Millions of Americans lack reasonable access to health care and are fearful that an illness or a change in their circumstances could deprive them of coverage. Many people are also confused and discouraged by complex rules and procedures associated with their health insurance coverage. Moreover, despite considerable attention to the cost of medical services, little is known about how to control or reduce the costs of health care in a way that will substantially improve the quality of service.
Consequently, a key goal of healthcare reform should be to eliminate financial barriers to access to health services and ensure that all individuals have adequate, affordable health insurance coverage. To achieve this goal, reform proposals should be designed to meet six key principles:
First, a core package of basic or essential health benefits must be defined and updated periodically to take into account advances in technology and changing community values. The process for defining this package should be transparent and involve consultation with the public.
Second, requirements that individuals share in the costs of health coverage and health services should be adjusted by income, within the bounds of administrative feasibility. This will help to reduce incentives for health plans to seek out only healthy individuals and avoid those who may require costly care.
Third, the prevailing fee-for-service payment system should be replaced by methods that better reward health care organizations and health care practitioners for improving the effectiveness and efficiency of their services. This includes establishing performance measurement systems for all health care organizations, requiring transparency in the pricing of health care services, and tying physician Medicare reimbursements to quality measures.