Perspective
The NEW ENGLAND JOURNAL of MEDICINE
july 9, 2009
n engl j med 361;2 nejm.org july 9, 2009 109
unsustainable trajectory of the sys-
tem, much less to offsetting the
rising costs of an aging popula-
tion and new medical advances.
Today there is a new openness
to changing a system that all
agree is broken. What we need
now is a clear national strategy
that sets forth a comprehensive
vision for the kind of health care
system we want to achieve and a
path for getting there. The central
focus must be on increasing val-
ue for patients — the health out-
comes achieved per dollar spent.
1
Good outcomes that are achieved
efficiently are the goal, not the
false “savings” from cost shifting
and restricted services. Indeed,
the only way to truly contain costs
in health care is to improve out-
comes: in a value-based system,
achieving and maintaining good
health is inherently less costly
than dealing with poor health.
True reform will require both
moving toward universal insur-
ance coverage and restructuring
the care delivery system. These
two components are profoundly
interrelated, and both are essen-
tial. Achieving universal coverage
is crucial not only for fairness
but also to enable a high-value
delivery system. When many peo-
ple lack access to primary and
preventive care and cross-subsi-
dies among patients create major
inefficiencies, high-value care is
difficult to achieve. This is a prin-
cipal reason why countries with
universal insurance have lower
health care spending than the
United States. However, expanded
access without improved value is
unsustainable and sure to fail.
Even countries with universal cov-
erage are facing rapidly rising
costs and serious quality prob-
lems; they, too, have a pressing
need to restructure delivery.
2-4
How can we achieve universal
coverage in a way that will sup-
port, rather than impede, a fun-
damental reorientation of the de-
livery system around value for
patients? There are several criti-
cal steps.
First, we must change the na-
ture of health insurance compe-
tition. Insurers, whether private
or public, should prosper only if
they improve their subscribers’
health. Today, health plans com-
pete by selecting healthier sub-
scribers, denying services, nego-
tiating deeper discounts, and
shifting more costs to subscrib-
ers. This zero-sum approach has
given competition — and health
insurers — a bad name. Instead,
health plans must compete on
health care 2009
A Strategy for Health Care Reform — Toward a Value-Based
System
Michael E. Porter, Ph.D.
D
espite many waves of debate and piecemeal
reforms, the U.S. health care system remains
largely the same as it was decades ago. We have
seen no convincing approach to changing the
Copyright © 2009 Massachusetts Medical Society. All rights reserved.
Downloaded from www.nejm.org at UNIVERSITY OF MICHIGAN on July 13, 2009 .