State health system performance and state health reform

State policy officials are focusing on improving health insurance coverage, but other important dimensions of performance, including quality and cost, are receiving less attention. This paper explores the implications of new data on state personal health spending, quality, and health system performance. Personal health spending is not related to mortality or quality, but Medicare spending is closely linked to preventable hospitalization. States need to link improved insurance coverage with policy strategies to improve quality and efficiency--such as requiring those covered to designate a medical home and changing payment methods to reward care coordination and more prudent stewardship of resources.     

A federal/state partnership for health system reform.

In view of the continued lack of consensus regarding health system reform, a new approach is needed to the pluralism that characterizes the U.S. political scene. A two-step strategy can help to break the deadlock around health care financing and provision: a framework around which to shape federal/state responsibility for health care and a process to ensure that policy is translated into action. This strategy, called a federal/state compact for health, builds on actions already under way in several states and represents a process that is both incremental and comprehensive in nature. The federal government would take the lead regarding policy making, financing, and establishing benefits. The states would administer the program with flexibility similar to that existing in Canada's provinces.     

The health care system under French national health insurance: lessons for health reform in the United States

The French health system combines universal coverage with a public-private mix of hospital and ambulatory care and a higher volume of service provision than in the United States. Although the system is far from perfect, its indicators of health status and consumer satisfaction are high; its expenditures, as a share of gross domestic product, are far lower than in the United States; and patients have an extraordinary degree of choice among providers. Lessons for the United States include the importance of government's role in providing a statutory framework for universal health insurance; recognition that piecemeal reform can broaden a partial program (like Medicare) to cover, eventually, the entire population; and understanding that universal coverage can be achieved without excluding private insurers from the supplementary insurance market.