Introduction
The Commonwealth Fund Commission on a High Performance Health System has stated that the objective of health care and a health system, for a population and the individuals in it, is to lead to longer, healthier and more productive lives. For health care to make this contribution everyone must have access to it; and the care must be of excellent quality (effective and safe), efficient (without waste of time or resources), and equitable. The Commission has gone further to recommend five key strategies to achieve these outcomes. These are:
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Extend affordable health insurance to all;
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Align financial incentives to enhance value and achieve savings;
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Organize the health care system around the patient to ensure that care is accessible and coordinated;
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Meet and raise benchmarks for high-quality, efficient care; and
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Ensure accountable national leadership and public/private collaboration.
In addition, my colleagues Karen Davis, president of The Commonwealth Fund, Cathy Schoen, and I, back at the turn of the millennium set out a "2020 Vision for a Patient-Centered Health System" that addresses your first question about the critical characteristics and enablers of a safe, patient-centered, high quality health system that optimizes patient outcomes. the vision included the following elements:
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Superb access, quality, and safety for all;
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Patient engagement in care;
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Clinical information systems that support high-quality care, practice based learning, and quality improvement;
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Care coordination;
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Integrated and comprehensive team care;
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Routine patient feedback to hospitals and physicians; and
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Publicly available information on patient-centered care, clinical quality, efficiency
Currently, the majority of adults in the U.S.—73 percent—report having access problems such as getting an appointment with a doctor the same or next day when sick without going to the emergency room—30 percent, getting advice from their doctor by phone during regular office hours—41 percent, or getting care on nights, weekends or holidays without going to the emergency room—60 percent. In addition, 47 percent, report problems with coordination of care such as failure to provide important information about their medical history or test results to other doctors or nurses they think should have it, not having test results or medical records available at the time of a scheduled appointment, their physician not receiving a report back from a specialist they had seen, etc. Interestingly, roughly 90 percent or more report that it is important or very important to have one place or doctor responsible for primary care and coordinating care, having a place to go on nights and weekends besides the emergency room, having access to their own medical records, and having all of their doctors have access to their medical records when needed.
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