An Affordable and Caring Health Care System for the 21st Century
The U.S. health care system is slowly failing. On some dimensions, American medicine is the best in the world. But quality of care varies significantly across the nation. More than 40 million Americans, most of them from working families, are currently uninsured. America continues to spend significantly more on health care than do other major economies in the world. And the spread of managed care has strained the traditional bonds of trust among physicians, patients, and health plans.
Shouldn't the nation expect better performance from a system projected to cost two trillion dollars in 2005?
We think so. But developing sounder alternatives requires both a vision of where the nation should go and a blueprint for getting there. We know where to begin.
We must fundamentally rethink how our health care system should work and develop strategies and practical alternatives for the future.
To do that, we must understand the core values of communities, consumers, and public and private decisionmakers on which health care policy should be founded. We must quantify available funding mechanisms and think creatively about ways to make health care services and coverage available to a larger percentage of the population.
We must find ways to increase value received for health care dollars spent at the community level.
We know how to describe empirically the trade-offs between cost control and quality. And we know how to communicate these trade-offs to community leaders and policymakers.
We need to understand how the legal system will respond to changes in health care delivery.
We are pursuing health law issues in coverage decisionmaking, quality of care, the effects of regulation, and privacy.
We must ensure that the health care system meets the needs of vulnerable populations.
These include the frail elderly, children with special health care needs, HIV-positive individuals, and the mentally ill. We've pioneered ways to gather reliable information about these groups, to measure their health status, and to link the care they receive to both costs and effects on health.
If a significantly improved health care system is to evolve, we must think creatively about ways to provide care in poor, rural, and ethnically diverse communities.
In particular, it is essential to develop programs that are culturally appropriate. We are already evaluating such approaches -- for example, using urban churches to promote mammography screening for breast cancer.
We intend to use this experience to help build an affordable and caring health care system for the new century. RAND has what it takes: unparalleled analytic skills, a deep understanding of the system, and a reputation among public and private decisionmakers that ensures our voice will be heard.
What Others Have To Say
Woodrow A. Myers Jr., MD
Director, Healthcare Management, Ford Motor Company
"When Ford, Daimler-Chrysler, GM and the UAW wanted to send a consistent message about health plan performance to our employees and the more than 130 health plans we contract with across the country, Ford recommended RAND. We had worked with RAND in the past and wanted a partner with an international reputation in assessing quality in the health care system. In addition to undisputed technical excellence, RAND has the talent to lead complex, collaborative projects. We have been very pleased with the results of this effort and look forward to enhancing our reporting tool with assistance from RAND."
RAND collaborated with the Big Three auto manufacturers, the UAW, the Greater Detroit Area Health Council, and the State of Michigan to design and implement a system for reporting health plan performance to auto workers. Because the Big Three have contracts in 34 states, the ratings from this system should have a national effect on the health care market and on the quality of care offered in different locations.
Alicia Luquin
"I think churches of all denominations are beginning to realize that they need to be actively involved in the physical health of their communities. It's the idea of caring about the whole person. From the day I walked into my church more than 15 years ago, I knew it was a church that cared for the physical as well as the spiritual dimensions of its members. When RAND first approached my church about the mammography project, I didn't know what RAND did. I found out it was a very reputable organization that was looking to help communities in practical ways. What I liked about dealing with RAND was that our contacts were very real people -- genuine, always willing to answer questions and to offer support and guidance. I could sense a strong commitment to improving the quality of health care."
Alicia Luquin is one of a group of dedicated volunteers who worked to increase the use of screening mammography in their urban churches. Training from the RAND team helped the volunteers understand both the purposes of the mammography program and the information about mammography to be shared with those whom they contacted. Alicia telephoned members of her congregation and of other congregations to learn how much they understood about screening and to explain its benefits. Follow-up calls reminded the women of the need for mammography and told them where they could get screening services.
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