A Pay-for-Population Health Performance System

In a commentary in the current Issue of JAMA (JAMA. 2006;296:2611-2613., David A. Kindig comments on steps to take since the IOM released its report on Pay for Perfomance and Medicare.. Among his remarks (the full commentary should be read by all of us) he says the health of the US population is far from optimal, both in terms of mean outcomes compared with other nations and in the unacceptable disparities within the country. The United States currently ranks 25th in women's life expectancy at birth among developed nations; while within the United States, the mortality rate for blacks (1098/100 000 persons) is 31% higher than the mortality rate for whites (836/100 000 persons). Adults with more than 13 years of education have a mortality rate of 211/100 000 persons while those with less than a high school education have a mortality rate of 575/100 000 persons. Minnesota has a mortality rate of 749/100 000 persons while Mississippi has a rate of 1035/100 000 persons. The percentage of persons reporting fair to poor health is 6% for persons above the poverty line and 20% for those in poverty