United States Health Care Reform in 2009: A Primer for Gastroenterologists
United States Health Care Reform in 2009: A Primer for Gastroenterologists
The US health care system is characterized by staggering costs alongside limited access, uneven quality, and subpar health outcomes. Although federal policymakers have long acknowledged this health care crisis, there still has been no fundamental realignment in health care organization or delivery. With a new Presidential Administration and deep economic recession, profound changes now appear imminent. These changes are likely to impact gastroenterologists significantly, including who they treat, how they deliver care, and how they are compensated. This article considers the most likely reforms, including health insurance and the drive toward universal coverage; a shift to reimbursement models that reward quality over the entire episode of care; reorganization of health care delivery around more highly integrated practices, patient-centered medical homes, and accountable care organizations; and electronic health records, comparative effectiveness research, and reporting transparency as necessary tools for implementing systemic change. Finally, anticipating these changes, this article concludes with specific recommendations to enable gastroenterologists to adapt to new practice environments.
In the United States health care expenditures average more than $7000 per person and total more than $2.4 trillion, an amount greater than India's entire gross domestic product (GDP) and 2.4 times that spent on health care by the average developed nation. Furthermore, health care spending accounts for an increasing proportion of the US economy: from 1980 to 2006 the share of economic activity devoted to health care grew 6-fold (from 9% to 16% of the GDP) and by 2018 expenditures are projected to exceed 20% of the GDP. These staggering costs exact a severe toll on American households, place American businesses at a competitive disadvantage, and threaten the fiscal balance of federal, state, and local governments. Yet despite such massive spending, access to care can be limited and the quality of care generally is uneven. Compared with Australia, Canada, Germany, New Zealand, and the United Kingdom, the United States ranks last or second to last in quality, access, patient safety, efficiency, equity, adoption of information technology, and quality improvement. Although federal policymakers have long acknowledged staggering costs and lackluster performance, particularly since the election of President Clinton in 1992, there still has been no fundamental realignment in the organization or delivery of US health care.
Only months into his first term, President Obama already has placed health care reform at the top of his policy agenda. Believing that health care reform is critical to the nation's economic recovery, his 2009 economic stimulus package included $150 billion in health care investments, primarily in health information technology and comparative effectiveness research. One month later, in his budget proposal to Congress, the President called for an additional $630 billion in investments through 2020. Determined not to repeat mistakes made by the Clinton Administration, the Obama Administration has invited multiple key stakeholders to participate in a dialog on reform. These participants have provisionally agreed to a certain set of basic principles, especially around cost control. Meanwhile, Congressional leaders are engaged in an intensive process to develop health reform legislation.
Thus, after decades of talking about health care reform profound changes finally appear imminent. Even if all of the initial goals of the Obama Administration are not achieved, changes are likely to affect gastroenterologists significantly, including who they treat, how they deliver care, and how they are compensated. This article considers ongoing and potential reforms that are most likely to influence practicing gastroenterologists, and offers recommendations to enable gastroenterologists to anticipate and adapt to new practice environments.
Abstract and Introduction
Abstract
The US health care system is characterized by staggering costs alongside limited access, uneven quality, and subpar health outcomes. Although federal policymakers have long acknowledged this health care crisis, there still has been no fundamental realignment in health care organization or delivery. With a new Presidential Administration and deep economic recession, profound changes now appear imminent. These changes are likely to impact gastroenterologists significantly, including who they treat, how they deliver care, and how they are compensated. This article considers the most likely reforms, including health insurance and the drive toward universal coverage; a shift to reimbursement models that reward quality over the entire episode of care; reorganization of health care delivery around more highly integrated practices, patient-centered medical homes, and accountable care organizations; and electronic health records, comparative effectiveness research, and reporting transparency as necessary tools for implementing systemic change. Finally, anticipating these changes, this article concludes with specific recommendations to enable gastroenterologists to adapt to new practice environments.
Introduction
In the United States health care expenditures average more than $7000 per person and total more than $2.4 trillion, an amount greater than India's entire gross domestic product (GDP) and 2.4 times that spent on health care by the average developed nation. Furthermore, health care spending accounts for an increasing proportion of the US economy: from 1980 to 2006 the share of economic activity devoted to health care grew 6-fold (from 9% to 16% of the GDP) and by 2018 expenditures are projected to exceed 20% of the GDP. These staggering costs exact a severe toll on American households, place American businesses at a competitive disadvantage, and threaten the fiscal balance of federal, state, and local governments. Yet despite such massive spending, access to care can be limited and the quality of care generally is uneven. Compared with Australia, Canada, Germany, New Zealand, and the United Kingdom, the United States ranks last or second to last in quality, access, patient safety, efficiency, equity, adoption of information technology, and quality improvement. Although federal policymakers have long acknowledged staggering costs and lackluster performance, particularly since the election of President Clinton in 1992, there still has been no fundamental realignment in the organization or delivery of US health care.
Only months into his first term, President Obama already has placed health care reform at the top of his policy agenda. Believing that health care reform is critical to the nation's economic recovery, his 2009 economic stimulus package included $150 billion in health care investments, primarily in health information technology and comparative effectiveness research. One month later, in his budget proposal to Congress, the President called for an additional $630 billion in investments through 2020. Determined not to repeat mistakes made by the Clinton Administration, the Obama Administration has invited multiple key stakeholders to participate in a dialog on reform. These participants have provisionally agreed to a certain set of basic principles, especially around cost control. Meanwhile, Congressional leaders are engaged in an intensive process to develop health reform legislation.
Thus, after decades of talking about health care reform profound changes finally appear imminent. Even if all of the initial goals of the Obama Administration are not achieved, changes are likely to affect gastroenterologists significantly, including who they treat, how they deliver care, and how they are compensated. This article considers ongoing and potential reforms that are most likely to influence practicing gastroenterologists, and offers recommendations to enable gastroenterologists to anticipate and adapt to new practice environments.
