Reining In Costs Requires a Paradigm Shift
The promise of health reform - providing the best possible care to all Americans - cannot be achieved without reining in cost. But to do so will require a fundamental restructuring of our health care system. We need a paradigm shift.
First, there is a broader shift in culture which must occur. We need to create a culture of promoting health and wellness and it must start early in life. Transforming our disease care system into a health care system involves schools, communities, and parenting as much as it does doctors, nurses, and pharmacists. Part of this shift is about educating people (including health professionals) about good nutrition and physical exercise. But this is only part of the puzzle.
As a physician, I care for many patients who have a reasonably good sense of what is good for them. But they are living in a world which often makes the right choices difficult. We can make the right choices easier by thinking about to make healthy foods more accessible, affordable, and identifiable. We can facilitate the right choices by rethinking how we design our work settings and communities in ways that promote physical activity. Prevention is at the core of health and wellness. We know that preventing illness costs less in dollars and human suffering than treating disease. We need to ensure that we have a health care system that builds on this principle.
Second, our health care system must reward the outcomes we wish to see. If we seek to promote health, we should reward healthy outcomes. Currently, we spend most of our money paying for office visits, medications, and procedures; we reward health care consumption. But we also know that more consumption doesn't mean better outcomes. If that were true, America would have the best health care outcomes in the world (we don't - in fact, far from it). Rewarding good outcomes increases the likelihood that we'll generate good outcomes. It also encourages physicians, hospitals, and other stakeholders to think creatively about enhancing health outcomes instead of focusing on utilization of services.
Third, the delivery system needs to be lean and efficient. This is where technology and coordination of care are critical. As a physician, I have lost track of the number of times I have seen expensive studies repeated because we couldn't find the original results from another hospital in a timely manner. Integrated medical records that connect institutions while rigorously protecting patient confidentiality can help us avoid these situations. My colleagues and I have also spent countless hours searching for critical patient information and deciphering handwriting in paper charts (which are still used by the majority of American medical practices). When you consider the hundreds or thousands of dollars that a single unnecessary imaging test can cost, it's easy to see how integrated information and communication systems could create valuable savings. It's also easy to see how electronic records can save time while preventing errors that result from manual transcription. If physicians and nurses could take the time they spend searching for information and invest that time in talking to patients, I believe that would be more satisfying for patients and practitioners.
Transforming an institution as large and entrenched as health care is not easy. It will be uncomfortable at times and will require tough choices. But it is what we need to do if we are serious about reining in cost and providing Americans with the health care they deserve.
Posted by: preventionmd | July 29, 2009 1:13 AM
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Posted by: lensch | July 27, 2009 12:29 PM
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