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U.S. Healthcare's quality-based compensation model.

U.S. Healthcare has developed a quality-based compensation model through which its primary care physicians, hospitals, and specialists can earn additional compensation based on the quality and cost-effectiveness of the care they provide to their patients. The model clearly delineates the expectations of U.S. Healthcare, and in contrast with traditional payment models, encourages improvement in performance. In addition, the model aligns the incentives of U.S. Healthcare purchasers, participating providers, and members in order to provide high-quality, cost-effective care that maximizes patient outcomes.

Capitation Fee↗

How to avoid flying blind. To truly improve U.S. healthcare, leaders must consider seven moral values.

To genuinely improve U.S. healthcare, we must base it on seven moral values familiar to Americans: Preserving individual dignity. Patients have a right to information about their medical condition and a right to participate in decisions about treatment. Society should make a basic package of healthcare available to all who need it. Caring for patients' welfare. As providers are obliged to have compassion for patients' suffering, they should also put patients' interests above their own and avoid conflicts of interest. Protecting the least well-off. Many who are poor, less educated, or members of racial or ethnic minorities bear disproportionate burdens of morbidity and mortality. They should receive care that compensates for those disadvantages. Seeking the common good. Our society has a strong disposition toward excessive individualism. We need greater emphasis on public health and preventive measures, as well as more opportunities for the public to help shape the healthcare system. Containing the healthcare costs. Waste is offensive both economically and morally. We can contain costs only by grappling explicitly with the need for healthcare rationing, which should be applied according to ethical criteria. Retaining a sense of responsibility. Society can help renew a sense of responsibility b anchoring it in the concept of subsidiarity, according to which the best government is the least government necessary to perform its appropriate tasks. Establishing high standards of quality. Providers should pursue excellence as measured by improved medical outcomes, uniform use of appropriate procedures, and increased consumer satisfaction. Quality-of-life judgments can be useful in making healthcare decisions, especially for persons who are dying.

Altruism↗

The grade is: 66 out of 100. Commonwealth gives U.S. healthcare a sickly ranking, but some say it's time to offer solutions, not point out problems.

When the Commonwealth Fund issued its first scorecard on the U.S. healthcare system, the news wasn't so great. But the project's authors said the score of 66 points out of 100 shouldn't be interpreted as a failing grade, but a sign the nation can do much better. The U.S. spends 16% of its GDP on healthcare, said Karen Davis, president of the Commonwealth Fund. "We are not getting good value for that investment."

Benchmarking↗

Governance in a period of strategic change in U.S. healthcare.

The increased enrollment in managed care plans, merger mania and the development of politically and financially powerful integrated delivery systems have significantly complicated the governance of U.S. healthcare organizations. These modifications in fiscal incentives and the corporate restructuring undertaken by American health organizations has resulted in limited fiscal savings or improvements in access to care. As a result, trustees are now faced with divesting their losers, and shuttering facilities and services to reduce fixed costs. Decision-making by trustees will be further thwarted in the future by: their institutions being forced to deliver more care without a proportional increase in revenues; physicians seeking to obtain more ambulatory revenues at a hospital's expense; the inability to adequately finance mental health and long-term care services except among the wealthy; the number of divestitures increasing so that eventually the organizational focus for most IDSs will once again be on regionally oriented hospital systems; and much more difficulty being experienced in attracting sufficiently qualified personnel to deliver high quality health services. Finally, many of these findings relevant to the United States also are being shared by governing boards in Canada, Germany, The Netherlands and the United Kingdom.

Capital Expenditures↗

Professional satisfaction among U.S. healthcare chaplains.

This article reports the results of a questionnaire sent to 1,099 chaplains with board certification from the Association of Professional Chaplains regarding determinants of professional satisfaction among U.S. healthcare chaplains.

Clergy↗

The U.S. healthcare system after NHI: financial ramifications for providers and personnel.

Although much attention has been paid to the general structure and possible implementation of a U.S. national health-insurance program, there remains the brass-tacks question of how such a plan would specifically affect today's providers and payers. Here the author outlines some of NHI's financial and organizational implications for patients, facilities, and staff.

Delivery of Health Care↗

U.S. healthcare: the intertwined caduceus of physicians, coverage, quality, and cost.

As cardiologists, we should increase our efforts to improve coverage, quality, and cost, both by caring for individual patients and by improving our systems. How? Coverage: by promoting a coordinated approach, beginning with state demonstrations of new safety net and individual and private insurance approaches. Quality: by adopting evidence-based practice and adapting practice guidelines for payment, beginning with non-payment for class III; by setting standards of practice below which we may not fall and paying for quality and service above this level; by involving patients as partners in their care and providing them with incentives. Cost: by challenging routine practices (why return in one year?); by beginning to address the widening gap between what is possible and what is affordable, taking part in broader discussions on what is worth the cost, supporting tort reform, and proposing alternatives; by improving our systems to reduce medical errors and addressing future physician shortages by working in teams with primary care physicians and nurses. Let's work with our patients to improve their health. Together we can make real progress.

Delivery of Health Care↗