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Health Care EconomicsFull Access

Other Options To Control Costs

Published Online:https://doi.org/10.1176/pn.39.18.0390008a

If consumer-directed health care is used primarily as a tool to shift costs from employers to employees, it will be quickly discredited, argues Karen Davis, Ph.D., president of the Commonwealth Fund.

Instead, she proposes five steps to help achieve a high-performance health care system:

Public reporting of cost and quality data. The routine collection of comprehensive quality measures across a broad range of providers is necessary to improve performance.

Investment in information technology. Other countries, with financial support from their governments, are surpassing the United States in adopting the use of electronic medical records and electronic prescribing.

Development of guidelines and standards. Establishing a National Institute on Clinical Excellence and Effectiveness could provide a scientific basis for the effectiveness of drugs, consultations, procedures, and tests.

Rewarding performance. Medicare and private insurance tend not to reward better care, including better management of high-cost conditions. Medicare can and should be a leader in promoting more effective care and should help to encourage private payers to reward higher quality.

Investment in research. The federal government annually pays $455 billion for health care in the United States but devotes only $300 million to the budget of the Agency for Healthcare Research and Quality. More research regarding ways to improve care, eliminate waste and ineffective care, and promote greater efficiency is crucial to improving the performance of the U.S. health system.