If we look to the European health care systems, especially the British, Swedish, French, Dutch, and German systems, they have implemented research on the comparative effectiveness of treatment alternatives; experimentws with bundled payments for treatment episodes; adapted disease management and chronic care coordination to a variety of different models, conducted different forms of pay-for-performance trials, and have gone further than the USA in investing in health information technology.

The greater problem is political. Cost containent means revenue reduction. One person’s costs are another person’s revenues. This has been a fundamental issue in health policy that has been commented on for the past 35 years, and applies to these silver BBs.

Comparative effectiveness of treatment alternatives identifies which treatments are more cost-effective than other treatments. However, such comparasions can threaten the income of providers. Did not a group of surgeons attempt to have one government program defunded because of research that showed that surgery for low-back pain was not more effective than other lower-cost treatments? Was not the mission of that agency revised to prohibit similar kinds of studies of comparative effectiveness of treatment alternatives?

Experimentws with bundled payments for treatment episodes: While DRGs have been in place for over 20 years years, we still have a system unlike the DRG systems in England, Germany and Holland where the physician payment is combined with the hospital payment. How can we expect hospitals and physicians to collaborate in effectively managing resoruces and quality as we continue the organizational seperation of the physician and the hospital.

Disease management and chronic care coordination: Not all pharmaceuticals work equallyeffectivelly for all patients. Paients need to be givern accurate and factual information as to the benefits and risks of different treatment options, without hidden rebates or promotions influencing ther prescribing decisions of physicians or the selection decisions of the prescription benefit manager. Disease management must move beyond asthma and diabetes and address obesity or metabolic syndrome, a much more diffcult issue. Chronic care coordination neeeds to look at return-to-work issues and rehabilitation issues. European systems which have more comprehensive social service structures have innovative solutions which we have been ignoring for too long.

Heah information technology has an incredible potential. Unfortunately, our current systems are so poorly designed and maintained that insurers and claim processors cannot even keep track of which physicians are contracted on a plan, when laboratories cannot send out duplicate copies of laboratory results to multiple physicians, when patients have to physicially walk the corridors of institutions and gather videotapes, radiology films, CDs and copies of charts to assure that they are delivered to the next provider. The use of “smart card” in France or the NHS “Spine” in the UK means that other nations are rapidly outdisttancing the US in their US of health information technology.