Is pay-for-performance really such a new thing? After all, “aligning incentives” was the ubiquitous mantra of the ‘90s. It applied to capitation and integrated care in the managed care era. But times change. It’s a fee-for-service world again, and aligning incentives means something different now -– although it’s still assumed that how we pay for […]

As numerous pre-election polls have made very clear, except in a few selected races, health care is playing a relatively minor role in determining the outcome of the 2006 midterm election. As a result, elected officials will arrive back in Washington with little pressure from voters to change the current direction of the country’s health […]

How might the chronically ill be safeguarded in a world of high-deductible, “consumer-directed” health insurance? During an October 2005 roundtable, cosponsored by Health Affairs and the California HealthCare Foundation, some answers were provided by two dozen leaders from the insurance, clinical, purchaser, consumer, and regulatory communities. Jill Yegian, the CHCF health insurance director, presents the […]

In his post, Jamie Robinson has raised the specter of an upside-down world of setting prices for biomedical innovations based on cost. Before we examine his serious admonition to focus on value in pricing new biotechnology drugs, let’s walk down the other trail: the argument that drugs should be pricy because they cost so darn […]

Early returns suggest that “consumer-directed” health plans can restrain health care costs and utilization, but whether these high-deductible plans can accomplish this without deterring consumers from seeking needed care is still up for debate. So state economist Melinda Beeuwkes Buntin and colleagues at RAND in an article [2-week free access] published today on the Health […]

What is the appropriate price for a biotechnology product? Jamie Robinson’s thoughtful post touches all the right bases in arguing that discussing the role of value in pricing is far preferable to discussing the cost of research, development and production.

The biotechnology industry has grounds for complaint. The research pipeline is disgorging breathtaking new treatments for cancer, rheumatoid arthritis, multiple sclerosis, and other once-intractable diseases. But instead of praise, or in addition to praise, the industry finds itself subjected to ever-louder criticism of its prices and earnings. America again seems to demand the best health […]

We wanted to alert Health Affairs blog readers to the Health Wonk Review. This biweekly compendium of the best of the health policy blogs was founded by Joe Paduda of Managed Care Matters and Matthew Holt of The Health Care Blog. More than two dozen health policy, infrastructure, insurance, technology, and managed care bloggers contribute […]

In yesterday’s New York Times, David Leonhardt has an interesting column exploring potential reasons why the United States spends so much more per capita on health care than other nations, without getting better results. This follows an earlier column in which Leonhardt argued that the last half-century’s increase in U.S. medical spending has been overwhelmingly […]

The Johns Hopkins University Press has just published Narrative Matters: The Power of the Personal Essay in Health Policy, an anthology of articles from the popular Narrative Matters section of Health Affairs. I can’t review the book in good conscience since, along with my colleagues Ellen Ficklen and Kyna Rubin, I have served as editor […]

Americans say that high costs and the lack of insurance and access to care are the most pressing health care problems for government to address, Robert Blendon and coauthors report in an article published today as a Health Affairs Web Exclusive [2-week free access]. Writing a month before the 2006 congressional election, the researchers also […]

Michael Porter and Elizabeth Olmsted Teisberg are experts in strategy and innovation, but, for better or for worse, they are relative newcomers to the health care arena. As a result, the language they use in Redefining Health Care often differs from the terms used by health policy analysts, even when their diagnoses and prescriptions are […]

While about one-quarter of physicians were using an electronic health record (EHR) as of 2005, fewer than one in ten physicians were using EHRs with functionalities such as electronic prescribing, researchers say in a Health Affairs article published yesterday [2-week free access] online and reported in today’s Washington Post.

The American health care systems perform impressively, producing what they are designed to deliver: cost inflation, inefficiency, and inequity. At regular intervals, local pundits declare that the outcomes of the incentive structures in the constituent parts of the systems are unacceptable, usually emphasising that “the nation cannot afford to spend 16 percent of GDP on […]

Two respected and influential public brain trusts have weighed in recently on major issues in the pharmaceutical arena, leaving us all better informed but probably no closer to consensus on the challenges of balancing quality against cost and market forces against government regulation. In “Research and Development in the Pharmaceutical Industry,” the Congressional Budget Office […]

Michael Porter and Elizabeth Olmsted Teisberg’s overall vision for health care delivery is an archipelago of free-standing Integrated Practice Units (IPUs), each focused on the total cycle of care for a medical condition. This contrasts to the view of competition among integrated delivery systems (IDSs) [2-week free access] that organize or arrange comprehensive health services […]

In their recently published manifesto, Redefining Health Care (2006), Michael E. Porter and Elizabeth Olmsted Teisberg — hereafter simply PT — offer a utopian vision of a health system that might occur to anyone possessed of a modicum of common sense but not too familiar with the real world of health care.

Redefining Health Care is a tour de force, a magisterial analysis, and a long-overdue application to the health sector of core principles of business strategy. It’s also a bit of “Goldilocks and the Three Bears.” Porter and Teisberg don’t like capitation, vertical integration, integrated physician-hospital organization, multispecialty group practice, or any of the other epiphenomena […]

I am pleased to announce that after twenty-five years as a bimonthly print journal and six years in online publishing, Health Affairs has entered the blogosphere as a new means of engaging readers in the health policy debate. The journal is all about an ongoing dialogue on health policy issues of concern to a diverse […]