The Obama administration will make historic changes to how the U.S. pays its annual $3 trillion health-care bill, aiming to curtail a costly habit of paying doctors and hospitals without regard to quality or effectiveness.

Starting next year Medicare, which covers about 50 million elderly and disabled Americans, will base 30 percent of payments on how well health providers care for patients, some of which will put them at financial risk based on the quality they deliver. By 2018, the goal is to put half of payments under the new system.

For doctors and health facilities, the system will tie tens, and then hundreds, of billions of dollars in payments to how their patients fare, rather than how much work a doctor or hospital does, lowering the curtain on Medicare’s system of paying line-by-line for each scan, test and surgery.

“We believe these goals can drive transformative change,” Sylvia Mathews Burwell, secretary of the Health and Human Services Department, said in the statement.

The program would be a major shift for hospitals, health facilities and physicians, eventually more than doubling the reach of programs that the U.S. said has saved $417 million and that have been a model for how the government hopes to influence, and slow down, health spending.

Medicare paid about $362 billion to care providers in 2014, the health department said in a statement, making it the biggest buyer of health care services in the U.S. Paying separately for each procedure, called “fee-for-service,” has long been viewed as an inefficient driver of U.S. health spending, which at more than 17 percent of gross domestic product is the highest in the world.

Broad Reach

The Obama administration’s announcement today is the first time the government has ever set specific goals to steer the nation away from fee-for-service payments.

Medicare’s practices are often echoed by private insurers who cover 170 million Americans. If the U.S.’s plan is successful, non-elderly consumers could eventually see cost savings, though they may also find that doctors and hospitals offer fewer services as they seek to cut waste and maintain profits.

Doctors and hospitals are already facing changes under the Patient Protection and Affordable Care Act, or Obamacare. About 20 percent of Medicare spending is now paid through programs in which health-care providers either take some financial risk for their performance or at least collect and report measures of their quality, the health department said. Expanding that figure was a key goal of the the law.

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