Health Care Reform Requires Accountable Care Systems

Stephen M. Shortell, PhD, MBA, MPH; Lawrence P. Casalino, MD, PhD JAMA. 2008;300(1):95-97 Most health care reform proposals focus on expanding health insurance to cover all US individuals. But the companion challenge is how to make such coverage affordable given the fragmentation, waste, and variation in quality of care of the current delivery system. Comprehensive health care reform will require proposals that both expand coverage and redesign the delivery system so as to achieve greater value for the increased investment. At the heart of the challenge is transforming a 19th-century craft-oriented delivery system to provide 21st-century biomedical science and technology.