  There is a mounting crisis in delivering affordable healthcare in the US. For
decades, key decision makers in the public and private sectors have considered
cost-effectiveness in healthcare a top priority. Their actions have focused on
putting a limit on fees, services, or care options. However, they have met with
limited success as costs have increased rapidly while the quality isn't
commensurate with the high costs. A new approach is needed. Here we provide
eight scientifically-based steps for improving the healthcare system. The core
of the approach is promoting the best use of resources by matching the people
and organization to the tasks they are good at, and providing the right
incentive structure. Harnessing costs need not mean sacrificing quality.
Quality service and low costs can be achieved by making sure the right people
and the right organizations deliver services. As an example, the frequent use
of emergency rooms for non-emergency care demonstrates the waste of resources
of highly capable individuals and facilities resulting in high costs and
ineffective care. Neither free markets nor managed care guarantees the best use
of resources. A different oversight system is needed to promote the right
incentives. Unlike managed care, effective oversight must not interfere with
the performance of care. Otherwise, cost control only makes care more
cumbersome. The eight steps we propose are designed to dramatically improve the
effectiveness of the healthcare system, both for those who receive services and
those who provide them.
