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Solution Framework of Market Forces

American College of Physicians:  Recommendations for HC Reform

7 April 2009 | Volume 150 Issue 7     

Note:  these recommendations from a group of college doctors are generally leading to a centrist view of medicine.  Their arguments for boards and reviews are not inherently bad, just inefficient.  The centrist review process can be good, as long as it does not become a decision body, promulgating policies to be followed, but rather making suggestions to doctors and best practice.   Such a best practice advocacy exists in other industries.

The coverage, cost, and quality problems of the U.S. health care system are evident. Sustainable health care reform must go beyond financing expanded access to care to substantially changing the organization and delivery of care. The FRESH-Thinking Project ( held a series of workshops during which physicians, health policy experts, health insurance executives, business leaders, hospital administrators, economists, and others who represent diverse perspectives came together. This group agreed that the following 8 recommendations are fundamental to successful reform:

1. Replace the current fee-for-service payment system with a payment system that encourages and rewards innovation in the efficient delivery of quality care. The new payment system should invest in the development of outcome measures to guide payment.

2. Establish a securely funded, independent agency to sponsor and evaluate research on the comparative effectiveness of drugs, devices, and other medical interventions.

3. Simplify and rationalize federal and state laws and regulations to facilitate organizational innovation, support care coordination, and streamline financial and administrative functions.

4. Develop a health information technology infrastructure with national standards of interoperability to promote data exchange.

5. Create a national health database with the participation of all payers, delivery systems, and others who own health care data. Agree on methods to make deidentified information from this database on clinical interventions, patient outcomes, and costs available to researchers.

6. Identify revenue sources, including a cap on the tax exclusion of employer-based health insurance, to subsidize health care coverage with the goal of insuring all Americans.

7. Create 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 through these exchanges. Employers should also be allowed to participate in these exchanges for their employees' coverage.

8. Create a health coverage board with broad stakeholder representation to determine and periodically update the affordable standard benefit package available through state or regional insurance exchanges.

In the first perspective, political scientists present their view of cost control in medical care (2). They explain why they think the Obama administration's approach is unlikely to slow growth in costs, and they offer suggestions, largely drawn from other countries, about strategies to control health care spending that they believe would be more successful.

The second perspective, from Healthcare Professionals for Healthcare Reform (, presents the group's vision of a 3-tiered system of coverage (3). At its center is a health board analogous to the Federal Reserve that would oversee the development and delivery of a system that provides basic health care for all while preserving options for more-than-basic services under private insurance or self-pay mechanisms.

In the third perspective, the FRESH-Thinking Project ( shares 8 fundamental essentials for successful reform (4).

These recommendations represent the consensus of a diverse group of health care, policy, academic, and business leaders who came together in a series of workshops to discuss health care reform.