Abstract: The United States faces tremendous challenges with its healthcare
system. By any standard, it is expensive and performs poorly in most measures
of health and thus, is in great need of reform. But how do we reform things
without making the situation worse? Some of the more fundamental problems arise
from the combination of a fee-for-service payment system for physicians with
insurance-based financing care. This combination results in conflicts among the
interests of patients, physicians and payers. This paper examines this issue
from a decision analytic perspective, starting with a definition of the
patient-centered view, and an assessment of the practicality of controlling
costs by making healthcare more patient-centric. It then illustrates how
fee-for-service models corrupt decision-making and other solutions designed to
reign in the abuses of the fee-for-service model and also negatively impacts
the quality of decision making for individual patients. Whatever the strategies
for health reform, the degree of patient-centeredness of care is a benchmark
that allows policy makers to understand how far they have had to deviate from
optimal to achieve the desired ends of cost control.