The Nuts and Bolts of Reform Proposals

Suggestions range from greater emphasis on preventive care to universal electronic records

By Amanda Gardner
HealthDay Reporter

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MONDAY, June 22 (HealthDay News) -- U.S. legislators continue to debate the details of what many hope will be the blueprint for a transformation of the nation's health-care system. While no fully formed proposals have emerged so far, here are some key elements:

Evidence-based guidelines.

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During a speech to the American Medical Association last week, President Barack Obama said that "less than 1 percent of our health-care spending goes to examining what treatments are most effective."

"There's a big gap between what we know the problems are and knowing exactly what are the best treatments for them, and there's another really important gap between knowing the most effective treatments and having those put into standard practice," said Thomas R. Oliver, an associate professor of population health sciences at the University of Wisconsin School of Medicine and Public Health.

What really happens today is that quantity of care is rewarded over quality: Those health professionals who order the most diagnostic tests and prescribe the most drugs get a bigger piece of the financial pie, according to advocates for change.

"We have spent far more money on research of new diagnostic techniques and new medications and not enough money on how to identify the best treatments," said Dr. Nancy W. Dickey, president of the Texas A&M Health Science Center.

This part of the reform effort would allocate more resources to determining which treatments work the best and how to implement them. The Recovery Act of 2009 has already earmarked $1.1 billion to this type of research, according to the White House Office of Management and Budget.

The evidence-based approach would offer the added benefit of protecting doctors who follow new, agreed-upon treatment guidelines from devastating malpractice lawsuits, while still leaving some avenue for people with legitimate medical claims. This would eliminate the need for caps on medical malpractice awards, advocates for change claim.

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