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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
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"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, were no better off than we were a decade ago."
About the same proportion of Americans15 percentlacks 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 CommentaryA Decade of Tracking Health System Changeis 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, its highly questionable whether these developments bode well for patients and those who pay the billsprimarily 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.
The Center for Studying Health System Change is a nonpartisan policy research organization committed to providing objective and timely research on the nations 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.