This administrative structure must have the autonomy to implement continuous quality improvement. It must be able to modify policies based on feedback from providers and patients at the front lines, without having to go back to the legislature for every administrative adjustment. Quality improvement programs are most cost-effective when led by physicians, not by insurance plans or government.3,4
Other functions of these boards should include allocation of government funding for health care education and training, incentives to meet manpower needs in provider shortage areas, medical research, public health programs, and scope-of-practice issues. They should also have substantial influence over the public financing of the health care system, including health care tax rates (premiums), to ensure that the funding of the system continues to reflect the realistic costs of providing quality health care, to ensure public health care funds are spent cost-effectively, and to ensure sustainability.
The high administrative cost of competition among health plans means escalating pressures to limit coverage, deny care, reduce physician and hospital reimbursement, and add administrative burdens to providers. Adding a competing "public option" would not help. It would perpetuate the high administrative costs of private insurance, and the overriding incentive for private plans would not be to offer a better product; it would be to avoid covering the sick, dumping them onto the public plan. Only a universal health care financing system with a single risk pool could simultaneously align incentives to encourage quality health care while reducing cost.
Instead of the centrally administered managed care strategies now employed by insurance plans, a universal system should implement a system-wide continuous quality improvement program focused on the processes of care. A few communities in the U.S. (Intermountain Healthcare in Utah, Rocky Mountain Health Plans in Colorado, Community Care of North Carolina) have successful, cost-effective, physician-led, quality improvement programs without insurance company intermediaries, showing us that it is possible.3,4,5
If we want cost-effective health care building on proven examples of "what works," we need a universal health care system with a single risk pool at the state or national level, with public funding and private care delivery, accountable to the public good, and with a physician led continuous quality improvement program.
References
1. American College of Physicians. Achieving a High-Performance Health Care System with Universal Access: What the United States Can Learn from Other Countries. Ann Intern Med 2008;148:55-75.
2. Chernichovsky D. Not "Socialized Medicine" -- An Israeli View of Health Care Reform. NEJM 2009;361:e46.
3. James BC and Savitzdoi LA. How Intermountain Trimmed Health Care Costs Through Robust Quality Improvement Efforts. Health Affairs 30, no. 6 (2011); DOI:10.1377/hlthaff.2011.0358
(Note: You can view every article as one long page if you sign up as an Advocate Member, or higher).
1
1
