Health care reform

Abstract: Improving the U.S. health care system requires simultaneous pursuit of three aims: improving the experience of care, improving the health of populations, and reducing per capita costs of health car...

Abstract: 100 years ago a series of studies about the education of health professionals led by the 1910 Flexner report sparked groundbreaking reforms. Through integration of modern science into the curricula at university-based schools the reforms equipped health professionals with the knowledge that contributed to the doubling of life span during the 20th century. By the beginning of the 21st century however all is not well. Glaring gaps and inequities in health persist both within and between countries underscoring our collective failure to share the dramatic health advances equitably. At the same time fresh health challenges loom. New infectious environmental and behavioural risks at a time of rapid demographic and epidemiological transitions threaten health security of all. Health systems worldwide are struggling to keep up as they become more complex and costly placing additional demands on health workers. Professional education has not kept pace with these challenges largely because of fragmented outdated and static curricula that produce ill-equipped graduates. The problems are systemic: mismatch of competencies to patient and population needs; poor teamwork; persistent gender stratification of professional status; narrow technical focus without broader contextual understanding; episodic encounters rather than continuous care; predominant hospital orientation at the expense of primary care; quantitative and qualitative imbalances in the professional labour market; and weak leadership to improve health-system performance. Laudable efforts to address these deficiencies have mostly floundered partly because of the so-called tribalism of the professions--ie the tendency of the various professions to act in isolation from or even in competition with each other. Redesign of professional health education is necessary and timely in view of the opportunities for mutual learning and joint solutions offered by global interdependence due to acceleration of flows of knowledge technologies and financing across borders and the migration of both professionals and patients. What is clearly needed is a thorough and authoritative re-examination of health professional education matching the ambitious work of a century ago. That is why this Commission consisting of 20 professional and academic leaders from diverse countries came together to develop a shared vision and a common strategy for postsecondary education in medicine nursing and public health that reaches beyond the confines of national borders and the silos of individual professions. The Commission adopted a global outlook a multiprofessional perspective and a systems approach. This comprehensive framework considers the connections between education and health systems. It is centred on people as co-producers and as drivers of needs and demands in both systems. By interaction through the labour market the provision of educational services generates the supply of an educated workforce to meet the demand for professionals to work in the health system. To have a positive effect on health outcomes the professional education subsystem must design new instructional and institutional strategies. (excerpt)

Abstract: Patient engagement is an increasingly important component of strategies to reform health care. In this article we review the available evidence of the contribution that patient activation—the skills and confidence that equip patients to become actively engaged in their health care—makes to health outcomes, costs, and patient experience. There is a growing body of evidence showing that patients who are more activated have better health outcomes and care experiences, but there is limited evidence to date about the impact on costs. Emerging evidence indicates that interventions that tailor support to the individual’s level of activation, and that build skills and confidence, are effective in increasing patient activation. Furthermore, patients who start at the lowest activation levels tend to increase the most. We conclude that policies and interventions aimed at strengthening patients’ role in managing their health care can contribute to improved outcomes and that patient activation can—and should—be measur...

Abstract: In the most important health insurance study ever conducted researchers at the RAND Corporation devised all experiment to address two key questions in health care financing: how much more medical care will people use if it is provided free of charge, and what are the consequences for their health? For three- or five-year periods the experiment measured both use and health outcomes in populations carefully selected to be representative of both urban and rural regions throughout the United States. Participants were enrolled in a range of insurance plans requiring different levels of copayment for medical care, from zero to 95 percent. The researchers found that in plans that reimbursed a higher proportion of the bill, patients used substantially more services - indeed, those who paid nothing used 40 percent more services than those required to pay a high deductible - but the effect on the health of the average person was negligible. In addition, participants who were assigned at random to a well-established health maintenance organization used hospitals substantially less than those in the fee-for-service system, again with no measurable effect on the health of the average person. This book collects in one place for the first time results previously dispersed through many journals over many years. Drawing comprehensive, coherent conclusions from an immense amount of data, it is destined to be a classic work serving as an invaluable reference for all those concerned with health care policy - health service researchers, policymakers in both the public and the private sectors, and students.