I've been thinking a lot about issues that are really holding us back from transformative change in health care. I believe two fundamental issues have to be addressed before outcomes (the health of our country) can improve: cost and culture. Cost of care is number one in American concerns; therefore, policies to improve transparency, reduce complexity and ensure fair and consistent pricing for care should be high priority. Culture is harder, but equally important. "Patient-centered care" must move beyond lip service and an emphasis on satisfaction to behavior change such as listening to the patient's values and preferences, "no wrong door" access policies, and coordinated, integrated health care.
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