Ten (or more) ways to improve health system efficiency

The Commonwealth Fund offers ten ways to improve the health system. The Institute of Medicine (PDF) offers its set of ten. My list of directions for reform that deserve more consideration and debate do not completely overlap:

  • Health savings accounts circumscribed according to value-based design
  • Removing preferential tax treatment of health insurance
  • Competitive bidding
  • Shared decision making
  • Death panels (no, not really, more like bodies that synthesize studies for evidence-based care)
  • Reference pricing
  • Value-based contracting
  • Administrative simplification
  • Legal safe harbor for providers and insurers that base decisions on evidence
  • Longer-term (> 1 year) insurance contracts
  • Price transparency

One correspondent suggested:

  • More risk-rating and larger subsidies for those who can’t afford their premium
  • Med mal reform to reduce claims frequency
  • Kill the GME program

There’s a whole lot that could be done in the area of pharmaceuticals and devices. There’s stuff that could be done in the areas of antitrust and medical practice ownership. What else? You may have other ideas. Put them in the comments.

Though I do like some of the above very much, I am not endorsing or promoting any of them in this post. (I have in others.) I will say only that most or all of them are far more interesting approaches than what we normally see coming out of Congress.



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