I agree strongly with Rita. For example, medical providers are rewarded for hospitalized patients, not well patients, even if the hospitalized patient gets an infection in the hospital. Yet providers are not sufficiently rewarded for helping chronically ill people manage their illness better so that they avoid the hospital.
There are a number of options to move away from fee for service, One alternative to fee-for-service is nonprofit health care cooperatives, proposed by the senate finance committe, where, for example, a doctor can earn a salary, rather than be paid by procedures/treatments. There is evidence that they are able keep the focus on outcomes, rather than this or that treatment. For example, mail and phone consultations are used more often, which can be efficient, but are about impossible to bill under traditional insurance. Apparently the physicians also end up working better with hospitals and specialists, which eat up a lot of money. I think of my elderly MIL who had a fair amount of disjointed care, with too many specialists doing too many discordant things, and her ending up with too much treatment yet not the best treatment. For example, is a significant dental procedure appropriate when you are dying of cancer? No one to coordinate the care as no one was paid to do so.
I understand that Massachusetts is also looking at ways to get away from expensive fee for service. I have heard about discussions where providers would be paid a fixed amount per patient, adjusted for age, health and other factors, with incentives for keeping a patient healthy as possible and happy. Some kind of bundling of payments for being responsible for a patient seems to make some sense.
We also may be able to use government incentives and disincentives to help encourage healthy behavior. We also could insure that procedures that are important and evidence based are encouraged.
I am with SamClem that education may not do much and healthy living is in large part a motivation issue. That is a tough nut to crack.
What I worry about all of this is it is so tough to get anywhere because we don't have a system to reform. We have a disjointed mess, with too many different interests. To please all those interests but try to have some protections we end up with 1000 page bills. And people tire of it, get distrustful and worried. I have tired of it because the debates are not on issues that I am interested in or concerned about, but are debates about the contest itself, rumor, and small hot button issues. I am so sick of it that I could spit. I am concerned that everyone will tire of it and nothing will be accomplished.
http://www.centerforpaymentreform.org/Here is some interesting comments by a physician, in an HuffPo article. I should clearly state that I am not a fan of Huffington Post, especially their medical articles, but this guy has some sensible things to say. I have not vetted his claim about tort reform in California.
http://www.huffingtonpost.com/dr-paul-toffel/health-care-reform-an-ori_b_258388.html