n engl j med 359;12 www.nejm.org september 18, 2008 1200 share this view that aligning provider incentives with payer goals will require organizational forms that can coordinate care more effectively than the fragmented current system.4 There are, fundamentally, no “new” methods of health care payment. Novel approaches such as those described here are new combinations of old ideas, with updated...

The presidential election has focused public attention on the need for health system reform--to ensure health insurance for all, to make health care more accessible and responsive to patients, and to slow the growth in health care cost. This issue brief sets forth a framework for expanding health coverage that offers Americans a choice of a product modeled on Medicare to those under age 65, mad...

This document presents the results from the applied research in health care financing in over 40 countries around the developing world conducted by the Health Financing and Sustainability (HFS) Project. It describes the conceptual framework and outlines for the agenda for the research. It presents the research results, summarizes the findings and policy recommendations, and points to areas for ...

There will be fundamental change in the Millennium, but not enacted in Washington, D.C. American health care is entering the "post-Managed Care" era in which payers, providers, plans, and patients reconstruct a new, more efficient, and, ultimately, more satisfying health care delivery system. The Millennium landscape of this evolving marketplace will be characterized by the following trends: (1...

The United States leads all industrialized countries in the share of national health care expenditures devoted to insurance administration. The U.S. share is over 30 percent greater than Germany's and more than three times that of Japan. This issue brief examines the sources of administrative costs and describes how a private-public approach to health care reform--with the central feature of a ...

OBJECTIVES : To provide descriptive information on behavioral health (BH) productivity and billing practices within a pediatric primary care setting. METHODS : This retrospective investigation reviewed 30 months of electronic medical records and financial data. RESULTS : The percent of BH provider time spent in direct patient care (productivity) was 35.28% overall, with a slightly higher quarte...

All nurses should practice to the full extent of their education and training. This key message from the Institute of Medicine report, The Future of Nursing: Leading Change, Advancing Health, applies to all RNs. Barriers need to come down that prevent nurses from reaching their full potential at a time when the US health care system needs to be operating at full capacity. With the focus of US h...

As hospital, physician, and health insurance markets consolidate and change in response to health care reform, some commentators have called for vigorous enforcement of the federal antitrust laws to prevent the acquisition and exercise of market power. In health care, however, stricter antitrust enforcement will benefit consumers only if it accounts for the competitive distortions caused by the...

Leaders in health care and health care policy believe the U.S. must rein in the growth of health spending, and most believe it is possible over the next 10 years to maintain the current proportion of gross domestic product devoted to health care, the latest Commonwealth Fund/Modern Healthcare Health Care Opinion Leaders Survey finds. Nearly all respondents (96%) agreed that spending must slow, ...

The Veterans Health Administration (VHA) in the Department of Veteran Affairs (VA) has emerged as a national and international leader in the delivery and research of telehealth-based treatment. Several unique characteristics of care in VA settings intersect to create an ideal environment for telehealth modalities and research. However, the value of telehealth experience and initiatives in VA se...