The U.S. health care system falls short on several dimensions of performance. The fragmented nature of the system--with multiple public and private financing and delivery processes, as well as numerous entities responsible for controlling costs and ensuring quality, safety, and access--poses many barriers to high performance. Several potential levers available to private and public stakeholders could promote reform. In particular, the federal government might consider helping to restructure the health care market so it functions more effectively and efficiently; for example, by investing in research and evaluation to determine best practice and funding technical assistance to spread innovation. Rather than addressing coverage, quality, and cost as separate issues, it might be time to consider them simultaneously. It is also important to consider how proposed public policies would affect each of the dimensions of health system performance.
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