It is indisputable that we have the worst, most expensive healthcare system in the world. Here is a thorough study from the Commonwealth Fund:
The same broken, fractured system is undergoing reform in many areas, and in the same way. Fractured.
Some examples include the Health Care Transformation Task Force, https://hcttf.org/, a non-profit working towards converting to a value-based payment system, instead of fee-for-service.
Value based payment was put in motion by the federal government in the Affordable Care Act, aka “Obamacare.” This holds providers accountable for costs and quality and rewards outcomes with financial incentives instead. This is a big step in the right direction as traditionally, providers get paid to do stuff to us. The more tests, procedures and treatments they provide, the more money they make.
However when I visited their website, I see a conglomeration of insurance companies, which makes me immediately mistrustful. I don’t think we can rely on for-profit insurance companies to work in the patient’s best interest, as they haven’t yet. They’re part of the problem.
However, this is important work, likely meeting a lot of resistance from providers. Changing the way we pay for care is vital to lowering costs and improving quality. We can no longer afford to support the healthcare industry. There’s no incentives for providers to be efficient. They earn more revenue by being inefficient. We have to incentive efficiency and quality.
I also question how is quality measured in a value-based payment model? Are ratings and reviews from patients included? Why aren’t they publicly available? Are we relying on the provider to tell the payor they provided excellent care? This needs improvement.
The US Preventative Services Task Force, https://www.uspreventiveservicestaskforce.org/uspstf/, authorized by Congress in 1984, to make recommendations about clinical preventative services and preventative medications that are evidenced-based. Their work is supported by AHRQ.
This is a good start, we need to standardize care and treatment as well.
As reported by the Commonwealth Fund, there are four features shared by the top performing countries:
They provide universal coverage and remove cost barriers
They invest in primary care systems that ensure high-value services are equitably available to everybody
They reduce administrative burdens they invest in social services.