The U.S. healthcare system faces huge challenges. It is the most expensive in the world, imposes unacceptable constraints on access to a substantial proportion of the population, and delivers poorer outcomes on average than almost all peer countries, including shorter expected life spans. As the U.S. moves toward the 2020 national election, there is no shortage of suggested solutions for getting out of this morass. Yet the country is as far as ever from agreeing on a solution, with major disagreements both within and between political parties and other stakeholders. We need a road forward.
HMPI is delighted to offer ten articles by scholars and policy analysts that seek to break the partisan gridlock. None of these arguments is wedded to a specific solution. Instead, to the extent that the authors have preferred systems, they reflect the varied cultures and preferences of the states and communities in the country. In turn, and most importantly, the authors highlight practical principles with the potential to cut across partisan boundaries to help build workable solutions that will have broad-based support in the country.
Among the principles, four aspects stand out: measurement, competition, longer-term decision making, and distributed decision making. First, the authors highlight multiple opportunities to overcome the obscurity within which providers and payers within the U.S. healthcare system work. They identify feasible opportunities to measure health outcomes, healthcare processes, costs, pricing, and quality-cost combinations. Such improved measurement can serve as the basis for greater cost-effectiveness, quality discipline, and access facilitation in any reformed healthcare system.
Second, several of the authors highlight the benefits of competition in a healthcare system with a mix of public, private, and non-profit actors. Competition, in combination with transparent measurement of quality, costs, prices, and access, is likely to be an integral part of any solution that is viable in the U.S.
Third, several authors offer suggestions for how to overcome the short-term decision-making within the existing silos of the healthcare system. Current incentives over-emphasize immediate treatments of health problems rather than promoting health maintenance or taking life-cycle perspectives on superior and cost-effective treatments. The suggestions, including long-term insurance, bundled payments, and other tools, are relevant to multiple combinations of healthcare reform.
Fourth, the suggestions highlight viable opportunities for distributed decision-making within a nationwide healthcare system. For instance, block grants to states combined with national objectives can support local and individual choices about healthcare preferences.
Thoughtful people might disagree about whether the U.S. healthcare system is in a crisis. Unambiguously, though, there is widespread recognition that the country is far from achieving the benefits that the financial investments, technical skills, and innovative advances this country should produce as a matter of course. We believe that the ideas in this special issue of HMPI will generate conversations that can lead to strong solutions with bipartisan support. The U.S. is one of the strongest healthcare innovators globally – if not the strongest. It is time that the country also takes a global lead in creating a healthcare system that offers a robust combination of access, quality, and cost-effectiveness.
Will Mitchell
Professor of Strategic Management
Anthony S. Fell Chair in New Technologies and Commercialization
Rotman School of Management, University of Toronto
Affiliated Faculty, Duke Medical School, Biostatistics and Bioinformatics