Healthcare Leaders Propose Extensive US Healthcare Reforms

Deborah Brauser

April 08, 2009

April 8, 2009 — The United States' current healthcare system needs to be reformed to provide all Americans access to an affordable standard healthcare, according to an article published in the April 7 issue of the Annals of Internal Medicine.

"The coverage, cost, and quality problems of the US health care system are evident," write Kenneth Arrow, PhD, Nobel laureate and professor emeritus of economics at Stanford University, Palo Alto, California, and other participants from the Focused Research on Efficient, Secure Healthcare (FRESH) Thinking Project. "Sustainable health care reform must go beyond financing expanded access to care to substantially changing the organization and delivery of care. We must simultaneously build the capabilities, infrastructure, and incentives to ensure that all Americans receive high-quality care."

The FRESH-Thinking Project is composed of physicians, health policy experts, health insurance executives, business leaders, hospital administrators, and economists. At the conclusion of 8 workshops, the group members agreed on 8 fundamental policy recommendations for US healthcare reform. "Doing nothing is not an option," write the authors. "Maintaining the status quo in health care represents a significant threat to government finances, the economy, Americans' standard of living, and our nation's future."

The group split their recommendations between delivery system reforms and financing reforms. "It is impossible to solve the problem of access to health care services without fixing the financing system," they write. "But without fixing the delivery system, it is impossible to solve the cost and quality problems in a sustainable manner." Their new delivery system recommendations include replacing the current fee-for-service payment system with one that encourages and rewards innovation, and establishing "a securely funded, independent agency to sponsor and evaluate research on the comparative effectiveness of drugs, devices, and other medical interventions." They also recommend simplifying federal and state laws and regulations, developing a health information technology infrastructure to promote data exchange, and creating a national health database.

For financing reforms, the authors recommend identifying revenue sources, creating a health coverage board, and creating state or regional insurance exchanges to pool risk so that "Americans without access to employer-based or other group insurance could obtain a standard benefits package." Employers would also be allowed to participate in these exchanges for their employees' coverage.

"Reform of the health system will not occur overnight[, but] we must find a place to start," write the authors. "The FRESH-Thinking project demonstrates that, despite diverse backgrounds and interests, people can agree on fundamental elements that will provide a solid foundation for a health care system."

The authors conclude, "The essence of these elements is the reform and modernization of how we both finance and deliver health care to ensure real value — better quality care and improved health of Americans at sustainable growth in costs."

In an accompanying editorial, the Annals of Internal Medicine editors write, "It seems that the number of ideas about how to fix health care might soon rival the number of uninsured Americans. Although this abundance of ideas can be dizzying, it is good that lots of people are actively thinking about the issue. Substantive reform will require much creative thought and a willingness of various stakeholders to step out of their own boxes."

That goal is why the editors chose to publish this article, along with 2 other perspectives on healthcare reform, they say. They write about all 3 articles, "Although these proposals only scratch the surface, we hope that both those orchestrating reform and those who will feel its effects consider the ideas that they offer."

Several of the study authors have disclosed financial relationships. A complete list of disclosures is available in the original article. The editorial authors have disclosed no relevant financial relationships.

Ann Intern Med. 2009;150:493–495, 498.


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