Investigators Highlight Critical Role of Delivery System in Health Reform

    • April 24, 2009

 Replacing a system that rewards the amount of treatment given, rather than the quality of care patients receive is essential to restructuring the health care system, advises a team of physicians, health policy experts, health insurance executives, business leaders, hospital administrators and economists brought together by the FRESH-Thinking Project.

The group, which included 10 Investigator Award recipients, published eight recommendations for a successful reform strategy in the April 7, 2009, issue of the Annals of Internal Medicine. “Perhaps the most important advice is the first item on our list in  Toward a 21st Century Health Care System,” said  David Meltzer, M.D., Ph.D., a recent (2007) Investigator Award recipient and associate professor in the Department of Medicine and the Department of Economics at the University of Chicago. “It focuses on the need to create a health care payment system that is not constrained by the fee-for-service system and all of the political issues that go along with it,” he said.

In an effort to identify innovative steps toward reform, the group also emphasized the importance of “improving the way research is evaluated and funded; finding new revenue sources to cover a broader population, specifically a cap on the tax exclusion for employer-based health insurance; and creating a national health information infrastructure that will promote the sharing of data,” Meltzer said. “We feel that in their three years of careful examination of the major issues related to substantial reform, the group identified important problems related to financing and delivery of care,” said Emily Tashman, executive director of the FRESH-Thinking Project.

Investigators Charged with Advancing Reform

The Robert Wood Johnson Foundation Investigator Awards in Health Policy Research program was founded in 1992 to tap our nation's best minds for solutions to today's health care challenges and develop groundbreaking ideas about reforming the system.  

In addition to Meltzer, who is using his award to “analyze and better understand the role of the hospitalist in patient care,” nine previous award recipients were part of the advisory group. Among the authors are: Lawrence Casalino, M.D., Ph.D., (1999 award recipient); Alan M. Garber, M.D., Ph.D., (2003 award recipient); Mark A. Hall, J.D., (2004 award recipient); Peter D. Jacobson, J.D., M.P.H.,(1995 award recipient); Harold S. Luft, Ph.D., (2004 award recipient); David Mechanic, Ph.D., (1994 award recipient and national program director); Sara Rosenbaum, J.D., (2000 award recipient); William M. Sage, M.D., J.D., (1998 award recipient); Jonathan S. Skinner, Ph.D., (2005 award recipient); and Stephen M. Shortell, Ph.D., M.P.H., (past national advisory committee member).

Through their research, Investigators have explored a range of topics on health reform, including decision-making by managed care organizations; the balance between state and federal interests in health care; and the influence of morality on health politics and policy. Below are highlights of some of the Investigators’ recent achievements:

Medicaid Model ProvidesPlausible Path to Universal Coverage

Michael Sparer, Ph.D., J.D., a 2002 award recipient, is professor of health policy in the Mailman School of Public Health at Columbia University.Sparer published “Medicaid and the U.S. Path to National Health Insurance,” in the January 22, 2009, New England Journal of Medicine (NEJM).

Investigators Advise President Obama to Look to LBJ’s Success With Medicare

David Blumenthal, M.D., M.P.P., national coordinator for health information technology in the Obama administration and James Morone, Ph.D., professor of political science at Brown University, both 2002 award recipients, published “The Lessons of Success—Revisiting the Medicare Story,” in the November 27, 2008, NEJM.   Blumenthal was interviewed about this analysis on November 26, 2008, for National Public Radio’s All Things Considered.

Why Hasn’t the Health Care System Collapsed?

Lawrence D. Brown, Ph.D., a 2004 award recipient, and professor of health policy and management at the Mailman School of Public Health at Columbia University, answered this question in “The Amazing Noncollapsing U.S. Health Care System—Is Reform Finally at Hand?”, published in the January 24, 2008, NEJM.

Total Cure: The Antidote to the Health Care Crisis

In his book, Total Cure, Harold S. Luft, Ph.D., presented SecureChoice, a comprehensive new proposal on how to provide the quality of care patients want, the flexibility clinicians need and the steps to enhance the value of health care while providing affordable health insurance for every American. Total Cure was published by Harvard University Press in 2008 and reviewed in the January 29, 2009, NEJM as well as the March/April 2009 issue of Health Affairs.  Luft, a 2004 award recipient, is director of the Palo Alto Medical Foundation Research Institute and the Caldwell B. Esselstyn professor of health policy and health economics, emeritus, University of California, San Francisco.

Just Health: Meeting Health Needs Fairly

In his book, Just Health, Norman Daniels, Ph.D., a 1997 award recipient, proposed a theory of justice for health that answers three key questions: What is the moral importance of health? When are health inequalities unjust? How can we meet health needs fairly when we cannot meet them all? Published by Cambridge University Press in 2008, Just Health was reviewed in the March 20, 2008, NEJM and in the June 4, 2008, Journal of the American Medical Association.  Daniels is the Mary B. Saltonstall professor of population ethics and professor of ethics at the Harvard School of Public Health.

Policy Challenges in Modern Health Care

Among the nation’s leading experts in health care policy, 25 Investigator Award recipients provided a composite look at some of the striking contemporary challenges we face in health care in the book, Policy Challenges in Modern Health Care, Rutgers University Press in 2005.

The Robert Wood Johnson Foundation Investigator Awards in Health Policy Research program supports cutting-edge research on America's most challenging policy issues in health and health care. We award grants of up to $335,000 each to investigators from a variety of disciplines for innovative research projects that have national policy relevance.

Through the program, the Robert Wood Johnson Foundation (RWJF) has invested more than $37 million in research over the last 16 years on a wide range of health and health care problems facing America. Descriptions of previously funded projects can be found at