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  • Health Care Reforms in the USA and England: Areas for Useful Learning - The Commonwealth Fund
    domestic product GDP and the system fails to insure a sixth of the population There are high medical error rates and missed opportunities to manage common chronic diseases In contrast publicly funded health care in the U K only accounts for less than 10 percent of GDP However as in the U S the English government is also making substantial efforts to reform the health care system to improve the quality of care to respond to severe economic pressures and to decentralize and remove layers of bureaucracy Using research supported by The Commonwealth Fund this article published in the Lance t identifies similarities and differences in their approaches to payment reform organizational restructuring and information technology and management Key Elements of Health Reform in the U S and England Payment reform Both the U S and England are seeking to reduce the growth in expenditures to sustainable levels ideally close to or no higher than growth in GDP In addition both countries are introducing similar revisions to existing payment schemes In the U S the Affordable Care Act allows for bundling of payments for inpatient physician services and postacute care with an ultimate goal of improved coordination across care settings England is experimenting more tentatively with bundling payments for hospitals to include preadmission and postdischarge care The two countries are also instituting value based purchasing which reward hospitals for improved quality of care and penalize low performing institutions The U S is experimenting with accountable care organizations that enable providers to share in the savings that result from more efficient higher quality care England meanwhile is establishing clinical commissioning groups that will enable primary care providers to control the allocation of about 65 percent of all National Health Service expenditures Organizational changes Both England and the U S are working to strengthen their primary care systems and have invested in developing and testing innovative models of care At the same time the U S has created two entities the Independent Payment Advisory Board which is tasked with finding ways to stem Medicare expenditures and the Centers for Medicare and Medicaid Innovation which will identify test and spread new models of care In England the Health and Social Care Act is leading to the dismantling of several agencies like primary care trusts and strategic health authorities but is creating a central commissioning board to supervise clinical commissioning groups establish risk sharing arrangements and develop payment strategies Information technology and management England is well ahead of the U S in the adoption of EHRs in the primary care sector but has struggled to create a hospital system and to link inpatient and outpatient care electronically In the U S even before passage of the Affordable Care Act the country invested up to 30 billion for the promotion of adoption and meaningful use of EHRs with an end goal of creating a nationwide secure interoperable system In addition the health care law creates a new independent Patient Centered Outcomes Research Institute which will

    Original URL path: (2016-04-30)
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