Friday, May 18, 2012
Delivery System Reform
On May 16, the Senate Health, Education, Labor and Pensions Committee convened a hearing on “Identifying Opportunities for Health Care Delivery System Reform: Lessons from the Front Line.” I was asked to participate on a panel with Dr. Al Kurose, President and CEO of Coastal Medical in Providence, RI and Marcia James, Director of Provider Engagement for Humana. Here is an excerpt of my prepared testimony:
American health care has many virtues. The system of job-based insurance for working-age people and Medicare for retirees provides ready access to care for most citizens (although access is more problematic for the poor through Medicaid). We have the most advanced network of clinics and inpatient facilities found anywhere in the world. And U.S. health care is also open to medical innovation in ways that other health systems around the world are not.
But there is no denying that health care in the United States is all too often highly inefficient. The system is characterized by extreme fragmentation. Physicians, hospitals, clinics, labs, and pharmacies are all autonomous units that are financially independent of one another. They bill separately from the others when they render services to patients; what’s worse, there’s very little coordination of care among them, which leads to a disastrous level of duplicative services and low-quality care in too many instances. The bureaucracy is maddening, the paperwork is burdensome and excessive, and there is very little regard for making the care experience convenient and pleasant for the patient.
At the heart of this dysfunction is Medicare — and more precisely, Medicare’s dominant FFS [fee-for-service] insurance structure.