Report calls for re-engineering US healthcare

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The nonprofit, nonpartisan Center for the Study of the Presidency and Congress is calling on all stakeholders to build on the framework of recent healthcare legislation.

"With the historic passage of the Patient Protection and Affordable Care Act and the Health Care and Education Affordability Reconciliation Act, [the] United States has begun the process of forming a firm and ample base to build a modern healthcare system that is more efficient, equitable and effective for all Americans,” according to the report .

“Our nation now has a foundation on which to build a comprehensive framework in which health is put back into the health care system,” the report stated.

Progress, according to the report, must be made in four areas:
1. Re-engineering America’s healthcare system: This can be accomplished by adopting new value-based payment methods, promoting team-based medicine, strengthening primary care and conducting comparative effectiveness research (CER) and health systems research. The report lists 12 recommendations, include shifting incentives toward pay for performance; developing a national strategy for CER; developing an interoperable health IT system available to all healthcare providers; a shift toward team-based medical care; and establishment of a healthcare center "analogous to the Federal Aviation Administration, [with] state-based regulatory mechanisms for reporting and reducing medical errors.”

2. Advancing public health: Among the report’s 10 recommendations in this area are increasing policymaker support for prevention by making an economic case for its cost-effectiveness and social value; extending the Congressional Budget Office scoring metrics time frame to 20 years to estimate long-term cost savings from prevention programs; implementing and expanding nutrition, physical activity and smoking prevention-specific policies at the federal level; and strengthening the public health workforce capacity.

3. Promoting global health and health diplomacy: The report recommends using health diplomacy as a central tool of “smart power,” developing an integrated U.S. global health policy architecture and collaborative framework for supporting; working with multilateral international institutions to create a focus sustainability of health systems; and investing in health workforce development in science, medicine and public health in the developing world, among other things.

4. Securing sustained funding for scientific and medical research: “Biomedical research funding at the National Institutes of Health (NIH) should be increased beyond the short-term boost provided by the stimulus funds in the American Recovery and Reinvestment Act and the Administration’s 2011 budget,” the report states. Other recommendations include increasing basic, behavioral and prevention research funding at NIH; launching the Patient-Centered Outcomes Research Institute; creating an overarching coordinating mechanism for comparative effectiveness and healthcare delivery research across agencies; and establishing a Center for Public Health Research at the CDC to support science in this area and foster interdisciplinary studies that examine the effects of factors such as economic status, housing, food and transportation policies, on health.

“A comprehensive re-engineering of the U.S. healthcare system cannot be achieved by fragmented investments and reforms,” the report concluded. “A 21st century strategy for health reform in the U.S. must…involve both social and personal responsibility to achieve a healthier U.S. All Americans should be able to live in communities in which they can…receive high quality, effective, and compassionate care when it is needed, and be protected from economic hardship due to medical expenses.”