Supporting my belief that healthcare reform will be driven under the cover of fixing our economic crises rather than through a comprehensive healthcare reform bill, the economic stimulus bill makes huge strides.
The bill expands coverage for nearly all children in America, and provides help for the unemployed who cannot afford insurance from their old employer (through COBRA), as well as those who need access to coverage for more than two years.
While these steps expand much needed coverage for many, so far they are missing the chance to reform the payment system, and thus, missing the chance to increase efficiency and effectiveness. I, like most of us, believe that we could spend less and get better results if the payment system was leveraged to integrate care, reward performance for chronic and preventive care, and bundle payments for costly acute care.
The expanded coverage for kids would be a suitable place for implementing a yearly fee for each child, with 25 percent held back, to be rewarded only if all vaccinations were given and guidelines were met for chronic childhood diseases, such as asthma and diabetes. Traditional fee-for-service should be limited to the little problems, like the broken arm or the occasional earache. A bundled payment could be used for the rare, but costly, open-heart surgery or cancer treatment.
If done right, the expanded coverage would not need to increase deficit spending.
This blog originally appeared at Action for Better Healthcare.