On Health Care Reform

In this Section I am proposing an approach to health care reform for long term sustainability.

For some years I, along with many others, have been concerned about the state of health care in our country. It is incomprehensible to me that a wealthy country like ours with so many creative people cannot figure out how to provide reasonable quality health care to all our people at a manageable cost. Despite the fact that we spend more dollars per capita than any other nation on health care we rank only 23rd among western nations in quality of health care outcomes and about one of every six of our citizens has no access to health care.

Most of the proposals for health care reform attempt to provide insurance for those who don’t have it, either by requiring employers to provide it or by establishing some government entity to do so. While these plans perhaps will provide some short term relief, they fail to address the basic shortcomings in our system. Some of these which are most evident are:

• One of every 6 people is not covered
• Administrative costs are very high compared to other systems
• Rapidly rising costs each year, greater than inflation
• Low rank in health care outcomes among western countries
• Sub-optimal use of available computer and communication technology
• Errors cause 44,000-98,000 death each year
• Attempts at reform are generally “bandaids” which fail to address fundamental flaws in our system (lack of “Systems-thinking” approach)
• High stress level of our society costs ~$200 billion per year in lost productivity and this is not addressed by our system.
• Multi-payer system discourages preventive care
• Health insurance companies focus on cost rather than quality of care and do little to improve health care
• High level of obesity – especially among children
• High cost of malpractice insurance.
• Physicians spend less than optimal time with patients because they have to see more patients in a given time period
• Patients are not sufficiently knowledgeable to deal effectively with the health care system

I have given this a great deal of thought over the past few years and it seems to me that what is needed is effective, good working, economically sound models. The first step should be to create those models, which then can be both expanded in size and replicated in other locations until the entire nation is well-served.

To create these models we should establish a number of prototype systems in various locations throughout the nation which agree to do the following:

1. Establish a system of population-based health care the goal of which is to maximize the health of all people in a defined population.

2. Achieve collaboration among the broad array of professionals needed to meet the health needs of that population.

3. Provide appropriate preventive as well as therapeutic services.

4. Incorporate social, behavioral and economic expertise needed to meet the needs of the population and create an economically sound system.

5. Utilize modern computer and communication technology to maximize efficiency and minimize administrative costs.

6. Provide education to make the patient a full partner in the system and include patients, as well as all stakeholder groups, in the governing board.

7. Conduct research on the effectiveness of the system and continually reshape it based on what is learned.

Most of these points came from a study entitled “Health of the Public – A Challenge to Academic Health Centers” which was supported by the Pew Charitable Trusts and The Rockefeller Foundation and the report published in 1993. I added a few points.

This concept seems to make sense. The question is what organization or entity can do all this? It seems that the Academic Health Center, together with other University units, is perfectly positioned for this role. They have all the health providers, social, behavioral, technologic, and economic expertise, and researchers needed to do all the above.

So imagine the following:

The federal government provides the funds needed to establish 8-12 models systems based in appropriate Academic Health Centers in varying locations throughout the US.

Imagine that these Academic Health Care Centers each create a model system to provide ideal health care for a relatively large defined population. They set up the system, run it, do research and learn how to do it better, and continually reshape the system.

The systems run for 3-5 years at the end of which time they have optimized the system in both effectiveness of health care provided and achieved a minimum cost basis of operation, while serving all the people in their catchment area.

These systems are expanded to enlarge the population in the above areas to regional and then statewide level and duplicated in other regions until the entire nation is covered.

In order to assure quality in this research phase a national board is established to oversee the progress of the Health Centers, to communicate progress to all involved, and to assure that funds are being expended appropriately.

One can compare this proposal with a number of others currently being put forth:

Institute For Alternative Futures – 2019 Health Care That Works For All
The Commonwealth Fund
Healthcare Reform, by the Commonwealth Fund
The Time Has Come for Comprehensive Health Reform: Statement from The Commonwealth Fund Commission on a High Performance Health System

Agenda for Shared Prosperity
Health Care for America Plan

Universal Health Care Foundation of Connecticut
Proposal for Health Care Reform in Connecticut

I look forward to your comments.

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