medical errors, waste, and duplication; * the absence of peer accountability, quality improvement infrastructure, and clinical information systems foster poor overall quality of care; and * high-cost, intensive medical intervention is rewarded over higher-value primary care, including preventive medicine and the management of chronic illness.
No single policy will fix the fragmentation of our health care system. Rather, a comprehensive approach is required—one that might lead progressively to greater organization and better performance. The following strategies were recommended: (A. Shih, 2008)
* Payment reform. Provider payment reform offers the opportunity to stimulate greater organization as well as higher performance. The predominant fee-for-service payment system fuels the fragmentation of our delivery system. We recommend that payers move away from fee-for-service toward bundled payment systems that reward coordinated, high-value care. In addition, we recommend expanding pay-for-performance programs to reward high-quality, patient-centered care. The more organization in delivery systems, the more feasible these payment reforms become (Exhibit ES-1). These payment reforms also could spur organization, since they reward optimal care over the continuum of services. Specifically, we believe that: * Patient incentives. Patients should be given incentives to choose to receive care from high-quality, high-value delivery systems. This requires performance measurement systems that adequately distinguish among delivery systems. * Regulatory changes. The regulatory environment should be modified to facilitate clinical integration among providers. * Accreditation. There should be accreditation programs that focus on the six attributes of an ideal delivery system we have identified. Payers and consumers should be encouraged to base decisions on payment and provider networks on such information, in tandem with performance measurement data. * Provider training. Current training programs for physicians and other health professionals do not adequately prepare providers to practice in an organized delivery system or team-based environment. Provider training programs should be required to teach systems-based skills and competencies, including population health, and be encouraged to include clinical training in organized delivery systems. * Government infrastructure support. We recognize that in certain regions or for specific populations, formal organized delivery systems may not develop on their own. In such instances, we propose that the government play a greater role in facilitating or establishing the infrastructure for an organized delivery system, for example through assistance in establishing care coordination networks, care management services, after-hours coverage, health information technology, and performance improvement activities. * Health information technology. Health information technology provides critical infrastructure for an organized delivery system. Providers should be required to implement and utilize certified...
References: A. Shih, K. Davis, S. Schoenbaum, A. Gauthier, R. Nuzum, and D. McCarthy, Organizing the U.S. Health Care Delivery System for High Performance, The Commonwealth Fund, August 2008
(A. Shih, 2008)
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