BOSTON – A New England Journal of Medicine article calls for the establishment of an independent institute for technology assessment and says electronic health records could “appreciatively” boost quality of care.

“The Proposed Government Health Insurance Company - No Substitute for Real Reform, “ was written by Victor R. Fuchs, professor emeritus of economics at Stanford University in Stanford, Calif.

“Cost control requires fixed budgets for basic coverage so that expenditures and revenues are in balance, as well as a payment system for providers that gives incentives for cost-effective care,” Fuchs wrote. “It also requires an independent institute for technology assessment to provide physicians with needed information and to create a value-conscious environment for future biomedical innovations. Also, the average quality of care could be raised appreciably if every patient had access to an accountable care organization that used electronic health records effectively, provided coordinated care, and monitored processes and procedures.”

In discussing the pros and cons of public plans, Fuchs suggests that neither public nor private plans have influenced the quality of care.

“As for quality of care, improvement can occur in two ways,” he wrote. “First, the level of best practice medicine can be raised by introducing new drugs, devices and procedures and improving the understanding of diseases. Such advances are highly dependent on basic-science research and clinical research.

“The existence of a government insurance company would be largely irrelevant to the pace of medical progress,” said Fuchs “There is also great potential for improving the quality of care by bringing more of the country's actual practices closer to best practice. But neither public plans (Medicare and Medicaid) nor private insurance companies have been able to accomplish this.”

“Real reform begins by acknowledging that the three major problems – coverage, cost and quality – must be attacked simultaneously,” Fuchs said.