If We Pay for Value, Will We Get It?

Quality measurement and performance-based payment systems are intended to promote high-value health care. Medicare is beginning to shift from process to population-based outcome measures, but the service (rather than the outcome) remains the focus under fee-for-service payment. An emerging challenge: how to mesh the differing perspectives of payers, providers, and consumers on what constitutes value in health care.

Treading water: the no-growth investment in health services research.

There is a "perfect storm" brewing in the American healthcare system. Healthcare spending has grown faster than our economy for many years and is projected to double in as little as 10 years. In spite of what we spend on healthcare, research tells us that we only receive appropriate care half the time. We are simply not getting what we are paying for. Health services research provides the data and the evidence needed to make better decisions, design healthcare benefits, and develop effective policies to optimize healthcare financing, facilitate access to healthcare services, and improve healthcare outcomes. Despite what we know and what we can learn from health services research, federal funding for this important field continues to erode. This article provides a primer on the federal budget process and summarizes findings from the Federal Funding for Health Services Research 2007.

Ensuring access to affordable drug coverage in Medicare.

The long-awaited outpatient prescription drug benefit in Medicare began January 2006. Despite its importance, the drug benefit is controversial. Instead of paying directly for prescriptions, the program will operate through competing private plans. Although it is too early to assess the full impact of Part D on beneficiaries, health plans and providers, employers, and taxpayers, we can discuss the major tradeoffs that will determine the success of the program. Key issues include whether market-based approaches will be more effective than direct government intervention in limiting spending; how will beneficiaries, drug plans, employers, and States adapt to the new program; and the balance between cost containment and access to innovative pharmaceuticals.

Reforming health insurance: realistic options and hard choices.

The persistently high number of people reporting that they have no health insurance has precipitated a number of new comprehensive proposals to extend coverage to most Americans. Such proposals must find solutions to fundamental problems that have thus far eluded policymakers, including the role of government regulation, how much to spend, and who should pay. The experience of the 1990s suggests that an effective policy would offer more choices of health plans through the private market, limit unnecessary government regulation, and provide appropriate subsidies to individuals.