What works and what doesn't work well in the US healthcare system — Luft 2006

Most believe that the US healthcare system is expensive, inconsistent, and leaves many uninsured. Reform has minimal policy consensus. Several ideas assume that systems that operate in one nation may be transferred to another or that only modest adjustment is possible. The former ignores basic social, political, and legal realities, while the latter ignores prospective benefits. Ideological proposals focus on financing increased coverage. Expanding the debate to evaluate other system components that don't perform well may reveal enough benefits for stakeholders to involve them in finding more complete solutions to a variety of problems. This study analyzes the American healthcare system's strengths and weaknesses. In the first category are the high proportion of people without coverage, the inefficient and inequitable incentives for the purchase and provision of insurance, the problems in deciding what should be covered, the ineffective payment incentives, administrative costs and complexities, the variable quality and lack of responsiveness to patient preferences, the less than optimal safety, under-valued primary care, provider de-professionalisation, and the costs that appear to be The second category includes rapid and widespread technical innovation, insured access to care, and clinical and patient autonomy. Our constitutional political system and public values about government and individuals are taken for granted. Existing players will participate in reform debates, thus their interests must be considered. Each reform proposal should consider underlying economic and social determinants of behavior. In a new system, players' responsibilities and functions may alter. Like financing, health system-specific law should be flexible. A broader understanding of health system issues complicates remedies. Yet, by addressing issues encountered by people with coverage, providers, and other stakeholders, the benefits may be widespread enough to establish the political consensus that has evaded US reformers.

Luft, H. S. (2006). What Works and What Doesn’t Work Well in the US Healthcare System. PharmacoEconomics, 24(S2), 15–28. https://doi.org/10.2165/00019053-200624002-00003