Paradox and Imperatives in Health Care : Redirecting Reform for Efficiency and Effectiveness, Revised Edition

**The Paradox:** Americans are not as healthy as people in dozens of comparable countries that spend 30 percent less on health care, and our medical marketplace overall is plagued by persistent problems of cost, quality, and access. Yet, the world’s best individual health systems are located in the U.S.—each a unique result of visionary leadership and private initiative, not government-driven health reform.**The Imperatives****:** Due to powerful new forces explained in this book, medical spending has stopped growing. Purchasers, payers, and patients are no longer willing or able to keep paying more. To stay in business and improve population health, providers and their business partners must eliminate the shameful waste generated by inefficient and ineffective production processes.**The Solution****:** Simply repairing or repealing the Affordable Care Act will not get us where we want to go. The fundamental roadblock is a wasteful system, not uninsured Americans. Reform needs to be immediately redirected to creating the best health care system that 17 percent of GDP can buy. Money saved by taking the new path to reform can then be used to improve population health through access for all. **Paradox and Imperatives in Health Care** is the roadmap for getting there. * Supplies updated perspectives on health care’s problems and solutions * Details the reasons why government-driven reform does not solve problems * Provides a justification for regulatory relief tied to performance improvement * Suggests specific new policies for a better approach to desired outcomes * Presents content written expressly for busy executives and policy makers "__This book displays my enduring optimism that visionary leaders who understand the paradox and imperatives are capable of delivering affordable, world-class health services to all Americans. After 45 years in the medical sector, I am an insider who cares deeply about improving our delivery system—a constructive contrarian excited by possibilities for a better future. To start moving us in this new direction, I propose private sector actions for providing care right all the time, as inexpensively as possible."__ —Jeffrey C. Bauer, Ph.D., Medical Economist and Health Futurist The Paradox: Americans are not as healthy as people in dozens of comparable countries that spend 30 percent less on health care, and our medical marketplace overall is plagued by persistent problems of cost, quality, and access. Yet, the world’s best individual health systems are located in the U.S.—each a unique result of visionary leadership and private initiative, not government-driven health reform. The Imperatives : Due to powerful new forces explained in this book, medical spending has stopped growing. Purchasers, payers, and patients are no longer willing or able to keep paying more. To stay in business and improve population health, providers and their business partners must eliminate the shameful waste generated by inefficient and ineffective production processes. The Solution : Simply repairing or repealing the Affordable Care Act will not get us where we want to go. The fundamental roadblock is a wasteful system, not uninsured Americans. Reform needs to be immediately redirected to creating the best health care system that 17 percent of GDP can buy. Money saved by taking the new path to reform can then be used to improve population health through access for all. Paradox and Imperatives in Health Care is the roadmap for getting there. Supplies updated perspectives on health care’s problems and solutions Details the reasons why government-driven reform does not solve problems Provides a justification for regulatory relief tied to performance improvement Suggests specific new policies for a better approach to desired outcomes Presents content written expressly for busy executives and policy makers " This book displays my enduring optimism that visionary leaders who understand the paradox and imperatives are capable of delivering affordable, world-class health services to all Americans. After 45 years in the medical sector, I am an insider who cares deeply about improving our delivery system—a constructive contrarian excited by possibilities for a better future. To start moving us in this new direction, I propose private sector actions for providing care right all the time, as inexpensively as possible." —Jeffrey C. Bauer, Ph.D., Medical Economist and Health Futurist "Most hospitals, health systems, and other provider organizations in the U.S. are still facing financial peril from continuing cuts in Medicare, new federal legislation, and a precarious economic environment. The second edition of this book updates analysis, forecasts, and recommendations made by the author. The book discusses the evolution of the Affordable Care Act, related regulatory trends, and changes in the roles and the business models of third-party health insurers. It also includes an expanded focus on the relative strengths and weaknesses of different business models for organizing the delivery of care, Case studies are included"--Provided by publisher. Introduction: The ParadoxThe ParadoxThe ImperativesAnalytical Foundation for SolutionsThe Target AudienceNote on AuthorshipThe Economic Challenge: ChaosEnd of Growth in Spending: The New NormalDramatic Decline in Overall Economic GrowthIncreasing Demands from Other SectorsConstrained Consumer SpendingIncreasing Diversification and CompetitionImprovement in Scientific Indications for Medical CareThe More Things ChangeThe Bottom Line: Redirecting ReformProblems with Predicting the Future of Health CareMedical Professionalism and Solving Economic ProblemsNotesThe Economic Imperative: Efficiency (.. Front Cover 1 Contents 8 Chapter 1: Introduction: The Paradox 12 Chapter 2: The Economic Challenge: Chaos 22 Chapter 3: The Economic Imperative: Efficiency (Cost) 44 Chapter 4: The Clinical Imperative: Effectiveness (Quality) 66 Chapter 5: Tools for Efficiency and Effectiveness 88 Chapter 6: Redirecting Reform: Strategic Recommendations 114 Chapter 7: Epilogue: Organizational Success Factors for Efficiency and Effectiveness 138 About the Author 148 Back Cover 152