Current proposals to improve the coordination of health care in the United States — such as accountable care organizations and bundled payments to providers — may be at odds with policies to promote competition to lower costs, according to a new “Perspective” co-authored by Katherine Baicker, professor of health economics at Harvard School of Public Health.

The article, co-authored by Helen Levy of the University of Michigan, was published online in the New England Journal of Medicine, August 14, 2013.

The authors suggest that policymakers look for opportunities to promote coordination of patient care without stifling competition. The use of electronic health records may meet both goals if implemented well, for example, but risk locking patients in to their current provider networks by making it difficult or costly to move their records if not implemented well.

Baicker and Levy call for policymakers, courts, and regulatory agencies to consider explicitly the trade-off between competition and coordination and to consider the effects of sometimes-conflicting policies across different health care and health insurance markets.

“We need to evaluate the net effect of the suite of new public and private insurance-market policies on both price and quantity [of health care] as we consider which policies might restore federal health care spending to a fiscally sustainable path,” they write.

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