Downing Lecture 2015 Integrating Health Care Financing and Delivery: the US experience

This talk examines the extent to which health insurance schemes can successfully intervene in the delivery of health care to reduce costs and improve outcomes. Traditionally, many health insurance schemes are passive - they reimburse the services ordered by physicians and do not question the services ordered. Most American health insurers are active; they attempt to channel patients toward certain providers by charging patients less to use those providers. Moreover, they actively intervene in the care process with the intent of reducing both overuse and underuse of health care services.

The American Medicare program enables a comparison of active and passive insurers. The evidence from the American Medicare program favors the active insurer: costs are less, especially for chronic diseases managed by primary care physicians; relatively limited measures of quality favor the active insurer; and regulatory changes of about a decade ago that were aimed at reducing selection appear to have succeeded.

Dr. Joseph Newhouse, Professor of Health Policy and Management at Harvard University, will present The Downing Lecture 2015.