Investing in quality

While most of the health reform debate has focused on expanding coverage, eliminating pre-existing conditions exclusions, or reducing costs, there are myriad ways that health reform will also improve the quality of your care. It will do this through rewarding quality of care over quantity, promoting better information-sharing, and investing in preventive care.

Let's start at your doctor's office. Currently, most doctors are paid through what is called a "fee-for-service" system. This means that for every visit, X-ray, or procedure that they perform, they get paid. This payment system encourages doctors to do more procedures because in the end, that will make them more money. But there is no financial incentive in that system for providing quality care, just quantity of care.

The problem gets worse the more doctors you see. Specialists charge for each visit too. They often run their own tests and procedures, sometimes duplicating the same tests you've already had. This wastes time and money without producing better results. Atul Gawande highlights this problem in Cost Conundrum, an article about health care costs from last summer. Gawande says that the current care system is like building a house, but "instead of paying a contractor to pull a team together and keep them on track, you [pay] an electrician for every outlet he recommends, a plumber for every faucet, and a carpenter for every cabinet. Would you be surprised if you got a house with a thousand outlets, faucets, and cabinets, at three times the cost you expected, and the whole thing fell apart a couple of years later?"

The new law starts with Medicare and Medicaid by creating important incentives to reward doctors for working together in teams and for providing high-quality care. Hospitals, doctors, and other providers are encouraged to form organizations that coordinate patients' care, rather than billing separately for every test and service. These initiatives won't limit access to care. In fact, they are supported by a broad array of patients' rights organizations. But they should save all of us time, money, and worry.

And what about spending less time at the doctor in the first place? The new law requires all health plans to cover preventive benefits. Cost-sharing fees for preventive care in Medicare are eliminated and Medicare will cover an annual wellness visit so that you can talk to your doctor about staying healthy. Health reform also calls for the creation of a national strategy to prevent illnesses and to improve the overall quality of health in the United States. The law also invests in prevention, screening, and disease research. This investment is important to catch illnesses early, save money, and save lives.

The health reform law aims to not only cover millions more, but to improve the quality of the care we all receive.