This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Watanabe, A. M. Articles by Browne, R. A. Search for Related Content PubMed PubMed Citation Articles by Watanabe, A. M. Articles by Browne, R. A. Related Collections Health policy and outcome research Other Ethics and Policy

(Circulation. 2004;109:1456-1459.)
© 2004 American Heart Association, Inc.

Mini-Review: Expert Opinions

Is a Paradigm Shift in US Healthcare Reimbursement Inevitable?

August M. Watanabe, MD; Ronald W. Dollens, BPharm, MBA; William N. Malatestinic, PharmD; Robert A. Browne, MD

From Guidant Corporation, Indianapolis, Ind (R.W.D.), and U.S. Medical Division, Eli Lilly and Company, Indianapolis, Ind (W.N.M., R.A.B.). Dr Watanabe is a Retired Executive Vice President, Eli Lilly and Company, Indianapolis, Ind.

Correspondence to Robert A. Browne, MD, FACP, Lilly Corporate Center (Drop Code 4025), Indianapolis, IN 46285. E-mail rbrowne@lilly.com

An extract of the first 250 words of the full text is provided, because this article has no abstract.

	Introduction

 
The fundamental goal of health care is to increase longevity and optimize physical, psychological, and social well-being at the individual, community, and society levels. An optimal healthcare system should fulfill these goals in an efficient and cost-effective manner. Although we believe that our healthcare system in the United States is going in the right direction, there is certainly room for improvement.¹ In the present article, we review some of the shortcomings of the present system and offer an alternative philosophy that might facilitate a more viable and efficient approach to healthcare expenditure.

	Fundamental Concerns About the Current Reimbursement System

 
In the present environment, health care is generally viewed as an expense, and, because "costs" are managed by budgets, this translates into a fiscal mindset in managing health care. Naturally, this attitude generates a pattern of fragmented thinking. That is, the individual components of healthcare cost, such as pharmacy and hospital inpatient admissions, are considered independently, whereas total healthcare value and other important patient outcomes are overlooked. This fiscal mindset also does little to encourage the provision of quality care because reimbursement is based more on quantity. The natural consequence of this is exemplified by the results of a recent study in which patients received only 55% of the recommended care.² The failure of the current system to promote quality care is also apparent in the infrequent use of incentives for preventive care or proactive disease management. Indeed, such services are often not reimbursed. In short, the focus is on episodic care rather than on encouraging proactive health . . . [Full Text of this Article]

This article has been cited by other articles:

				D. C. Ackerly, A. M. Valverde, L. W. Diener, K. L. Dossary, and K. A. Schulman Fueling Innovation In Medical Devices (And Beyond): Venture Capital In Health Care Health Aff., January 1, 2009; 28(1): w68 - w75. [Abstract] [Full Text] [PDF]

				D. J. Kereiakes and J. T. Willerson US Health Care: Entitlement or Privilege? Circulation, March 30, 2004; 109(12): 1460 - 1462. [Full Text] [PDF]