Health Reform initiatives constitute the equivalent of a conceptual three-legged stool: increase access to health care through the provision of insurance coverage, lower the ever-rising rate at which health expenditures grow, and improve health care quality. Regarding the issue of quality, a story in the April 17-18, 2021 issue of the Wall Street Journal highlighted the fact that no commercial airline in the U.S. has had a fatal crash since 2009. During that 12-year period, U.S. airlines have accomplished an astonishing feat. They carried more than eight billion passengers without a fatal crash. Numbers of this sort once were considered unimaginable, even among the most optimistic safety experts. This achievement was the result of a sweeping safety reassessment amounting to a revolution in thinking sparked by a small group of senior federal regulators, top industry executives, and pilots-union leaders after a series of high-profile fatal crashes in the mid-1990s. Health care is an entirely different industry, but it represents a sector that is no stranger to loss of life and injury through errors made in providing care. A good question is whether comparable lessons can be learned that will produce a turnaround similar to what the air travel sector has been able to accomplish.

The Role Of Government In Enhancing Health Care Safety

Health systems and clinicians increasingly are becoming aware of new federal rules that mandate offering patients access to the notes clinicians write in electronic health records (open notes). Taking effect on April 5, 2021, these rules enact the bipartisan 21st Century Cures Act by aiming to increase interoperability and ensure greater transparency in health care. According to an article published in April 2021 in The Joint Commission Journal on Quality and Patient Safety, many patients reading notes following office visits are enthusiastic about this new experience, citing several benefits that have clinical significance. They report remembering more details of encounters, feeling more in control, being better able to manage their care, and completing tests and referrals more effectively. Forty percent of patients share notes they read with others, and family care partners who access these notes report in even higher percentages than the patients themselves that it can help ease the burdens of care management. As the open notes practice evolves, it can expect to be associated with clinical improvements, for example, a majority of patients who read their notes reported understanding their medications better, and 15% reported improved adherence to their medicines.

The Centers for Medicare & Medicaid Services play an enormous role in the provision and financing of health care services. Among its many essential functions, each year it identifies hospitals that will receive lower payments for a year under the Hospital-Acquired Conditions Reduction Program because they had higher rates of infections and patient injuries. The government assesses the rates of infections, blood clots, sepsis cases, bedsores, hip fractures, and other complications that occur in hospitals, which might have been prevented. Medicare reduces every payment by 1% for those hospitals over the course of the federal fiscal year, which runs from the beginning of each October to the end of September of the following year.

A Public Option For Health Insurance In The Nongroup Marketplaces

Some Members of Congress have proposed introducing a federally administered health insurance plan, or “public option,” to compete with private plans in the nongroup marketplaces established by the Affordable Care Act. A new report from the Congressional Budget Office (CBO) describes key design considerations and some of their major implications. The agency explains how those design choices would affect the: public option’s premiums; private insurers’ premiums and participation in the market-places; health insurance coverage in the United States; and federal outlays and revenues. The insurance risk of the public option would be borne by the federal government by having it bear financial responsibility for medical claims covered by the plan. Certain design choices could, for example, result in a public option that used the federal government’s ability to set administered prices and its purchasing power to offer marketplace enrollees a lower-premium plan with a broad provider network. Such a plan would most likely encourage a significant number of individuals to enroll in the public option. Other design choices could be made to establish a public option that was similar to private plans in premiums and provider networks.

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