At the center of any serious health care reform must be reform of the delivery system. The current fragmented fee-for-service system produces haphazard quality, fosters the use of unproven interventions, and increases costs. Although this delivery system fails to generate optimal results, the best alternative is unknown. Indeed, it is unlikely that there is a single best way to organize and deliver health care services. Sustainable reform must facilitate innovation by fostering different ways of organizing and paying for health care services.1
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