Vivek Murthy

Vivek Murthy

Vivek Murthy, MD, is an internal medicine physician at Brigham and Women’s Hospital and an instructor at Harvard Medical School. He is also the co-founder and president of Doctors for America.

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.

By Vivek Murthy  |  July 24, 2009; 6:01 PM ET  | Category:  Health Care Reform , Health costs , Prevention Save & Share:  Send E-mail   Facebook   Twitter   Digg   Yahoo Buzz   StumbleUpon   Technorati  
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As a fellow physician I wanted to comment on the issue of preventive care. It's long been a point of deep frustration for me. Providing services such as simple vaccinations, counseling or annual physicals have been often obstructed by insurance companies denying preventive care. The idea of redirecting our society to incoporate a more physically active lifestyle and give prevention a larger role is exciting. I think are some additional points to consider if we really want the current system to change. Looking at outcomes is a good way to swing the focus away from ordering expensive procedures but we must keep in mind that healthcare requires an active patient participation as well. We have to be careful to avoid penalizing doctors for patient non compliance. Secondly, there is so much fear that decision making will be taken away from doctors when many don't realize it has already happened. The people who control medical decisions now are insurance companies and big business. We have to place patients and their doctors in charge. Finally, in order to really reduce the amount of unnecessary testing, we also need to address the practice of defensive medicine. The culture of frivilous lawsuits and exorbitant settlements have to be changed.

Posted by: preventionmd | July 29, 2009 1:13 AM
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Look, in the past US auto makers managed to divert outrage about the patently unsafe cars they were building by concentrating interest on drunk driving and speeding. Now, of course these did contribute to the problem, but now we know that they were not as important as unsafe design and improper maintenance. The situation is similar today. The problems you write about are real; they are very important, but there are the problems you omitted, high overhead of private insurance, the plethora of forms required of physicians, and high drug prices, that, in theory, we could solve today. The powerful insurance industry wants to keep the eye of the public away from these problems, and I am afraid you are helping them.

Posted by: lensch | July 27, 2009 12:29 PM
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