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      Envisioning a Better U.S. Health Care System for All: Coverage and Cost of Care

      1 , 1 , 2 , 3 , for the Health and Public Policy Committee of the American College of Physicians
      Annals of Internal Medicine
      American College of Physicians

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          Abstract

          <p class="first" id="d5557607e98">This paper is part of the American College of Physicians' policy framework to achieve a vision for a better health care system, where everyone has coverage for and access to the care they need, at a cost they and the country can afford. Currently, the United States is the only wealthy industrialized country that has not achieved universal health coverage. The nation's existing health care system is inefficient, unaffordable, unsustainable, and inaccessible to many. Part 1 of this paper discusses why the United States needs to do better in addressing coverage and cost. Part 2 presents 2 potential approaches, a single-payer model and a public choice model, to achieve universal coverage. Part 3 describes how an emphasis on value-based care can reduce costs. </p>

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          Most cited references74

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          Annual healthcare spending attributable to cigarette smoking: an update.

          Fifty years after the first Surgeon General's report, tobacco use remains the nation's leading preventable cause of death and disease, despite declines in adult cigarette smoking prevalence. Smoking-attributable healthcare spending is an important part of overall smoking-attributable costs in the U.S.
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            Universal health coverage and universal access.

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              Addressing overutilization in medical imaging.

              The growth in medical imaging over the past 2 decades has yielded unarguable benefits to patients in terms of longer lives of higher quality. This growth reflects new technologies and applications, including high-tech services such as multisection computed tomography (CT), magnetic resonance (MR) imaging, and positron emission tomography (PET). Some part of the growth, however, can be attributed to the overutilization of imaging services. This report examines the causes of the overutilization of imaging and identifies ways of addressing the causes so that overutilization can be reduced. In August 2009, the American Board of Radiology Foundation hosted a 2-day summit to discuss the causes and effects of the overutilization of imaging. More than 60 organizations were represented at the meeting, including health care accreditation and certification entities, foundations, government agencies, hospital and health systems, insurers, medical societies, health care quality consortia, and standards and regulatory agencies. Key forces influencing overutilization were identified. These include the payment mechanisms and financial incentives in the U.S. health care system; the practice behavior of referring physicians; self-referral, including referral for additional radiologic examinations; defensive medicine; missed educational opportunities when inappropriate procedures are requested; patient expectations; and duplicate imaging studies. Summit participants suggested several areas for improvement to reduce overutilization, including a national collaborative effort to develop evidence-based appropriateness criteria for imaging; greater use of practice guidelines in requesting and conducting imaging studies; decision support at point of care; education of referring physicians, patients, and the public; accreditation of imaging facilities; management of self-referral and defensive medicine; and payment reform.
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                Author and article information

                Journal
                Annals of Internal Medicine
                Ann Intern Med
                American College of Physicians
                0003-4819
                January 21 2020
                January 21 2020
                : 172
                : 2_Supplement
                : S7
                Affiliations
                [1 ]American College of Physicians, Washington, DC (R.C., H.D.)
                [2 ]Oregon Health & Science University and Portland Veterans Affairs Medical Center, Portland, Oregon (T.G.C.)
                [3 ]Louisiana State University Health Sciences Center, New Orleans, Louisiana (L.S.E.)
                Article
                10.7326/M19-2415
                31958805
                22178981-9147-4a49-98f2-b8e124c10f1a
                © 2020
                History

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