"Control knobs" theory Health care reform

the 5 control knobs health-sector reform

in “getting health reform right: guide improving performance , equity,” marc roberts, william hsiao, peter berman, , michael reich of harvard t.h. chan school of public health aim provide decision-makers tools , frameworks health care system reform. propose 5 “control knobs” of health reform: financing, payment, organization, regulation, , behavior. these control knobs refer “mechanisms , processes reformers can adjust improve system performance”. authors selected these control knobs representative of important factors upon policymaker can act determine health system outcomes.

their method emphasizes importance of “identifying goals explicitly, diagnosing causes of poor performance systematically, , devising reforms produce real changes in performance”. authors view health care systems means end. accordingly, authors advocate 3 intrinsic performance goals of health system can adjusted through control knobs. these goals include:

the authors propose 3 intermediate performance measures, useful in determining performance of system goals, not final objectives. these include:

access: effective availability patients receive care
quality of care: consideration of both average quality , distribution of quality

while final performance goals largely agreed upon, other frameworks suggest alternative intermediate goals mentioned here, such equity, productivity, safety, innovation, , choice.

the 5 proposed control knobs represent mechanisms , processes policy-makers can use design effective health care reforms. these control knobs not important elements of healthcare system, represent aspect can deliberately adjusted reforms affect change. 5 control knobs are:

the 5 control knobs of health care reform not designed work in isolation; health care reform may require adjustment of more 1 knob or of multiple knobs simultaneously. further, there no agreed-upon order of turning control knobs achieve specific reforms or outcomes. health care reform varies setting , reforms 1 context may not apply in another. important note knobs interact cultural , structural factors not illustrated within framework, have important effect on health care reform in given context.

in summary, authors of “getting health reform right: guide improving performance , equity” propose framework assessing health systems guides decision-makers’ understanding of reform process. rather prescriptive proposal of recommendations, framework allows users adapt analysis , actions based on cultural context , relevance of interventions. noted above, many frameworks health care reform exist in literature. using comprehensive yet responsive approach such control knobs framework proposed roberts, hsiao, berman, , reich allows decision-makers more precisely determine “mechanisms , processes” can changed in order achieve improved health status, customer satisfaction, , financial risk protection.