ɐ vɚɹˈaɪəɾi ʌv ɹᵻfˈɔːɹm ˈɛfɚts hɐvbɪn ɐtˈɛmptᵻd, ɹˌɛkəmˈɛndᵻd, ɔːɹ ɪnˈɪʃɪˌeɪɾᵻd tə ɹᵻdˈuːs ɪts ˈɪnfluːəns sˈʌtʃ ɐz mˈuːvɪŋ təwˈɔːɹdz bˈʌndəld pˈeɪmənts ænd kˌæpɪtˈeɪʃən.
A variety of reform efforts have been attempted, recommended, or initiated to reduce its influence (such as moving towards bundled payments and capitation).