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Change Health Care Fundamentally, Experts Say

By Emily Ethridge, CQ Staff

April 21, 2008 -- The health care delivery system needs sweeping changes to improve its quality and efficiency, experts polled in a Commonwealth Fund survey said.

The current system for providing care access, coordinating treatment by hospitals and other types of providers, delivering health care services, and sharing information does not provide patients with the highest-quality treatment, respondents said. None of the 1,087 health policy opinion leaders surveyed said no changes to the health care delivery system were needed and just 8 percent said only modest fixes were necessary. However, 89 percent of respondents called for fundamental and systematic changes.

"The majority of health care opinion leaders believe that our delivery system is broken," said Commonwealth Fund President Karen Davis.

Improving primary care, encouraging care coordination, and advancing care management for patients with complex medical conditions were cited as most important factors for improving the health care system.

In addition, new payment systems for doctors and other providers would improve the delivery system, seven of 10 surveyed said. The typical fee-for-service scheme encourages doctors to provide more services instead of offering higher-quality solutions, they said.

Nearly eight of 10 respondents said it was important or very important to reform current payment schemes. Eighty-four percent of those surveyed said primary care providers should receive supplemental payments for offering comprehensive, coordinated care. The same percentage also supported providing incentives for avoiding unnecessary hospitalizations. Most respondents also supported capitation, in which a provider is paid according to the number of patients he treats instead of the number of services he performs.

Sixty-three percent of those surveyed called for the government to provide infrastructure support to areas lacking organized health care delivery systems. Most of those respondents said information technology services should be prioritized for government-funded programs.

Half of the respondents said retail health clinics add to the organizational split, although 75 percent said those clinics are more convenient for patients and many said they provide services at a lower cost.

The Commonwealth Fund surveyed health policy opinion leaders in academic and research organizations, health care delivery, business and insurance industry, and government and advocacy groups.

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