A regulatory approach to health care reform

Although the technical prowess of American medicine is widely appreciated, considerable concern centers on the delivery and financing of health care, and, in particular, on issues of cost and access. Progress in addressing these concerns has been slow in coming with standard approaches to reform failing to win wide approval. It is here suggested that a series of relatively straightforward regulatory reforms could redirect the medical delivery enterprise and reduce many of the distortions that plague it today. These regulatory reforms center on insurance portability, the elimination of discounting, insurance reform, the provision of provider-specific outcomes data, and technology assessment. These regulatory changes offer the prospect of making the system more rational and efficient, while minimizing rationing and avoiding major institutional change. They also may stimulate additional novel suggestions for reform.