|Changing the health care system for patients is the ultimate political challenge. Because of powerful vested interests, change will not occur without substantial increases in public indignation over insurance failures, lack of access, and poor quality. Four major changes are required:
First, we must provide universal coverage, whether by tax-based, single-payer, or mandatory regulated insurance. A single (lean) standard benefits package of essential care must be provided for all, without exclusions, restrictions or copayments. Second, government or private payers will not reimburse individuals but only pay not-for-profit integrated networks on a capitated basis. These entities represent a new type of managed care organization that will be responsible for defined populations; they will provide evidence-based, appropriate, preventive, episodic, and comprehensive continuing care by multidisciplinary teams in all settings. Global budgets will provide strong incentives to eliminate unsafe, ineffective, and inefficient care. Third, the entire system requires oversight at the national level by the Federal Government, through regional organizations that assure sufficient facilities (e.g., emergency rooms, cardiac centers, transplantation centers) and monitor quality of care by plans, not by individuals. Government regulates insurance companies, sets standards (like the National Quality Forum), and requires health care organizations to compensate patients for costs of treatment-related injuries. Finally, we must require our professional schools to provide training in basic safety science (e.g., error theory, ergonomics, and system analysis), leadership skills, respect for coworkers, teamwork, communication skills, and emotional support of patients and colleagues.
Envisioning Patient Safety in the year 2025: Eight Perspectives
Kerm Henriksen, Caitlin Oppenheimer, Lucian L. Leape, Krik Hamilton, et al.