However, a great deal of system change has taken place, largely for the better. Innovation and adaptation is still happening. Incentive alignment is fundamental. Doctors and patients do respond to incentives. The RAND experiment showed that people go to the doctor less if they have to pay part of the cost and, generally speaking, free care does not benefit health.
Information is very important, valuable, and information systems are costly.
Information allows evaluation of variations in cost, access and quality and productivity and it can suggest where to look for improvement. The NHS is practically an information-free zone, an indefensible situation in Enthoven's view. Doctors have a choice between accepting responsibility to manage cost themselves or seeing someone else do it for them. US doctors are split, but a substantial number have successfully embraced capitation and cost containment. Doctors can add value by managing costs and the rest of us have to be willing to reward them for that.