Human Judgment and Health Care Policy

摘要

Modern health care is increasingly fragmented (eg, a typical elderly patient sees 4-11 physicians), poorly coordinated (eg, a physician may need to coordinate with 99 other physicians in 53 different practices for every 100 Medicare patients seen), wasteful (eg, 30%-50% of health care is inappropriate or unnecessary), and often does more harm than good (eg, 40,000-98,000 people die each year from medical errors). To date, 4 major responses have been offered to improve the current less-than-ideal situation in health care: (1) promotion of a culture of accountability and performance based on quality of care measurements, (2) implementation of systems to minimize medical errors, (3) economic incentives to minimize financial conflict of interests (often seen as drivers of inappropriate care), and (4) incorporation of comparative effectiveness research and evidence-based medicine as a key scientific foundation.