Healthcare Reform Must Include Multiple Components

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Wayne Kuznar

The current economic crisis offers an opportunity to focus on priorities in healthcare in an effort to enact true healthcare reform, said Len Nichols, PhD, healthcare economist and Director of the Health Policy Program at the New America Foundation, during the 2009 annual meeting of the American College of Cardiology (ACC).

The key components of healthcare reform will include not only expansion of coverage but also reform of delivery systems, payment reform, alignment of incentives, and reductions in the growth of healthcare costs. Expansion of coverage is estimated to cost $150 to $175 billion annually, or about 1% of gross national product.

In the end, “the cost of doing nothing is high,” said Dr Nichols. Business as usual will soon no longer be affordable, he said.

For payment reform to occur, investment in delivery systems will be necessary for health information technology research to compare the effectiveness of various strategies, as well as payment reform. “It is critical that we align incentives among providers, payers, and patients,” said Dr Nichols. Sharing risks and rewards in sustainable ways is key in the shift from the current fee-for-service system, he said. Malpractice reform and verification of quality care are other crucial components.

Dr Nichols warned of the danger of “brute-force price controls” in reform, and spoke of the importance of the appropriate use of technologies and procedures.

Along these lines, a separate symposium on appropriate use criteria underscored the value of appropriate use criteria in limiting the growth in healthcare spending.

The use of imaging procedures in particular has been growing more rapidly than other procedures, and represents an area that can be contained to reduce costs, said Pamela Douglas, MD, past president of the ACC and professor for research in cardiovascular diseases at Duke University in Durham, North Carolina.

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Last modified: February 14, 2019
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