Criteria and Guidelines for Reforming the U.S. Health Care System

This Sounding Board commentary offers a perspective on reform of the\nAmerican health care system. Shortell and McNerney argue that changes in\ndelivery are likely to be incremental because of our inability to devise a\nsystem that is acceptable to a broad cross section of the public. Different\napproaches to the problem of health care are being advocated, and the authors\noffer guidelines that can be used as reference points for all proposals. \nTheir themes of assessment and accountability are reflected in five criteria:\na set of benefits mandated for all; the allocation of resources on the basis\nof defined needs; the payment of providers on the basis of performance; the\nestablishment of clinical and fiscal accountability at the level closest to\nthat of care delivery; and the establishment of a global cap on expenditures\nbased on the needs of the population and the capabilities of providers in the\narea. (KIE abstract)