More than two-thirds of respondents to the latest Commonwealth Fund/Modern Healthcare Health Care Opinion Leaders Survey believe the way we pay for health care in the United States must be fundamentally reformed. Fee-for-service payment—the most prevalent system throughout the country—is not effective in encouraging high-quality, efficient care, they say.
In the survey, there was strong support for a move away from fee-for-service payment and toward bundled approaches—that is, making a single payment for all services provided to a patient during the course of an episode or period of time. Under fee-for-service, providers are reimbursed for individual services, like hospital stays and medical procedures, rather than for providing the most appropriate care for the patient over the course of an illness. This creates incentives for providing more technical and more expensive, but not necessarily more effective, care.
When asked their opinions about policies for improving U.S. health system performance, 85 percent of survey respondents cited fundamental provider payment reform, including incentives to provide high-quality and efficient care over time, as an effective strategy. "The current financial crisis has changed the nature of the debate over health reform," said Karen Davis, Commonwealth Fund president. "More than ever, it will be essential to craft a plan that will give more Americans health security while simultaneously controlling costs. These results show that most leaders favor rethinking the way we pay health care providers, in order to attain better value and lower costs for the nation."