Preventing Chronic Disease: September 2010: 10_0078

Observations on Incentives to Improve Population Health
J. Michael McGinnis, MD, MPP
Suggested citation for this article: McGinnis JM. Observations on incentives to improve population health. Prev Chronic Dis 2010;7(5).
http://www.cdc.gov/pcd/issues/2010/sep/10_0078.htm. Accessed [date].

Initial Reflections
The pace of progress in population health can be influenced by the incentives in play and the metrics that trigger them. The MATCH (Mobilizing Action Toward Community Health) articles in this issue of Preventing Chronic Disease explore the use of incentives to improve population health and hold implications for the development and application of the measures to which they are linked. Metrics in population health can serve to draw and focus attention, encourage action, and direct rewards and penalties. When those rewards and penalties take on an economic dimension, the results can be powerful.

This potential application of population health measures is especially important if the aim is to transform the allocation of social energy and resources, as it clearly must be. Currently, our national health investment profile is deeply flawed — more than 95% of every health dollar goes to treatment rather than prevention. In a system in which all our salient incentives are structured to reward volume over value, we miss virtually no opportunity to treat disease, often unsuccessfully or erroneously.

On the other hand, each day we miss countless opportunities to prevent disease and promote health. If we seek to reform health care payment systems to yield better health returns, investment in prevention has to move to the highest — not lowest — priority. If our aim is to fashion the health equivalent of indicators that shape our economic policies, the most rational social investment strategy would center around prevention and our health care payment system would follow suit.

A reformed health care payment system can advance health as the fundamental priority in 3 ways. First, every American should receive coverage for the clinical preventive services that are appropriate to him or her without copayment. Second, grant support should be set aside for community-based initiatives that are necessary to improve the health and health care of the community’s residents. Finally, resources to address the overall health care needs of a population should be shaped by a blend of the community’s health needs and efforts, as reflected by metrics that indicate trends for determinants of the population’s health status.

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Preventing Chronic Disease: September 2010: 10_0078