Monday, August 11, 2008

Health Care and Consumer Reform

The Washington Post online has reported this month that about 82% of Americans are not happy with the current system of health care in the U.S., and they want it overhauled. The Commonwealth Fund survey indicated that the majority of people in the study interview are very frustrated with health care issues such as inefficient and time-consuming record keeping and timely access to medical care. Americans want and deserve improved quality of care with more affordable options. They also want and deserve improved performance by medical providers, access to health care locations, and better treatment by physicians and staff at the time of service.

MSNBC reported the findings and indicated that about a third of those surveyed wanted a complete rebuilding of the U.S. health care system, and about half wanted fundamental change. The majority of respondees felt that health insurance should be simplified, and about 90% of those in the survey supported a wider use of health information that could be shared more efficiently between medical providers. Overall, about 16% of those surveyed felt the system works well and only needed minor reform. The views held were similar regardless of income and insurance status.

The Commonwealth Fund also reported that efficiency and accountability among health care providers needed improvement. Medical providers should be rewarded for high quality care and patients shoudl be incentivized for seeking health providers that offer the best and most efficient care. The number of uninsured should be reduced, and all Americans should have access to affordable care. Americans want a regular family physician who is available to see them on a timely basis and get referrals to specialists and other medical providers. They want improved quality and timeliness of care.

According to the report as released on the Washington Post website, the majority of Americans are very frustrated with the way their health care is managed. There is a lack of coordination including the delay in getting test results and the amount of follow up that is required by the patient. Almost half of those surveyed said they had to make multiple calls to find information. Important health data is not shared between doctors and nursing staff on a timely basis or at all, and the majority of patients wanted access to their medical records. People want a single point of service and coordination of medical information about their care. Patients also reported major issues with contacting physicians for appointments, phone advice, and after hours follow up.

Recommendations by the Commonwealth Fund were offered for improved care--moving away from fee-for-service plans and paying doctors and hospitals based on quality of care. Barriers should be removed that prevent doctors from sharing vital information; doctors and hospitals should be accredited based on quality measures; patient information should be more readily available to physicians at the point of care; and accountability for patient care should be more clearly enforced. Doctors and other medical providers should be trained to work as teams. And the federal government should mandate and support electronic health care records as an alternative to control costs and ease access to information by providers.

In February, 2008, Consumer Reports conducted a similar survey asking questions on how the health care system should be changed. About 80% of the respondees said that a reformed system should guarantee the following: coverage for all uninsured children; protection against financial ruin due to a major illness or accident; the ability to obtain coverage regardless of a pre-existing condition; coverage that continues even when people are laid off, changing jobs, or starting their own business; premiums, deductibles, and out-of-pocket expenses that are affordable relative to family income; and, the ability of people to keep their current health insurance if they choose. Additionally, the Consumer Reports survey also found that Americans are worried about escalating health costs, regardless of their financial status. Overall, 81% of those polled by CR said they're concerned about being able to afford health care in retirement, 68% worry about being bankrupted by medical bills following a serious illness or accident, and 65% fear losing their job-related health coverage.

Consumers were asked their support on the following issues:
-- The most popular proposal -- a mixed public/private system that would require all uninsured Americans to buy health insurance -- drew support from half of the respondents.
-- Thirty-six percent of respondents support public insurance, similar to the Canadian health-care system.
-- One-third of respondents favored a mix of employer-sponsored plans, private health-insurance plans, Medicare, Medicaid, and other public programs, which is the arrangement we have today.
-- Only 26% supported the idea of giving tax incentives for individuals to purchase insurance and relying on market pressures and competition among insurance companies to hold prices down.

The report also offered the following suggestions for improved health care:
1.) Complete coverage: Private insurance and public programs must be expanded to guarantee that everyone is covered from cradle to grave, regardless of health status and ability to pay.
2.) Fair cost spreading: No family should face financial ruin to pay for healthcare. Costs should be spread fairly among government, employers, and consumers.
3.) Safer care: Millions of Americans are harmed each year by the care they receive. Improved safety systems would save billions of health-systemdollars.
4.) Better care: Comprehensive, easy-to-understand public information about the safety, cost, and quality of care by doctors, hospitals, and nursing homes would help consumers and employers choose the best care.
5.) Prevention: Smoking and obesity related illnesses such as certain cancers, heart disease, and type 2 diabetes threaten to overwhelm health expenditures. The primary-care physicians whose job it is to prevent and control those conditions are the most poorly paid of all doctors. Our system should find ways to fix those problems.

It is true that Americans should have the best health care system in the world, but asking the government to pay for it (ultimately the American taxpayers) is not the best course of action. Mandating certain controls, such as sharing health records may reduce costs, but the issues raised by common database sharing need to be fully fleshed out in order to eliminate any potential problems associated with access to patients' private medical information. Transparency of medical information and costs is an area of health care that should be greatly improved. Better access to physicians is also something that should also be improved. Whatever the methods, Americans deserve a health care system that functions more like a finely tuned jet engine than a propeller driven bi-plane.

Until next time. Let me know what you think.

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