By NextBestFitPhase 1: Enactment & build · Step 1.3
Build the claims, payment & data systems
Months 0–18, then continuous · UHA Chief Information Officer; MACs; U.S. Digital ServiceDiscuss this step
How other countries handled this same piece of implementation, what happened, and what it means for this plan.
Side by side
| Country | Approach | Result | Lesson for this plan |
|---|---|---|---|
| This plan (U.S.) | Scale Medicare's existing fee-for-service claims infrastructure from about 1.3 billion to about 5 billion claims a year, add hospital global-budget payments, dental and vision claim types, and a national real-time eligibility check. | ||
| Taiwan | Built claims processing within a year; introduced a national smart card (2004) and a cloud medication record (2013). | Near real-time claims and drug-interaction checks. | One payer allows national data infrastructure that fragmented systems can't build. |
| United Kingdom | National Programme for IT (2002–2011) tried to build a national electronic record centrally. | Spent about £10B and was largely abandoned. | Big-bang central IT fails; extend proven systems incrementally. |
| Estonia | Nationwide health information exchange built on the X-Road data layer and national digital ID. | Near-universal e-prescriptions and record sharing. | Interoperable standards beat one monolithic system. |
Taiwan
- What they did
- Built claims processing within a year; introduced a national smart card (2004) and a cloud medication record (2013).
- What happened
- Near real-time claims and drug-interaction checks.
- Lesson for this plan
- One payer allows national data infrastructure that fragmented systems can't build.
United Kingdom
- What they did
- National Programme for IT (2002–2011) tried to build a national electronic record centrally.
- What happened
- Spent about £10B and was largely abandoned.
- Lesson for this plan
- Big-bang central IT fails; extend proven systems incrementally.
Estonia
- What they did
- Nationwide health information exchange built on the X-Road data layer and national digital ID.
- What happened
- Near-universal e-prescriptions and record sharing.
- Lesson for this plan
- Interoperable standards beat one monolithic system.
More precedent
- Taiwan launched NHI claims processing within 12 months and later introduced a universal smart card (2004) that holds recent visits and prescriptions.
- GAO's review of HealthCare.gov found inadequate oversight and testing.