HEALTH CARE REFORM IN THE UNITED STATES

David Carey, Bradley Herring and Patrick Lenain
ECONOMICS DEPARTMENT WORKING PAPER No. 665
Organisation for Economic Co-operation and Development, OECD - February 2009

Available online [44p.] at: http://www.olis.oecd.org/olis/2009doc.nsf/ENGDATCORPLOOK/NT00000B6A/$FILE/JT03259332.PDF

“……In spite of improvements, on various measures of health outcomes the United States appears to rank relatively poorly among OECD countries. Health expenditures, in contrast, are significantly higher than in any other OECD country. While there are factors beyond the health-care system itself that contribute to this gap in performance, there is also likely to be scope to improve the health of Americans while reducing, or at least not increasing spending.

This paper focuses on two factors that contribute to this discrepancy between health outcomes and health expenditures in the United States:
inequitable access to medical services and subsidized private insurance policies; and inefficiencies in public health insurance.

It then suggests two sets of reforms likely to improve the US health-care system. The first is a package of reforms to achieve close to universal health insurance coverage. The second set of reforms relates to payment methods and coverage decisions within the Medicare programme to realign incentives and increase the extent of economic evaluation of different medical procedures….”

TABLE OF CONTENTS

Population health status is lower and health expenditure is higher than in many other OECD countries
Population health status is falling behind that in other developed countries
Health expenditures are high and rising quickly
Efficiency of the health-care system - health status in relation to inputs
A growing proportion of the population is underinsured
A growing proportion of the population is uninsured
An increasing proportion of the population is underinsured
Reforms to extend health insurance coverage
Market failures in the health insurance market
Reforms to expand insurance coverage and to improve health outcomes in relation to health costs
Medicare reforms to improve value for money
Create a Comparative Effectiveness Institute
Decrease the generosity of supplemental Medicare insurance designs for beneficiaries without chronic conditions to reduce moral hazard risks
Reduce overpayments to Medicare Advantage
Use competitive tenders for purchases of medical equipment and supplies
Bibliography