Scott Young
Kaiser Permanente Executive

Scott Young

Scott Young, M.D., is the associate executive director for clinical care and innovation for the Permanente Federation in California.

No System ... No Cost Control

Of all the major flaws in our health care system, high cost is the most destructive. One out of every six dollars is currently spent on health care. By 2018 that figure will rise to one in every five dollars. And in the recent time of significant economic expansion the annual inflation in health care costs outstripped the growth of our gross domestic product by more than double. This trend is neither desirable nor sustainable.

Why is that? In our country the vast majority of care is provided by uncoordinated, independent providers operating in an financial environment that rewards more care. Not better care. Not coordinated care. Not care based on the best available evidence. Health care financing in the United States is simply not set up to provide coordination for physicians, hospitals and patients in determining the right care, in the right place and at the right time.

How and where health care is delivered should be a major component of any reform agenda aimed at both reducing cost and improving the quality of care. In other words we need to create a health care system. A few entities have done this by both aligning and coordinating the delivery and financing of care. Kaiser Permanente, Group Health Cooperative and Intermountain Healthcare are a few examples of organizations that bring physicians, hospitals and financing together to meet the needs of patients. Currently these care settings are not available to all Americans, a result of a financing system that rewards uncoordinated care. So while a model exists for how it can happen in this country, most physicians and health care practitioners do not practice in these environments. We have to ask ourselves -- why is this true? Why do the majority of physicians choose to practice in a non-integrated environment?

The unrelenting rise in health care costs is a burden to individual patients, employers, governments and our nation's ability to compete globally. Is it possible to rein in the cost of health care? Yes, but minor changes to the current manner in which we pay for care only perpetuates more of the same - more uncoordinated care at a higher cost. We need change that rewards coordinated care aimed at bringing physicians and hospitals together in the best interest of the patient.

By Scott Young  |  July 24, 2009; 5:34 PM ET  | Category:  Economic crisis , Health Care Reform , Health costs Save & Share:  Send E-mail   Facebook   Twitter   Digg   Yahoo Buzz   StumbleUpon   Technorati  
Previous: Rein Costs In or They'll Rein Us In | Next: Reining In Costs Requires a Paradigm Shift


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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 12:32 PM
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