How Physicians Can Change the Future of Health Care

• Published in: JAMA : the journal of the American Medical Association Vol. 297; no. 10; pp. 1103 - 1111
• Main Authors: Porter, Michael E, Teisberg, Elizabeth Olmsted
• Format: Journal Article
• Language: English
• Published: Chicago, IL American Medical Association 14-03-2007
• Subjects: Biological and medical sciences; Clinical outcomes; Competition; Cost control; Delivery of Health Care; General aspects; Health care expenditures; Health Care Reform - methods; Health participants; Health Services Accessibility; Humans; Leadership; Managed Competition; Medical sciences; Miscellaneous; Outcome Assessment (Health Care); Physician's Role; Physicians; Public health. Hygiene; Public health. Hygiene-occupational medicine; United States; United States; Medicine; Physician; Health status; Health staff; Public health; Care
• ISSN: 0098-7484; 1538-3598
• DOI: 10.1001/jama.297.10.1103

Today's preoccupation with cost shifting and cost reduction undermines physicians and patients. Instead, health care reform must focus on improving health and health care value for patients. We propose a strategy for reform that is market based but physician led. Physician leadership is essential. Improving the value of health care is something only medical teams can do. The right kind of competition—competition to improve results—will drive dramatic improvement. With such positive-sum competition, patients will receive better care, physicians will be rewarded for excellence, and costs will be contained. Physicians can lead this change and return the practice of medicine to its appropriate focus: enabling health and effective care. Three principles should guide this change: (1) the goal is value for patients, (2) medical practice should be organized around medical conditions and care cycles, and (3) results—risk-adjusted outcomes and costs—must be measured. Following these principles, professional satisfaction will increase and current pressures on physicians will decrease. If physicians fail to lead these changes, they will inevitably face ever-increasing administrative control of medicine. Improving health and health care value for patients is the only real solution. Value-based competition on results provides a path for reform that recognizes the role of health professionals at the heart of the system.