Commonwealth Fund proposes health system overhaul

Marion Davis

02/20/2009

UNDER PROPOSED CHANGES, the rate of uninsured U.S. residents could stabilize around 4 percent by 2012. /

NEW YORK – A new report by the Commonwealth Fund proposes a comprehensive set of insurance, payment and system reforms that it says could slow the growth of health spending by $3 trillion by the end of the next decade.
Key elements of the proposal include mandating that everyone be insured; creating a low-cost public health insurance plan – to supplement private-sector options – for people too young for Medicare, and setting up a government health insurance exchange.
In addition, the plan aims to:

Align incentives with value and effective cost control, moving away from the fee-for-service payment system “toward one that emphasizes value rather than volume,” strengthens primary care and holds providers accountable for quality and efficiency.

Coordinate care, moving away from the current fragmented health care system toward one in which everyone has a personal source of care that is accessible and accountable.

Invest to accelerate the adoption and effective use of health information technology and target public health initiatives on prevention and efforts to improve outcomes for chronic conditions.

Establish new national policies that foster collaboration among the public and private sectors to set and achieve new goals and carry out reforms.

“The report’s central message is that we all stand to gain by taking bold action,” said Commonwealth Fund Senior Vice President and report lead author Cathy Schoen in a news release. “With middle-income as well as low-income families at risk, and businesses struggling to provide insurance for their employees, there is broad public support for fundamental change. Windows of opportunity for real health reform do not stay open long.” The plan, she concluded, lays out “a challenging but navigable path to a more secure future.”
The report, “The Path to a High Performance U.S. Health System: A 2020 Vision and the Policies to Pave the Way,” is based on national and international studies and policy analyses done by the fund’s Commission on a High Performance Health System since 2005.
The report says if implemented, the proposal would slow the growth of health care spending from 2010 to 2020 from 6.7 percent per year to 5.5 percent, or a cumulative $3 trillion of the $42 trillion the United States is expected to spend over the next 11 years.
The cumulative savings would accrue to families, business and the public sector, the report says, and savings would extend across all income groups, and at the same time, coverage and access would be extended to all U.S. residents.
Without new national policies, the number of uninsured is projected to increase to 61 million over the next decade, not counting more than 25 million more who are underinsured, the fund said. Simultaneously, national health spending is expected to double to $5.2 trillion per year by 2010, to consume 21 percent of national resources.
The full report is available at www.commonwealthfund.org.

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