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September 26, 2007

Competition on Outcomes and Physician Leadership Are Not Enough to Reform Health Care

Author Affiliations

Author Affiliations: King's Fund, London, England (Drs Dixon and Chantler); and Wagner School of Public Service, New York University, New York, and King's Fund (Mr Billings).

JAMA. 2007;298(12):1445-1447. doi:10.1001/jama.298.12.1445

Society flies blind when it comes to health care. The value of treatments to patients, in particular with respect to health gain, is not routinely measured. As a result, reforms focus less on improving health and value to patients and more on cost minimization; consequently, such reforms are led by administrators, not physicians. Physicians are disgruntled and disenfranchised, and perversities result such as, in the United States, cost shifting and other forms of dysfunctional competition. The way forward is for physicians to seize the initiative, take as their goal improved value of care to patients, organize medical practice around medical conditions and care cycles, and measure risk-adjusted outcomes and costs, all within a competitive health system. Positive-sum competition for value to patients will result that only physicians can deliver. Tinkering with financial incentives in the system will never be enough.