Over the last four decades, both the public and private sectors have experimented with payment approaches designed to change provider behavior, motivating providers to deliver better care at lower cost.
Since the RAND Health Insurance Experiment, RAND Health has led the way in efforts to understand the links between physician payment, quality of care, and system cost.
A single-payer health care plan could expand coverage to all New York residents, but it would require significant new tax revenue. Overall health care costs would decrease slightly over time if administrative costs are reduced and state officials slow the growth of payments to providers.
The New York Health Act could provide insurance to all New York State residents without increasing overall spending if administrative costs are reduced and growth in provider payment rates is restrained. New taxes, instead of premiums and out-of-pocket payments, would finance the program.
There are many challenges in measuring quality of care for seriously ill patients. Potential solutions to improve community-based programs that treat these patients include engaging in communication, shared decisionmaking, and advance care planning.