Which payment model delivers the best results?

Harvey Fineberg • MARCH 3, 2015

Harvey Fineberg of the Institute of Medicine discusses the goals of healthcare, including safety and effectiveness, and asks how they fare under various payment models. According to Fineberg, the U.S. needs to adopt systematic improvements in order to improve care and control costs. Fineberg praises markets as a fair disciplining proposition, but warns that the fee-for-service model results in doctors doing more than is necessary. Similarly, he says that capitation has cost advantages, but warns that it is an invitation for doctors to do less than is needed because they get paid the same either way. According to Fineberg, we do not know what system is best, therefore we need more experimentation.

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