The Affordable Care Act's state-based health insurance exchanges, which will open in 2014, will enable millions of individuals and small employers to comparison-shop for health plans. Citing the experiences of the Netherlands and Switzerland—where exchanges have been part of the health care landscape for some time—the authors of a New England Journal of Medicine "Perspective" argue that additional measures will be needed to control costs and improve quality. Commonwealth Fund Harkness Fellow Ewout van Ginneken, Ph.D., and Katherine Swartz, Ph.D., say that reforms are needed to improve the value of the plans offered, and to discourage plans from avoiding enrolling sicker patients.
