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Reflections on a Decade of Tracking Health System Change

Lots of Change; Little Progress on Slowing Cost Growth or Improving Care Quality and Access

News Release
March 15, 2006

Alwyn Cassil (202) 264-3484 or

WASHINGTON, DC—Despite a decade of tumultuous change, the perennial problems of high costs, uneven quality and inequitable access continue to plague the U.S. health care system, according to a commentary published today by the Center for Studying Health System Change (HSC).

"In a decade that saw the rapid rise and hard fall of tightly managed care, there was plenty of change but little progress in solving the cost, access and quality problems in the health care system," said Paul B. Ginsburg, Ph.D., president of HSC, a nonpartisan policy research organization funded principally by The Robert Wood Johnson Foundation (RWJF).

Noting the rapid changes in health care financing and delivery, catalyzed by the 1993 Clinton initiative to reform health care, RWJF created HSC in 1995 to monitor these trends and assess their impact on people through national surveys of households and physicians and site visits to representative communities.

In the commentary, Ginsburg and coauthor Cara S. Lesser, HSC director of site visits, point out that in the course of all the "mergers and break-ups and alphabet soup of new types of organizations, management strategies and payment arrangements…In many respects, we’re no better off than we were a decade ago."

About the same proportion of Americans—15 percent—lacks health insurance, health care spending now consumes 16 percent of the overall economy and disparities between the health care "haves" and "have nots" have widened.

The Commentary—A Decade of Tracking Health System Change—is available here.

"Competition for the health care dollar has become intense," the articles states, as hospitals and physicians have moved to increase revenues by focusing on profitable service lines, including cardiac and cancer care.

"Since most of the increased competition is aimed at increasing service volume rather than improving quality and increasing efficiency, it’s highly questionable whether these developments bode well for patients and those who pay the bills—primarily employers and government," the article states.

Identifying three lessons about what motivates and constrains change in the health care system: 1) Public perception matters; 2) all health care is local; and 3) the devil is in the details, the authors urge policy makers and health care leaders to engage the public; recognize that the local nature of health care markets means strategies to improve care will play out differently across communities; and keep in mind that meaningful change will not occur overnight.

"We need to encourage our political and health care leaders to look beyond the next election or fiscal year and talk more frankly about real solutions to the enduring problems of high health care costs, uneven quality and inequitable access," the commentary concludes.

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The Center for Studying Health System Change is a nonpartisan policy research organization committed to providing objective and timely research on the nation’s changing health system to help inform policy makers and contribute to better health care policy. HSC, based in Washington, D.C., is funded principally by The Robert Wood Johnson Foundation and is affiliated with Mathematica Policy Research, Inc.


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The Center for Studying Health System Change Ceased operation on Dec. 31, 2013.