Looking at the U.S. health care system in the rear-view mirror

John Wennberg and his colleagues hold up a rear-view mirror on the U.S. health care system, reflecting pervasive inconsistencies and showing that more resources are not necessarily equivalent to better care. The work shows that although many hospitals are investing time and money to improve efficiency, quality, and overall patient care, the system is in trouble. Two basic reforms would help produce a system that encourages value, with efficient, effective, patient-centered care. These changes involve how we pay for care and investment in health information technology. We should begin by implementing these principles in Medicare, the largest U.S. purchaser of care.