This Issue Brief discusses the evolution of the health care delivery and financing systems and its effects on health care cost management and describes the changes in the health care delivery system as they pertain to managed care. It presents empirical evidence on the effectiveness of managed care and concludes with an analysis of the potential of future health care reform to influence the evo...

A recent policy perspective was published in the New England Journal of Medicine March 5, 2015 by the Secretary of Health And Human Services, Sylvia Burwell, on setting value-based payment goals for Medicare [1]. These goals include having at least 30 % of the Medicare payments provided through such mechanisms as accountable care organizations (ACOs) and bundled episodes of care by 2016, rising...

Many health policy analysts envision provider payment reforms currently under development as replacements for the traditional fee-forservice payment system. Reforms include per episode bundled payment and elements of capitation, such as global payments or accountable care organizations. But even if these approaches succeed and are widely adopted, the core method of payment to many physicians fo...

The possibility of health care reform has helped focus attention on equity in the receipt of health care. This is a particular issue for the Medicaid program, as State variations in eligibility and payment policies have historically created inequity. This study examines equity for Medicaid beneficiaries and State taxpayers during the latter 1980s. Findings indicate that federally mandated expan...

In response to managed care pressures and imminent legislative reforms, provider organizations across the United States are coming together to form organized or integrated delivery systems. This paper describes various approaches to developing such systems and, drawing on ongoing research, examines what is known about the performance of such systems, the barriers they face, and the key factors ...

Scholars and lawyers working in the area of public policy have been preoccupied with the issue of how to maintain social values in a shifting governance framework. Much of the debate has been focused on specific sectors and defensive strategies. In the area of welfare reform, in particular, criticism has been directed at cutbacks in client benefits and reduced provider accountability due to the...

Sweden and Spain experiment with different provider models to reform healthcare provision. Both models have in common that they extend the role of the for-profit sector in healthcare. As the analysis of Saltman and Duran demonstrates, privatisation is an ambiguous and contested strategy that is used for quite different purposes. In our comment, we emphasize that their analysis leaves questions ...

New strategies to control U.S. health spending growth are urgently needed. Although provider payment cuts are likely, cutting fee-for-service (FFS) payments will hurt quality and access. A more sensible approach would be to restructure the delivery system into organized networks of providers delivering reliable, evidence-based care. But restructuring will not occur without payment policy reform...

There is a general shortage of healthcare providers, ranging from physicians to physical therapists. These shortages will reach crisis levels when more than 30 million people are mandated in 2103 to acquire healthcare insurance and are added to pool of prospective patients. Even now, absent those more than 30 million, it is difficult to schedule an appointment with a primary care provider. Thus...

The Catholic Health Association (CHA) Leadership Task Force on National Health Policy Reform has offered a proposal that, if enacted by Congress, would result in profound changes in the way providers deliver healthcare in the United States. The proposal would result in fewer acute healthcare facilities, challenge some acute care facilities to provide additional services and require each Catholi...