Can We Pay for Health Care in Ways That Clinicians and Patients Believe in?

Why does a system delivering so much care still feel unaffordable?

Many systems, especially in high-income countries, deliver an enormous volume of tests, procedures, and clinical visits, but still struggle with missed diagnoses, delayed treatments, and preventable harm, even as patients and employers face rising costs. This paradox points to deeper structural issues in how coverage is organized and how services are paid for. Depending on how they are designed, benefits and reimbursement rules can either magnify waste and inequity or help channel resources to the right care, at the right time, and for the right people.

What kind of payment environment strengthens the clinician-patient partnership?

Around the world, patients are asking to be more involved in decisions regarding their health, and clinicians want to practice in ways that reflect their professional standards rather than their billing codes. Payment arrangements that recognize outcomes and care coordination can support this partnership, but only if structured to allow for clinical judgment and patient dialogue. Building that kind of environment depends on the tools and data that clinicians consider legitimate—measures that reflect what they consider good care. Looking at how payers juggle affordability, provider payment, coverage decisions, and cost-sharing reveals when financial incentives are aligned with trust and thoughtful care.

How can public payers and better data unlock the next wave of reform?

Large public insurers, such as Medicare and Medicaid, as well as national health systems in other countries, have powerful levers to test and scale new payment approaches. As these payers experiment with models that reward safer, more efficient care, they increasingly rely on detailed clinical information from electronic health records to understand what is happening to patients. Yet even with growing evidence that these models can improve quality while lowering costs, their spread has been slower than hoped. For professionals across the health care ecosystem, understanding how these data inform coverage decisions and risk management is needed to anticipate how new tools or strategies might drive more equitable and improved health outcomes.

Key question to take forward

As you watch the video and consider your own setting, you might reflect on:

How could payment and data systems be redesigned to reward better outcomes and safer care?

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