How Reform Went Wrong
Scoping the Problem | Identifying the Root Causes | How Reform Went Wrong | Value–Based Competition
The problems with the U.S. health care system are not the result of inattention. Well-intended reformers have long recognized that the system has been on a collision course with demographic and economic reality. However, reform efforts have failed because the diagnosis of the problem was wrong. With the wrong diagnosis, the attempts to treat the system have addressed the wrong issues or offered piecemeal, ultimately ineffective solutions aimed at symptoms rather than causes.
Redefining Health Care reviews the history of the U.S. health care system and the many attempts to improve it. The book examines why the major reform movements have failed despite the concerted efforts of countless dedicated, intelligent, and knowledgeable groups and individuals. These reform movements have overlapped in time, in repeated waves of actions and reactions. Fortunately, a few of the newer initiatives show promise of moving the system in the right direction, but none of the proposed reforms will, by themselves, fix the system.
Past Objective: Reduce costs, avoid costs
Focus was on costs, bargaining power, and rationing.
System characterized by:
Focus was on legal recourse and regulation.
System characterized by:
Present Objective: Enable choice, reduce errors
Focus is on choice of health plan.
System characterized by:
Focus is on provider and hospital practices.
System characterized by:
Future Objective: Increase value
Focus should be on the nature of competition.
System characterized by:
Source: Porter, M., and E. Teisberg, “Redefining Competition in Health Care,” Harvard Business Review, June 2004, 64–77. Copyright © 2004 Harvard Business School Publishing Corporation. All rights reserved.
