PRINCIPLES OF HEALTH REFORM

                

The U.S. spends twice as much on health care as any other industrialized nation, with costs far exceeding rates of inflation.(1) Regrettably, these increased costs do not translate into improved health outcomes for Americans.

Thus it seems that any efforts towards meaningful health reform will focus in two main areas:

1.)Improved patient outcomes

2.)Lowering costs

Our current health care system is based primarily on an “illness model”. The current health care system spends billions of dollars to help people recover from illnesses, whether acute or chronic.

Indeed, many of the advancements in technology have helped millions of people recover from significant impairments. However, it is no secret that for people with chronic health challenges, it is simply not enough. There is no “magic pill” or surgery that will cure chronic health challenges like Multiple Sclerosis, Lupus, Fibromyalgia, Chronic Degenerative Disc Disease, to name a few.

Even conditions like Diabetes, which can be managed with oral medications or insulin, require a total daily life commitment on the part of the patient.

For each patient, living with chronic illness requires a long term life commitment on the part of each individual- and their loved ones. And according to recent data from the Kaiser Family Foundation (2), “more than 4 in 10 adults report having a chronic health challenge such as heart disease, cancer, asthma, arthritis, or diabetes of an handicap that limits their daily lives”

Overall, our current health system focuses primarily on the medications and surgeries, but does little to support the lifestyle changes needed to help a patient optimize level of functioning with a chronic health challenge.

It would seem that outcomes could be drastically improved by this wellness approach to health care.

Currently many millions of patients with chronic health challenges seek symptom relief and improvement in quality of life through Complementary/alternative medicine.

It is time that rigorous scientific study of the potential benefits of complementary/alternative medicine in patients with chronic health challenges take place. If results are beneficial, then widespread implementation can and must occur, in our conventional health system.

It is hypothesized that patients engaged in proactive wellness programs will

require far fewer technological or pharmacological interventions. Lowering costs while enhancing quality of life- a hypothesis well worth testing- and implementing now.

Besides integrating wellness strategies, cost containment in health care must focus on lowering skyrocketing administrative costs. Billions of dollars are spent every year in health related administrative costs. Both patients and doctors would agree that health care paperwork has increased exponentially in recent years. Three of the major sources of administrative costs include managed care, billing, and regulatory costs.

Managed care arose in the early 1990’s to drastically reduce costs. While most would agree that managed care has greatly enhanced the efficiency of the health care process, and contained costs, it is highly questionable what benefits, if any, managed care has had on patient quality of life, or outcomes. Both doctors and patients report feeling like the office experience is like “an assembly line”- very impersonal and rushed. Certainly the system needs to be much more efficient and streamlined so patients get what they need, doctors have time to practice and it seems the most logical next best step is close scrutiny of the current role of managed care; the actual costs of managed care and  embark on a cost-reduction strategy.

Many of the efficiencies implemented by managed care have become standards of practice today, and could be maintained without the large costs of managed care companies oversighting today’s health care. The number of sessions and services per illness can be standardized and automatically authorized when a service is entered by a clerk prior to an office visit. Conservatively, such uniform standards of health practice would save many millions of dollars of managed care costs every year.

Likewise, part of the nightmare in medical billing is the lack of uniformity in health care insurance policies. There are wide discrepancies in deductibles, in amounts reimbursed for particular services etc…It is time that some consensus occur on what costs are reasonable and customary in an effort to simplify the billing procedure.

Consensus on these standards of care needs to take place across the board and agreed upon with Medicare, Medicaid, Government and private payors.  Even if three standards were agreed upon, a low- cost, moderate cost and high cost, the care that would be reimbursed would be very predictable by both patients and doctors and so much simpler to administer.

For example, employers might chose to offer the low-cost health option, and the employee might chose to pay a little more to upgrade to the moderate-price option. No surprises, no guesswork, no needing a team of billing specialists to decipher which services are covered and which are not. Lots of cost savings, ending enormous administrative red tape.

In addition, health care regulatory costs are rising annually. Since health care involves people, there must always be some oversight to insure patient safety.

However, in recent years, the cost of regulations seems to be skyrocketing exponentially. In a recent study by the Cato Institute, “the high cost of health services regulation is responsible for more than seven million Americans lacking health insurance”. (3)

Areas of current health regulation include:

Health facilities regulation

Health professionals regulation

Health insurance regulation

FDA regulation of Pharmaceuticals and Medical Devices

Medical Malpractice

In the word of Christopher J. Conover, Associate Research Professor with the Center for Health Policy, Law and Management at Duke University:

“Finding ways to reduce or eliminate this excess (regulatory) cost should be an urgent priority for policymakers.”

Health care administrative costs have another risk- and that is the risk to the doctor-patient relationship. Health care practitioners would attest that they spend more time with paperwork than ever, representing a huge obstacle to quality time with patients.

Perhaps data needs to be collected on the impact of administrative costs on patient outcomes and quality of life.

The complexity of the U.S. health system warrants comprehensive strategies to improve patient outcomes while reducing costs. This article has attempted to outline important areas for legislators, health care providers and health administrators engaged in health reform endeavors.

With all health reform efforts, citizen participation is essential to represent patients needs and concerns and to insure success.

(1) Research and Markets, “The US Spends Twice as much on Health Care as Any Other Industrialized Nation” http://www.researchandmarkets.com/reports/c32946

(2) “Kaiser Public Opinion Spotlight: The Public on Health Care Costs” www.kff.org/spotlight/healthcosts/index.cfm    2007.

(3)Conover, Christopher, J, “Health Care Regulation A $169 Billion Hidden Tax”, Policy Analysis, Cato Institute, No. 527, October 4, 2004.