Taylor J. Christensen, MD

Taylor J. Christensen is an internal medicine physician and health policy researcher. He blogs at Clear Thinking on Healthcare.

Pay for performance and shared savings are good, but they’re not the solution

Policy

January 9, 2025

Think about every health care reform effort we’ve been working on for the last decade or two, including accountable care organizations (ACOs) and the value-based purchasing models from CMS. The vast majority of them use one or both of the following strategies in an attempt to financially reward providers for delivering higher value (it’s like they’ve realized that financial incentives need to be fixed!):

Quality bonuses: For providers who deliver …
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Pay for performance and shared savings are good, but they’re not the solution

A real-life example of irrational health care spending

Taylor J. Christensen, MD

Policy

January 17, 2021

This week at work, I had a patient in the hospital who had been through a pretty challenging illness, and he was going to have to be discharged to a skilled nursing facility (SNF) to rehab for a few weeks. Sadly, SNFs in my area do not currently allow any visitors due to the pandemic. The patient is very close to his daughter, who lives out of state, and she …

Our optimal future U.S. health care system

Taylor J. Christensen, MD

Policy

December 17, 2019

Next in a series.

The Healthcare Incentives Framework helps show how to fix incentives in health care systems. It starts by enumerating the five jobs we expect a health care system to do for us and then identifies which parties in the health care system (providers or insurers) have a natural incentive to fulfill each of those jobs. Those incentives arise naturally, but the big challenge is shaping …

What would an optimal government-run health care system look like?

Taylor J. Christensen, MD

Policy

December 5, 2019

Next in a series.

What would an optimal single-payer health care system look like?

Taylor J. Christensen, MD

Policy

November 29, 2019

Next in a series.

What would an optimal libertarian health care system look like?

Taylor J. Christensen, MD

Policy

November 21, 2019

Next in a series.

In prior posts, I described my Healthcare Incentives Framework. If you haven’t read those, I recommend you check them out first to have the full context for this post. But here’s a refresher of the main points of the framework without re-explaining all the rationale:

The Healthcare Incentives Framework helps show how to fix incentives in health care systems. It starts by enumerating …

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What would an optimal libertarian health care system look like?

The barriers to patients choosing higher-value providers and insurers

Taylor J. Christensen, MD

Policy

November 10, 2019

Next in a series.

I have developed a framework, which I call the Healthcare Incentives Framework, that helps me understand health care systems. It outlines the jobs we expect a health care system to do for us and identifies which parties in the health care system have the primary incentive to fulfill each of those jobs. This is helpful because, if we are unsatisfied with how …

How to structure financial incentives in our health care system

Taylor J. Christensen, MD

Policy

November 2, 2019

Next in a series.

In my previous post, I explained the basics of my Healthcare Incentives Framework, which enumerates the jobs we want a health care system to do for us and links them to the parties in the health care system that have the greatest incentive to fulfill those jobs. If you haven’t read that post, I recommend you read it first. For those …

A framework for understanding health care systems

Taylor J. Christensen, MD

Policy

October 25, 2019

First in a series.

Way back as a business strategy undergrad and then as a medical student, I developed a framework for understanding health care systems. I call it the Healthcare Incentives Framework, and I believe it clarifies the big-picture components of health care systems that people need to grasp to be able to understand the sources of problems, which then leads to appropriate solutions. The whole thing cannot be explained …

What this medical student learned from doing a rotation in Thailand

Taylor J. Christensen, MD

Policy

June 13, 2016

As an American medical student doing an elective in Thailand, I was initially troubled when I saw how Thai patients were treated. I’m not speaking of the way Thai physicians apply medical science, mind you — they rely on UpToDate and sundry U.S. guidelines just as we do — but that was mostly where the similarities ended.

Morning rounds with the team of residents (sans attending, but apparently there was one …

Is our system built upon a flawed foundation of fee for service?

Taylor J. Christensen, MD

Policy

January 17, 2013

When someone is arguing that our health system needs an overhaul, one of the most common reasons they cite is because it is “built on a flawed foundation of fee for service.” Of course we blame fee-for-service reimbursement for the rampant overtesting, overtreating, and fragmentation (among other things) in our health system, but this doesn’t mean that it is inherently bad, and here’s why.

First, a little contextualization will help. Fee …

A medical student meets Donald Berwick

Taylor J. Christensen, MD

Policy

December 16, 2011

While attending the Institute for Healthcare Improvement Annual Forum recently, my friend, Jared Conley, and I had the good fortune of finding ourselves standing a table away from Don Berwick in a relatively empty conference room. As MD/PhD in Health Policy students, we were interested in asking him a question about ACOs, so we approached him and introduced ourselves, hastily adding, “We know you’re busy, so we just have …

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A medical student meets Donald Berwick

Taylor J. Christensen, MD

Taylor J. Christensen, MD

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