Designing Administrative Organizations for Health Reform

Publication Date:

Publisher:

Author(s): P.N. Van de Water

Research Area: Health

Type: White Paper

Abstract:

This paper describes proposals to create new entities or agencies as part of a reformed health coverage system. The paper catalogs the major types of federal executive agencies and non-governmental entities and considers some of the issues involved in choosing an appropriate organizational design.



Many proposals for expanding health coverage involve the creation of organizations to produce information on comparative effectiveness, make coverage decisions, manage the marketplace for health insurance, or offer a public health insurance plan. These new organizations might take the form of a federal executive branch agency, an independent commission, government corporation, legislative branch agency, or public-private entity. Some proposals would create entities with substantial independence from the usual political processes, such as the Federal Reserve enjoys.



The choice of an appropriate organizational structure to carry out a public function raises several issues: the source and predictability of the entity's funding; its operational flexibilities; its degree of political independence and accountability; and the structure of its management.



Organizations that use governmental powers and funds and make public policy need to be accountable as well as effective. A Federal Reserve-like entity might be suitable for producing advisory information but not for making decisions that directly affect the health coverage of individual Americans.