PPACA, a complex piece of legislation, aims at improving all three dimensions of the health care system – access, cost, and quality. Among those three goals, increasing access to care is the law’s highest priority. The law’s major provisions are briefly summarized below.
Shifts in premium costs from one group to another, the topic of the paragraph above, merely redistribute the impact of health care cost increases, without doing anything to moderate the increases. An essential strategy for dampening cost inflation is reform of the nation’s existing physician payment systems, with their misaligned fee-for-service-based incentives promoting overuse of high-paid diagnostic and therapeutic procedures while giving short shrift to evaluation, prevention, and management services. PPACA takes a few tentative steps in that direction, funding pilot programs and demonstration projects involving pay-for-performance, financial risk sharing by providers, bundled payments, and other alternative delivery and payment mechanisms. These projects are under way at a number of the nation’s leading facilities. But the vast majority of health care services are still provided on a fee-for-service basis.
Health care in the United States - Wikipedia
Responding to such criticisms, PPACA drafters renamed the new entity as the Patient-Centered Outcomes Research Institute, re-cast it as a non-governmental organization, prohibited it from making determinations about insurance coverage, required its proceedings to be conducted with transparency and its research to be made available to the public, and barred the Secretary of Health and Human Services from using the new Institute’s research findings “in a manner that treats extending the life of an elderly, disabled, or terminally ill individual as of lower value than extending the life of an individual who is younger, not disabled, or not terminally ill.” Treatments’ clinical effectiveness is considered a proper subject for the Institute’s research; cost-effectiveness is not. Barred from direct influence on government reimbursement policy, the new Institute must fulfill its more limited mission through the effective production, gathering, and dissemination of research results to the medical profession and the general public.
And health outcomes are no better in the high …
Quite a lot of America’s relatively poor record on health benefit per dollar spent is due to inefficiencies built into the health care system. The percentage of total health care expenditures spent on administration and insurance in the U.S. (7.7% in 2006) is almost double that reported in Canada (4.1%), and more than triple the level in Japan (2.3%). The Institute of Medicine, a prestigious research entity, estimated that almost one-third of U.S. health care spending goes to waste on billing and excess administrative costs, duplicative x-rays and other diagnostic tests, and unnecessary or ill-advised procedures. Counting as “waste” the additional procedures needed to repair previous mistakes adds an estimated $17 billion annually to the inefficiency toll.
Reform of the United States Health Care System: An Overview
Most of the roughly 50 million uninsured are not unemployed or welfare recipients, as many believe. Rather, the majority are members of working families. Although adults under age 65 typically receive health insurance as an employment benefit, not all are so fortunate. Most small businesses, many medium-sized firms, and even some large firms do not offer health insurance to their employees. Private health insurers’ premiums for individuals are notoriously costly, beyond the budgets of many working families. As a result, 67% of the uninsured are members of families with at least one full-time worker.
Reform of the United States Health Care System: An Overview ..
It is well known that the U.S. health care system (if the word “system” can properly be used to describe such a complex, disorderly set of arrangements) fails to provide timely and appropriate care for a substantial segment of the population, and that the care that the public does receive is far more expensive than care provided in any other nation. What is less well known is which segments of the population lack coverage, and how the high-cost care that does reach the public results in many respects in mediocre health outcomes. Myths about American health care are pervasive, and factual correctives are needed.