The traditional focus of healthcare systems design has comprised two broad decisions. The first has focused on how to get the money to pay the bills, and here we find two broad approaches: taxation and compulsory social insurance. The other has been a focus on the types of providers needed, usually hospitals, clinics and whether to use general practitioners as gatekeepers. Along the way, though, we have learned that generally speaking how you raise the money is less important than what is done with it. We have also learned how difficult it is to reform the health system simply by encouraging reform by providers. Their incentives can broadly be tweaked through how the payment system works. To that end, we have seen various forms of purchaser/provider relationships emerge, managed competition and so on to define ways to influence the providers. Little, however, has been done, to look more closely at the way the payers of care actually do what they do.

In many countries, they can be seen broadly as flow-through bodies, simply paying the bills run up by patients with providers; in other countries, they have some role in the planning of the provider system, but are often embargoed from challenging the legitimacy of the legacy provider infrastructure by encouraging new providers to enter the market to better meet the needs of patients and deliver care in innovative and more cost-effective, better outcomes ways.

This wiki is focused around system design, but importantly offers an opportunity for authors to construct approaches to describe, improve, and innovate in the broad payer environment.  It is taken as a premise that payers should be more influential, and perhaps supremely influential in establishing the structure and the broad contours of the health system, to meet compelling human and social needs for heatlhcare.

Things we need to understand include where the future of healthcare is going, what we need to know and think about for that future, and what systems need to be put into place to ensure sensible, effective and sustainable future health systems. This, to me, is a key challenge for payers and custodians of public funds, a responsibility shared with providers, but we should realise that providers will need to evolve as healthcare needs evolve and that payers may need to 'encourage' that evolution.

It is also worth keeping in mind that providers of care are not really in the same business as payers of care.

Think of this as Health Version 2.0: the next evolution in healthcare and development using 21st century tools and the involvement of the broadest possible community of people.