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All of the above are true, previously tested, and grossly oversimplified. At the root of a failure to innovate are two issues: 1. Over regulation (or irrational regulation) – risk aversion is a rational response to draconian penalties for bureaucratic non-compliance (that is independent of clinical outcomes). 2. A perverse fee-for-service incentive system rewarding over utilization and low-value care (RVU base reimbursement). Until the payment system truly moves to a risk-based, value based model that rewards successful individual and population health management and outcomes, we will be stuck with increasing costs and lower quality. But to achieve a value based approach, people will need to accept narrow provider networks and commit to longer periods of affiliation with a given plan or, alternatively, a single payer system (which can still be market-based and is not the same as Government-run healthcare, a common false claim). We currently have a “sick-care” system, not a healthcare system. Incentives must include rewarding “upstream” primary/primordial preventative care that will take years to decades to see ROI but will be absolutely necessary to bend the healthcare cost curve. Rewarding providers and systems for short-term encounters fosters more lower value care. You get what you incentivize.
We are an outlier among advanced countries when it comes to the cost of health care. We’ve been waiting for innovation and/or something like narrow networks (restricting a patient’s choice of provider) to “solve the problem” for many decades. It’s well past time to recognize that our costs are high because our health care prices are high (“It’s the prices, stupid”). Other advanced countries have solved this problem in a number of different ways. We need the political will to copy one or more of these price-controlling mechanisms if we are to address our health care cost problem.