Health experts urge insurance, pay changes

WASHINGTON (Reuters) - U.S. lawmakers returning next week to work on major healthcare legislation need to focus on insurance market reforms, consumer rebates and other measures that will curb soaring costs over time, economic and health experts said on Tuesday.

Registered Nurse Kimberly Arial (L) and Martha Dixon, M.D. work to treat a patient inside the emergency room at Ben Taub General Hospital in Houston, Texas July 27, 2009. REUTERS/Jessica Rinaldi

The group of academics outlined dozens of changes in their report, from restructuring payments under the Medicare insurance program for the elderly and disabled to providing doctors incentive payments for helping avoid costly treatments or complications.

All of the proposals, some of which are already included in various congressional plans, together will help provide better care for patients while lowering costs over time, said Dr. Mark McClellan, a former economic official under President Bill Clinton and health official under President George W. Bush.

“We turned away from focusing just on short-term, isolated individual measures. While those small things like cutting Medicare prices across the board can have some short-term benefit, we don’t think steps like that are sufficient,” said McClellan, head of the Engelberg Center for Health Care Reform at the Brookings Institution, a Washington think tank that led the group.

Much of the national debate over efforts to reform the U.S. healthcare system and provide more Americans access to health insurance has centered around whether the government should provide its own alternative insurance plan and how much the overhaul will cost.

President Barack Obama, who made reform efforts a cornerstone of his campaign, has said he wants to pass a plan this year.

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With congressional Democrats and Obama set to renew their pitch, the group said lawmakers need to ensure that final legislation includes various steps aimed at structural changes and payment incentives to reduce costs even decades from now.

While some of the group’s proposals are not new -- such as promoting electronic health records and research that compares rival treatments -- they join a chorus of other recent reports and comments that could help focus the debate.

“We believe that legislation needs to support a set of individual changes to help us get there,” McClellan told reporters in a conference call to discuss the report.

Among the recommendations are insurance industry changes that would make it easier to pool consumers who do not get health coverage from their employers, according to the group’s members, who hail from Harvard University and the University of California as well as other universities and think tanks.

Limits to employer tax breaks for insurance as well as a bidding process for private Medicare plans would also help foster insurance competition and lower costs, they said.

Robert Zirkelbach, spokesman for the industry group America’s Health Insurance Plans, declined to comment on the recommendations but said the group supports efforts aimed at containing costs and making insurance more affordable. The group represents Cigna Corp, UnitedHealth Group Inc and Aetna Inc, among others.

McClellan’s group also said payment changes are needed for doctors and other healthcare providers such as lump-sum, or “bundled,” payments for a treatment that would discourage costly mistakes rather than payments for each service.

Consumers, too, need added incentives to stay healthy such as rebates on their insurance premiums for meeting certain health goals or reducing their risk for disease by quitting smoking or other steps, it added.

The groups report, funded by the Robert Wood Johnson Foundation, was posted online at

Editing by Mohammad Zargham