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Material: Michael E.Porter ‘s paper named a Strategy for Health Care Reform- toward a value based system issued in Jul.09,2009 the New England Journal of Medicine.
Reflection: what we need now is a clear national comprehensive vision for the kind of health care system we want to achieve and a path for getting there. The central focus shall be increasing value for patients –the health outcomes achieved per dollar spent. Good outcomes that are achieved efficiently are the goal, not the false savings from cost shifting and restricted service. The only way to truly contain costs in health care is to improve outcomes: in a value-based system, achieving and maintaining good health is inherently less costly than dealing with poor health. True reform will require both moving toward universal insurance coverage and restructuring the care delivery system. How can we achieve universal coverage in a way that will support, rather than impede, a fundamental reorientation of the delivery system around value for patients? There are several critical steps. First, we must change the nature of health insurance competition. We must introduce regulation to end coverage and price discrimination based on health risks or existing health problems. In addition, health plan shall be required to measure and report their subscriber’s health outcomes, starting with a group of important medical conditions. Second, we must keep employers in the insurance system; third, we need to address the unfair burden on people who has no access to employers-based coverage who therefore face higher premiums and greater difficulty on securing coverage. Fourth, to make individual insurance affordable, we need large statewide or multistate insurance pools, fifth, income-based subsidies will be needed to help lower income people to buy insurance, finally once a value-based insurance market had been established, everyone must be required to purchase the insurance so that young and healthier people could not opt out. For restructuring the delivery system where most of the value is created and most of the costs are incurred. First, measurement and dissemination of health outcomes shall become mandatory for every provider and every medical conditions. Second, we need to radically reexamine how to organize the delivery of prevention, wellness, screening and routine health maintenance services. Third, we need to reorganize care delivery around medical condition. Fourth, we need a reimbursement system that aligns everyone’s interests around improving value for patients. Fifth, we must expect and require providers to compete for patients, based on value at the medical-condition level, both within and across state borders. Sixth, electronic medical records will enable value improvement, but only if they support integrated care and outcome measurement. Finally consumers must become much more involved in their health and health care. Michael port did not mention why this is the right strategy.
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