Health reform

Adequate safeguards against health care fraud are essential to the proper functioning of any health care system. This analysis examines health care fraud in the U.S., and its findings underscore the importance to national health reform of comprehensive anti-fraud protections covering both public and private health insurance industry.

Fraud is an unfortunate but real part of the health care landscape. As health reform legislation takes shape anti-fraud provisions will be critical. This means considering steps to strengthen the reach and scope of the HIPAA insurance fraud provisions of 1996, requiring anti-fraud compliance procedures for all insurers participating in a reformed health care system, and sufficiently funding federal and state agencies to ensure that cases of fraud are quickly detected and addressed.

The purpose of this paper is to help state policy makers understand how federally qualified health centers (FQHCs) can fit into states’ health care reform plans and help achieve state reform goals related to access, quality, and cost. This topic was the subject of a day-long meeting hosted by the National Academy for State Health Policy (NASHP) on May 5, 2008, in Washington, D.C.  

State-based health reform will achieve much more if it occurs in the context of a national strategy. Expectations for state leadership in health reform have never been higher. States are thought to function as “laboratories of democracy,” but they do not fulfill this role effectively because insufficient attention is paid to experimentation and knowledge translation.  Congressional proposals to encourage state action cover too narrow a span of state health policy, do not provide states with sufficient authority to tackle major health policy challenges, and supply insufficient funding. This paper concludes with a description of a more robust state-federal partnership that would be more likely to yield substantial health reform.   [Health Affairs 27, no. 3 (2008): 736–747; 10.1377/hlthaff.27.3.736]