The Ideal System For Preventive Services

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First, the ideal system would integrate financing and delivery, not necessarily as in common ownership, but in the sense of incentive alignment and collaboration and coordination. Providers would accept responsibility for managing resources and benefit from improving care processes. This has to mean per capita prepayment so that one can transfer resources smoothly from acute care to preventive services—when we can decide which preventive services will reduce needs for acute care. Also, the ideal system would integrate providers and populations, so that the providers could plan for or contract with the right resources to care for their defined populations and be able to practice population medicine. From this would emerge an appropriate emphasis on primary care and prevention. There should be an integration of the full spectrum or continuum of care—inpatient, outpatient, primary care, home care—to provide care in the least costly and most appropriate setting, so that care in the different settings is integrated. One organization would control and be responsible for all the processes so that quality lapses arising from missed handoffs could be addressed and corrected, rather than blaming them on the other party. The ideal system would integrate medical groups or associations to assure that the right specialty mix was there and that there is teamwork in referrals and care processes. And there would be optimum use of para-medicals. Doctors should be integrated with hospitals, so

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