Wednesday, July 11, 2007

Health Care Reform

Much has been said lately about the state of the health care system in the U.S. Every presidential candidate is talking about it, Michael Moore has made a movie about it, and terms like “single payer health system” and “universal health care” are becoming more and more popular.

I agree that the health care system in the U.S. is incredibly broken. In fact, I believe that the scope of the problem is equal to or may even exceed the problem of world hunger. But just as with world hunger, health care in the U.S. won’t be corrected instantly with one massive program or a “single payer system.” To fix health care in our country, I believe that a series of building blocks must first be put into place that will create a strong foundation on which further changes can occur.

Here’s what I believe those building blocks should be:
First, we need to move as much care as possible out of the hospital setting. Health care provided within an acute care hospital’s four walls is very expensive, so all care that can be moved and rendered in a cheaper setting should be. Here are some examples of how this can be accomplished:
1. Encouraging people who come to the emergency room for care but don’t need urgent care to find a medical home that they can afford. Too often, the poor or uninsured feel they have no other choice than to visit the emergency room for care when they are ill, even if they are not experiencing a medical emergency. They often can expect to receive care they can afford, but generally experience longer wait times and no follow-up care. Too often they don’t receive care soon enough and may have developed complications that would have been avoidable if they had been seen sooner. (CHRISTUS has piloted some innovative programs aimed at helping the uninsured find an affordable medical home. You can read about one of them, our community health worker program called Care Partners, on page 13 of our 2006 annual report.)
2. Strengthening our preventative medicine programs and aligning incentives so people have motivation to use them.
3. Stronger integration with education through avenues such as our school-based health programs, which educate people on disease prevention and appropriate health care utilization while they are teens. This will enable them to become healthier adults and also help educate the next generation of children about the importance of health care.
4. Supporting and developing collaborative programs for low-cost, affordable, suitable housing. If people do not have appropriate social environments and are not educated and at least literate, it will be more difficult for them to pursue preventive health care, let alone be able to follow medical instructions if they are acutely ill upon discharge.
5. Providing basic health insurance for all. This would allow the amount of charitable care to be more equitably shared by all health care providers in the country. It would also help us ensure that the 44 million uninsured people in the U.S. are able to receive the health care they need, particularly the uninsured children. These children are receiving little to no care at all, unless they are covered by a state-sponsored program (like a state-wide Children’s Health Insurance Program).

These are only the basics. After that, we will need to decide how to handle more sophisticated care and elective surgeries like cosmetic and bariatric procedures. Also, we must resolve how we will fund care for the elderly such as independent and assistant living programs. Those issues can be determined after the initial building blocks are put into place.

Also, as the government redesigns the health care system, they need to ensure that one basic tenet is changed: Medicare reimbursement must parallel the most fundamental building blocks in important the redesign. This means that if we really believe that the points I mentioned above will decrease the amount of care received in an acute setting (where the major cost is presently), then we need to make sure ASAP that reimbursement provides an incentive to provide care in a non-acute setting.

One of the reasons the health care system is in such a bad state is because incentives are not aligned to create the changes that need to occur. Acute care (which is often unnecessary) receives the highest reimbursement (funding), while social services, rehab services, home care, and long-term acute care are minimally funded. If we want health care to change, we should be paying as much for a person to go to a health club as we are paying to treat their diabetes (which might be avoidable by making healthy choices like exercising and eating properly).

Once again, I believe the changes must build upon one another. I am constantly reminding our Associates that we will only get where we want to be on our Journey to Excellence in 2016 because we did what was required in 2008 and then built upon that success. The health care system is the same: we fix the foundation and then build upon it.

We at CHRISTUS Health want to come to the health care redesign table and work with the leaders in Washington to design a system that works. We don’t have all the answers, but we do believe we have tried things that have given us some of the answers, and we would love to share our knowledge.


Anonymous said...

Dr Royer,
I wrote earlier about the problems at Spohn Memorial. I don't know if you had anything to do with the improvments that have happened but thank you

Anonymous said...

Just wondering what you think about the HPV vaccine for young women and why our insurance does not cover it for females over age 16.