November 15, 2007 / 5:25 AM / 10 years ago

Map to better U.S. health care: centralize, organize

By Maggie Fox, Health and Science Editor

WASHINGTON, Nov 15 (Reuters) - Experts laid out a health care road map for U.S. presidential candidates on Thursday, recommending more organized care, with an emphasis on overall health as opposed to expensive interventions.

They said it will be essential to ensure that everyone in the United States has health insurance and said the most pragmatic way to achieve this would be a combination of federal, state, employer and private coverage.

And the country needs to train more primary care physicians and move away from expensive, specialized medicine, the panel appointed by the non-profit Commonwealth Fund recommended.

"We do not get good value for our health care dollars," Karen Davis, president of the Commonwealth Fund, told reporters in a telephone briefing. "The United States falls short when compared to other countries."

The Fund, which commissions research on health care and advocates for universal coverage, issued a scorecard in October 2006 that gave the United States a rating of 66 out of a possible 100 on 37 health indicators such as premature death and infant mortality.

Earlier this week the Organization for Economic Cooperation and Development noted that Americans spend far more than any other country on health care at $6,401 per person per year in 2005, compared to the OECD average of $2,759.

The 2008 elections represent a unique opportunity to turn around rising spending and set up a system that will provide better care for everyone, Davis said.

"There is no question that health care is at the top of the nation's agenda in the presidential election and will be key issue for the next president," she said.

Most of the 2008 presidential candidates have offered some kind of health care proposal, with Democrats mostly calling for expansions of government insurance augmented by the private sector and Republicans advocating a market-based approach.

UNFETTERED PAYMENTS

The Fund appointed a committee of health policy experts from government, private industry, health care delivery organizations, academia, and professional associations to come up with a plan.

One of the main recommendations was to move away from "unfettered fee for service" payments that encourage doctors to perform expensive procedures such as diagnostic screening tests or surgical operations.

Instead, doctors should be rewarded for keeping patients healthy, said Dr. James Mongan, chief executive officer of Partners HealthCare System, Inc. in Boston and chair of the panel.

Insurance companies can help do this but first everyone needs insurance, Mongan said. "The first strategy is affordable coverage for all Americans," he said. Currently, 47 million Americans have no health insurance.

Some of this might be mandated, the report said, and insurers may have to be barred from refusing coverage to some people.

Another must-have: electronic health records. That will be the basis for another recommendation, which is more cohesive care, with doctors talking to one another and patients taking more of an active role in managing their own health.

Not all decisions can be left to a free market, the panel said. "Many of the highest-cost patients arrive at a hospital on a stretcher, with little or no ability to make care decisions. Every American -- not just those with the luxuries of time and ability to navigate their way -- deserves excellent care," the report reads.

(Reporting by Maggie Fox; Editing by Stuart Grudgings)



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