The U.S. health care system faces well-known challenges: 46 million people without health
insurance coverage in 2007, rapidly rising costs that now consume over 16 percent of the
Nation’s economic output, and uneven and inequitable quality of care. With Congress focused on the substance of health reform rather than the details of its implementation, a new report provides recommendations to lawmakers and the Obama administration about how to translate complicated new policies into reality in a timely fashion. In particular, the report calls for the president to designate an agency and a person to direct the implementation of health reform. The report also calls for lawmakers to include in legislation a carefully constructed schedule for phasing in reforms.

The National Academy of Public Administration and the National Academy of Social Insurance
partnered with the Robert Wood Johnson Foundation to undertake a sweeping analysis of the
management and administrative issues that arise in expanding health coverage. The two-year
project identified and described core administrative functions that need to be performed
regardless of the health system in place, and assessed how these functions might be performed
under different health care alternatives. The study drew lessons from experience in the United
States and abroad, and recommends administrative and management approaches designed to
facilitate the improvement and expansion of health care coverage.

The report concentrates on seven administrative functions essential to several health care reform proposals:

• planning and coordinating implementation;
• subsidizing health insurance premiums and cost sharing;
• administering health insurance mandates;
• regulating health insurance;
• restructuring health insurance markets;
• designing administrative organizations; and
• simplifying administration and controlling costs.

In each area, the report defines the choices, summarizes what is known about them, and draws conclusions.