Fall 2007 What Have I Said So Far? : Part 2
Stanley Feld M.D.,FACP,MAE
The consumer must fix the healthcare system. None of the other stakeholders has been successful. In fact, of the last 30 years the healthcare system has been made worse by the insurance industry, government and policy makers.
All their systemic changes have failed, because they have, for the most part, been to the advantage of the facilitator stakeholders and not the primary stakeholder, the patient. Facilitator stakeholders’ profits have soared, insurance premiums have skyrocketed while access to care has plummeted. Patients, physicians, hospital systems and the government have adjusted to changes to the detriment of the patient. The facilitator stakeholder adjustments have resulted in further dysfunction in the healthcare system.
Presently, employers and all the stakeholders except for the insurance industry are in pain. However, the stakeholder most at risk is the consumer. Only 20% of the population is sick and interacts with the healthcare system at any moment in time. 80% of the population does not interact with the healthcare system. They think everything is fine. However, the entire populations’ health and well being is at risk! If we stay on the present course, I predict the system will break down completely. Access to care will be limited and rationed. Access to life saving medical advances will vanish. Future advances in medical care will disappear.
The goal of the healthcare system should be;
1. To provide patients
a. with access to good quality care
b. with education to judge quality care
c. with incentives to be motivated to be responsible for their care
d. with the freedom to judge and select the physician of their choice
e. with the information of their evaluations so it is truly portable
f. with choice of health insurance vehicles that are affordable to everyone
g. with education vehicles so they can become “Professors of their Disease” and be truly responsible for their care
h. effective and affordable drug insurance to enhance patient compliance with medication
2. To provide physicians
a. with a precise definition of the meaning of quality care for various diseases.
b. with incentives to provide quality care for both acute and chronic disease
c. with the educational opportunity and motivation to improve the quality of care they deliver.
d. with an actual vehicle developed by their peers 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 electronically.
g. with the ability to improve the patient physician relationships
h. with the ability to enable patients to practice effective self-management techniques to prevent costly complications of chronic disease
i. with the ability to improve communication and access to patient information so as to reduce the cost of redundant evaluation and treatment
3. To decrease the overall cost of the system
4. To eliminate the 47 million uninsured
5. To align stakeholders’ incentives to provide satisfactory profit margins to hospitals, and pharmaceutical companies and insurance companies.
These are ambitious goals. Processes must change in order for the United States to deliver effective health care to the population now and in the future. Consumers can not leave it up to the facilitator stakeholders and policy wonks to fix the system. Their policies have distorted the healthcare system to serve their vested interest. The patient or future patients must drive the process of change through appropriate demands on our politicians in order to repair our healthcare system.
In my view none of the politicians running for president have a clue. They will only wake up if we make appropriate demands. Patients can make effective demands for a healthcare system that works. They have to demand that they own their healthcare dollar and be responsible for their care!