American Health Care.

Recently I've read a complaint regarding our National health care system. Fellow blog readers can read this:

http://www.miricommunity.net/viewtopic.php?f=21&t=3004

Running a national health care system is not cheap...its costly..expensive drugs, doctors want higher pays...patients don"t want to pay and patients have high expectations.

Americans too having problems with their health care system.
Mr Obama is trying his best to put his country health care at the best.
If you in America, if you do not have an insurance policy, you are in deep trouble.

Here an article about Americans health care reformation.

Putting U.S. Health Care on the Right Track

Posted by NEJM • September 23rd, 2009 •

Denis A. Cortese, M.D., and Jeffrey O. Korsmo, M.S.

Americans do not consistently receive high-value health care. Collectively, our country spends more on health care than any other nation, but our people do not receive the best outcomes, safety, service, or access in return. Although some organizations, regions, and states deliver high-quality, affordable care, many do not. It’s time to make high-value health care the norm in the United States.

To reach that goal, we must hold physicians and other providers accountable for providing high-value health care, defined in terms of both quality and cost: value=quality÷cost. In this equation, quality includes clinical outcomes, safety, and patient-reported satisfaction, and cost encompasses the cost of care over time. Outcomes for hospital care, procedures, and chronic conditions can be assessed with the use of such measures as hospital admissions, emergency department visits, unplanned readmissions, death rates, postoperative complications, missed days of school or work, measures of organ function, and scores on general health surveys. Safety can be evaluated by means of such measures as central-line infection rates, medication errors, and postoperative complications. And patient satisfaction can be quantified with tools like those used by the National Research Corporation’s Healthcare Market Guide. Performance data are available from such respected sources as the Agency for Healthcare Research and Quality, the National Quality Forum, the Leapfrog Group, the AQA Alliance, the University HealthSystem Consortium, the Medicare Provider Analysis and Review File, and the Commonwealth Fund. Regional Medicare spending data from the Centers for Medicare and Medicaid Services (CMS) or from the Dartmouth Atlas of Health Care could provide the equation’s denominator.

We could thus create a value score for each medical institution and make it publicly available. Such a score would offer clearer information than is currently available on many aspects of providers’ care. If one institution can diagnose a patient’s condition with $10,000 worth of tests whereas another must spend $15,000 to achieve the same result, there is a clear value gap. Armed with concrete data, patients could choose a high-value facility over one that charges more but delivers less. Health care professionals would then begin to compete on the elements that matter most — outcomes, safety, service, and cost. Providers with worse outcomes, less-satisfied patients, and higher costs would lose patients, which would spur them to improve value.

Some critics argue that it’s not fair to use currently available metrics to compare providers, since the data may not have been adjusted properly for severity of illness or the poverty level or minority status of patients. It’s true that the available data are imperfect, and they should be risk-adjusted to the extent that current expertise permits. However, given the vacuum within which Americans currently make health care choices and third parties pay for services, paying for value would be a significant step toward evidence-based purchasing.

Researchers at the Dartmouth Institute for Health Policy and Clinical Practice who study regional variation in health care quality and spending have documented that more care does not necessarily translate into better care. Dartmouth research suggests that the United States could reduce its health care costs by 30% or more if all regions practiced to the standard of the best-performing medical centers.¹

Organizations offering higher-value care tend to have several common attributes. In his report on a meeting held in Washington in July, entitled “How Do They Do That? Low-Cost, High-Quality Health Care in America,” John Iglehart noted three characteristics that unified the 10 high-value communities that were represented at the gathering: a patient-centered culture, physician leadership, and not-for-profit status.²

In addition, several other factors foster high-value care. First, organizations that deliver value focus on its elements: outcomes, safety, patient satisfaction, and costs. They consistently collect performance metrics, conduct benchmarking studies, and use systems-engineering principles to improve outcomes, streamline clinical processes, and wring waste out of the system.

Second, patient care services must be coordinated across people, functions, activities, sites, and time. Physicians can organize themselves in a variety of ways — group practices, integrated networks of independent physicians, physician–hospital organizations, or “virtual” groups — to accomplish this goal. The point is to develop mechanisms for coordinating care among medical and surgical specialists so that patients have access to teams of physicians who can meet their needs. All team members in such systems are accountable to patients, to one another, and to the group’s leadership for high-quality results. These providers share a unified (electronic) medical record, which “builds in” continuous peer review as part of daily patient care activities.

Finally, many observers have suggested that a salary structure for physicians can reduce the incentives that drive overutilization. It is one of several payment schemes that can help to align the delivery system toward high-value care. The goal is to reduce conflict of interest so that physicians have less of a personal financial incentive to order unnecessary tests or procedures. Instead, they can focus on providing the right level of coordinated care for each patient — no more and no less.

In addition to a salary system, certain incentives can encourage high-value care. Some institutions add a value- or quality-based bonus (e.g., on the basis of patient-satisfaction scores) to physicians’ annual salaries. Unlike productivity-based rewards that drive increases in volume, incentives to produce better outcomes, safety, and service reward physicians for high scores on one or more of these components of value.

In general, a key way of spreading high-value health care is to pay for it.³ Indeed, we believe that paying for value is a fundamental requirement for effective health care reform. Unfortunately, much of the financing in proposed health care reform bills comes from continued across-the-board reductions in Medicare’s price-controlled fee-for-service payments. That won’t work.

Legislators must establish new ways of providing fair payment to doctors and hospitals offering high-quality, lower-cost care. Congress can use the Medicare program to start us along this path. We believe that Congress should set a 3-year deadline for creating and implementing new Medicare payment methods. The CMS could initially establish new value-based payment methods, incorporating metrics for outcomes, safety, and service for the most expensive three to five conditions and procedures — sending providers the message that they must begin reengineering care delivery to create better value for patients.

One idea is to base a portion of Medicare payments to physicians and hospitals on value scores, rewarding those who offer high-value care and providing an incentive for others to improve. Value scores can be constructed for many types of payment models, including hospital diagnosis-related-group payments, physicians’ fees, payment updates, and other payment formulas, including those for bundled payments. Providers would then be paid on the basis of their value scores. Over time, we believe that health care professionals would change their behavior — for example, sharing information and eliminating unnecessary tests — in order to increase value.

The philosopher Seneca said, “We most often go astray on a well trodden and much frequented road.” There is a clear path to higher-quality, more affordable health care, if we are willing to veer from the familiar route. We must define value, publicly display understandable value scores, and pay for value. If tools and incentives are aligned to support this goal, we’ll be on the right track to transform U.S. health care.

No potential conflict of interest relevant to this article was reported.

Source Information

From the Mayo Clinic, Rochester, MN.