Repairing the Healthcare System
Feld M.D., FACP, MACE
Our greatest asset is our health. Access for diagnosis, treatment and health maintenance is through our health care system.
In the past thirty six years as a Clinical Endocrinologist, I have seen many advances in health maintenance and in preventing the complications of chronic disease. I have also experienced economic and political distortions in a healthcare system that has impeded the progress of our quest for a healthier society.
We have heard that the healthcare system is broken. We have also heard that while all goods and services industries have embraced (not totally true) the electronic era, physicians have resisted the electronic revolution for some reason. If medicine is to step into the 21 century, medical practices simply how to adopt an Electronic Medical Record (EMR). The EMR will solve the problems within the healthcare system. In my opinion, this view of the solution is a very simplistic, and not correct. It is true however, that physicians have resisted instituting EMRs, and for many good reasons.
Why have physicians resisted the EMR? It is hard to find a coherent answer in the literature. Again, no one has asked the practicing physician. In the future, this blog will discuss the multiple reasons for the resistance, and probable solutions.
Since we do not have universal EMRs, we are lead to believe that all the problems with the health care system are the physicians fault for not adopting the EMR!
However, a sober look at the problem reveals all of the stakeholders are at fault. The stakeholders are the government, the insurance industry, the pharmaceutical industry, the hospitals, the physicians and the patients. We will discuss the role of each have played in the distortions and dysfunction of the healthcare system.
In my view, the patient and the physician are the key stakeholders. Without the patient and the physician, we would not need a healthcare system. The patient is the player and the physician’s role should be the coach, making the diagnosis and teaching the player what he has to do to get well and stay well.
However, in 2006, the patient and the physician are generally listed last among “important” stakeholders by government, insurance companies, hospitals and policy makers.
Since the patient is most important stakeholder. The patient should be in the forefront of policy making. The physician is second. All the other stakeholders are in reality simply facilitators for the patient and the physician. Everything done in the healthcare system should be done for the benefit of the patient first, and not for the economic bottom line of the other stakeholders. After all it is the patients’ healthcare system! Is it not? The demand for repairing the healthcare system and action to fix it has to be made by the patient,
The patient with his consumer power is going to have to be the one that fixes the system. None of the other stakeholders has been able to fix the system to date. In fact, the insurance industry, government and policy makers have made the health care system worse by their solutions. Systemic changes have been made over the years. The result has been further adjustments by the facilitator stakeholders for their profit advantage. These adjustments in turn have lead to further changes and further adjustment by those stakeholders. These adjustments have resulted in further distortions in the healthcare system. Presently, all the stakeholders are in pain. However, the stakeholder with the most at risk is the consumer of healthcare. His health and well being are at risk! If we stay on the present course, I predict the system will break down completely and access to care will be limit and restricted. Advances in medical care will be non existent.
The goal of this blog is to walk thoughtful people through the evolution of the problem, and the process of cure. The ultimate goal is to;
1. Provide patients
a. with access to good care
b. ability to judge quality care
c. true assets and vehicles to be responsible for their care
d. the freedom to select the physician of their choice to deliver quality care
2. Provide physicians
a. A precise definition of the meaning of quality care
b. with the opportunity to provide quality care for acute and chronic disease
c. with an opportunity to improve the quality of care they deliver
d. with a vehicle to prove that they are delivering quality care
e. with a mechanism for delivering care at a transparent price’
f. with the ability to effectively communicate with patients
g. with the ability to develop effective patient physician relationships
h. with the ability to help patients prevent costly complications of chronic disease
i. with the ability to improve communication and access for patient information so as to reduce the cost of redundant evaluation and treatment
3. Provide patients with the information of their evaluations so it is truly portable
4. Provide insurance vehicles that are affordable to everyone
5. Provider patients with education vehicles so they can become “Professors of their Disease” and be truly responsible for their care
6. Knowledge is power. This knowledge through education will increase patient compliance and adherence to recommended treatment and thereby reduce the cost of care.
7. Create both quality of life and economic incentives that with stimulate patients to be responsible for their own care
8. Decrease the overall cost of the system
9. Eliminate the 45 million uninsured
10. Decrease cost to the government
11. Increase profit margins for the insurance industry
12. provide satisfactory profit margins to Hospitals, and Pharmaceutical companies
These are ambitious goals. Processes must change in order for the United States to deliver effect health care to our citizens now and in the future. We, the people can not leave the fix up to the minor stakeholders and policy wonks. They have failed in the past. Their policies have distorted the healthcare system to serve their vested interest. The patient or future patients must drive process in order to repair our healthcare system.
In this blog, I, Stanley Feld M.D., FACP, and MACE, as an individual will try to stimulate you, the patient or potential patient, the major stakeholder, who presently has the smallest voice to be the most powerful stakeholder with the loudest voice. You can make effective demands for a healthcare system that works because you have been put in charge and are responsible for your care!
anonymous • May 31, 2006
Hello Dr. Feld,
I like your point about how fixing the healthcare system cannot be about pure profit, but has to be about the patient. None of the major healthcare players really think about the patient except the physicians. And even they are constantly being forced to think about the patient in an acute setting. The diabetic patient who comes in with a necrotic foot is not a Diabetic first, but rather a person with a necrotic foot problem. Once the foot is treated or amputated it’s back home for the patient, with no further concern for his ongoing diabetes. It just doesn’t make sense. Out system is optimized for acute care, but even that is incredibly expensive, and has mixed levels of delivery.
I have been thinking a bit about your statement that no one has asked physicians how to fix the healthcare system, and I wonder if the issue is really not that physicians haven’t been asked, but rather that physicians have not taken a proactive stance towards fixing the healthcare systems. In my experience working in hospitals I have seen several complex policies thrown at hospitals and physicians from the government and from insurance providers. Sometimes the policies were created by physicians who now work for these organizations. Usually practicing physicians will just adapt. It’s easier to just deal with the policy and go on seeing patients that really need to be seen than to take time out of a busy practice to go upstream and try and fix the problem at its roots.
We can’t just sit back and expect that the policymakers will beat a path to our doors to ask our opinion on what should be done. We need to take the steps to put ourselves in positions of influence. Only then will we be able to change the system. The alternate approach is to try to build something that is more attractive, but that also requires significant influence, beyond just knowing pure medicine.
I think your blog is an excellent step towards getting people a good framework to think about these issues so when we do get some physicians into those positions they will have their heads screwed on straight.
Hope these ramblings weren’t too rambling.
Thanks again. I eagerly look forward to your next post.
You hit on several important points. It is indeed too difficult to go out and try to change the system when you have to and love to see patients and try to help them.
Your patients and your multiplier. You have to educate and motivate them to go out and change the system. I will get into the instruction on how to do this in detail as the blog progresses. Meanwhile we need a posse’ to gather up the patients to do this for them and us.
You can help by having all your friends subscribe to the blog.
Thanks for your comment
Stanley Feld M.D.,M.A.C.E.