A Model for State Health Care Reform

Prologue: One of the major challenges facing U.S. health system reformers is finding a way to repair the shortcomings of the system while maintaining the cherished American values of autonomy, pluralism, and choice. For this reason, many believe that looking to health systems such as Canadas or Great Britain's—which reflect the centralized nature of their respective governments—as models for reform has only limited usefulness. Our population is vast and diverse; we value individual over collective endeavor; and we prefer local problem solving to federal mandates. Any health system reforms that are to succeed must accommodate these unique aspects of American culture and politics. In this paper, Stephen Shortell proposes an approach to health system reform built on these assumptions. His model, called health promotion and accountability regions (HPARs), are, in his words, “common incentive structures for managing population-based care. “The HPARs, organized as public/private partnerships at the state level, “serve as an organizational cornerstone around which health care reform might be implemented,” he explains. The model includes both basic benefit packages and financing options, linking the functions of planning, insurance, payment, delivery, and evaluation. Shortell is the A.C. Buehler Distinguished Professor of Health Services Management and professor of organization behavior in the Department of Organization Behavior of Northwestern University's J.L. Kellogg Graduate School of Management in Evanston, Illinois, where he is also a member of the Center for Health Services and Policy Research. He holds a doctoral degree in the behavioral sciences from the University of Chicago. Shortell is senior author of the award-winning book Strategic Choices for America's Hospitals: Managing Change in Turbulent Times and is a member of the National Academy of Sciences' Institute of Medicine.