AMSA On Call

Go Back

How we pay for medical care in 2014: Paying for quality and efficiency



Whitney McFadden
AMSA Health Policy Chair


Bodenheimer and Grumbach outlined in their book, Understanding Health Policy: A Clinical Approach, a view of health policy and the faults of our current healthcare system. It seems we are very familiar with the pitfalls of our current system. In order to be clear and not dwell too much on the obvious, our system struggles with overuse and underinsurance/lack of insurance that is being addressed with the Affordable Care Act. Today we pay for healthcare out-of-pocket, with individual private insurance, employment based private insurance, or government financing. Insurance plans for healthcare began in the depression due to unstable payments. Medicare was established to cover the elderly and lower income individuals. Currently physicians are paid in a multi-tier system including fee-for-service, episode illness grouping, capitation (per head fee to general practitioner and specialist), and salary.
 
2014 will be a year of new payment methods for healthcare. The sustainable growth rate (SGR) has historically be underfunded requiring congressional intervention to avoid the reduction in payment to medical reimbursement that would make it unsustainable. This year, a bipartisan fix will change payments to value based on measure of better quality and efficiency instead of the current greater volume and intensity of services. Some evidence exists in community clinics that this method has been successful and alternative payment models (i.e. transitional care) have been attempted as possible solutions. McClellan makes the point that we currently do not know how to create a system that is cheaper and rewards improved health outcomes. 

One solution is single payer healthcare, which addresses the funding source. However our problems with how payments will be made to increase efficiency would still remain. There are methods by which we can change the way our healthcare dollars are spent, but we will not find those solutions on the national stage. Instead, each clinic and hospital must look at their individual patient population, the diseases they treat, and the access to care in the community in order to develop a system that is financially viable. We would benefit from establishing a medical economics team at every health provider institution to allow for individualized services from technologic tools that we know work well. The team based approach to healthcare that is the foundation for our medical training should extent to healthcare funding. Instead of trying to find the rules that would apply to everyone, we need to establish the framework by which everyone can create their rules, and do it with ease, efficiency, and completeness.

Facebook Twitter DZone It! Digg It! StumbleUpon Technorati Del.icio.us NewsVine Reddit Blinklist Add diigo bookmark

Post a comment!
  1. Formatting options
       
     
     
     
     
       

What is AMSA On Call?

AMSA On Call is the official blog of the American Medical Student Association. Join us as we discuss the hottest issues in health care. 

Join Us This Fall!

AMSA Training Grounds

This fall, in Chicago and Chapel Hill, future physicians from around the world will come together for inspiration, camaraderie, knowledge, networking and fun—you have to be there! Register today.

Follow Us

Follow us on FaceBook Follow us on Twitter AMSA on YouTube AMSA RSS


Save the Date

AMSA's 2015 Annual Convention
AMSA's 2015 Annual Convention

February 26 - March 1, 2015
Arlington, VA / Washington, DC

Current Campaigns

AMSA actively focuses on campaigns throughout the year that align with our organization's aspirations, mission and values.

The New Physician (TNP)

The New Physician MagazineRead AMSA's award-winning magazine & past issues.