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We have the world's costliest health system, yet we fail to make care accessible to everyone and fall far short of providing the patient-centered, safe, high-quality care that we know is possible. The conclusion is inescapable: there is room for improvement. Only by facing the fact squarely and putting into action the best ideas and examples from around the country and the world can we achieve a health care system that truly meets our needs and aspirations.
To build a truly high performance health system, bold action is required. The following steps would start us on course:
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Provide automatic, affordable health insurance for all. Fund staff recently proposed a framework(34) for extending health insurance coverage to all Americans, building on existing sources of group insurance. Proposed strategies include adding to employer coverage, opening up a Congressional Health Plan for small businesses and uninsured individuals, and expanding Medicare and CHIP. Automatic enrollment through the income tax system and graduated tax credits would make coverage affordable for all, while requiring only modest commitment of federal funding.
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Put the patient first. Physician practices, hospitals, nursing homes, and other health care providers need to redesign practices and systems around what works for patients. Listening to patients, obtaining patient feedback, and involving patients in governance and care processes can all help. Simplifying care and having a trusted personal physician or advanced practice nurse can both improve safety and adherence to recommended care. Insurers and regulators can support change by rewarding care that is responsive to patients' preferences.
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Report cost and quality data publicly. The Medicare program has been a leader in posting nursing home quality data on its website, but those efforts are just a modest beginning. If we are serious about doing better, we need to know where we stand. Data reporting should cover physicians, hospitals, nursing homes, other health care providers, and health plans.
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Invest in health information technology. Other countries are quickly surpassing the United States in adopting electronic medical records and prescribing systems.(35) Their governments have invested in infrastructure and established the necessary standards, and the United States needs to do the same.
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Promulgate guidelines on quality and effectiveness. It is long past time to establish a scientific basis for all health care services — not just new drugs, but consultations, procedures, and tests. This could be accomplished by establishing a new national institute on clinical effectiveness.
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