Harvey Fineberg NEJM article on how to fix the US health care system

As the Supreme Court prepare to consider the Affordable  Care Act, the New England Journal has published a thoughtful commentary by Harvey Fineberg on on what is needed to fix the US health care system.  He is President of the Institute of Medicine, and Chair of an Advisory Committee for a NESCent group creating new education materials for evolution and medicine.

A Successful and Sustainable Health System — How to Get There from Here  by Harvey V. Fineberg, M.D., Ph.D.

N Engl J Med 2012; 366:1020-1027March 15, 2012 (the article is open access)

A new type of thinking is essential if mankind is to survive and move toward higher levels.

— Albert Einstein1

America’s health system is neither as successful as it should be nor as sustainable as it must be. The Patient Protection and Affordable Care Act of 2010 (ACA) introduces the prospects for major reforms in payment for and organization of care, in prevention and population health, and in approaches to continuous improvement. Yet it remains under legal assault and a cloud of controversy. Even if it is fully implemented, the ACA will not represent a complete solution to the core dilemma of affordability and performance. The country’s political appetite for further reform may be sated, but unless we attend to the major sources of waste and impediments to performance, the United States will remain vulnerable to an excessively costly health system that delivers incommensurate health benefit. 

I purposely refer to a “health system” rather than a “health care system” because the solutions need to focus on the ultimate outcome of interest — that is, the population’s health and each individual’s health — and not only on the formal system of care designed primarily to treat illness.

A successful health system has three attributes: healthy people, meaning a population that attains the highest level of health possible; superior care, meaning care that is effective, safe, timely, patient-centered, equitable, and efficient2; and fairness, meaning that treatment is applied without discrimination or disparities to all individuals and families, regardless of age, group identity, or place, and that the system is fair to the health professionals, institutions, and businesses supporting and delivering care.

A sustainable health system also has three key attributes: affordability, for patients and families, employers, and the government (recognizing that employers and the government ultimately rely on individuals as consumers, employees, and taxpayers for their resources); acceptability to key constituents, including patients and health professionals; and adaptability, because health and health care needs are not static (i.e., a health system must respond adaptively to new diseases, changing demographics, scientific discoveries, and dynamic technologies in order to remain viable)       Full article available here