Monday, August 03, 2009

How to Reform Healthcare Sensibly: Focus on Two Clear Goals

The focus of the current healthcare reform debate is way out of balance:

  • Issues of money and insurance are by far the main focus
  • Issues of quality and knowledge are a minor focus
  • Issues of empathy and compassion are mostly out of focus.

Focusing on all these issues in a balanced way is absolutely essential for creating a sustainable, high value system in which everyone: (a) has access to excellent affordable healthcare, (b) gets the knowledge and guidance needed to make informed decisions and take responsible action, and (c) is incentivized to "do the right thing."

If, however, we continue to focus on financial matters without equal regard to quality, knowledge, empathy, and compassion will result in more of what we already have: A healthcare system (comprised of many disparate sub-systems) that delivers inferior quality care and poor access compared to other countries, while (a) costing much more than any country in the world and (b) knowing almost nothing about the most cost-effective ways to prevent and treat health problems (see this link).

In other words, the American healthcare system has the lowest level of value (cost-effectiveness) in the industrialized world with no end in sight! Our dire situation will only get worse UNLESS we begin to take a balanced approach that focuses on improving care quality and efficiency, providing everyone access to good care and information, and fostering healthy lifestyles.

The ONLY way to accomplish this, it seems to me, is to focus on these two goals:

  • Enabling all clinicians to continually learn how to make (and keep) their patients healthiest and happiest for longest, using the most cost-effective methods of treatment and prevention, and encourage/reward them for doing so.
  • Enabling all consumers/patients to continually learn how to make (and keep) themselves healthiest and happiest for longest, using the most cost-effective methods of self-care and self-maintenance, and encourage/reward them for doing so.

Enabling and rewarding clinicians and consumers/patients to do these things would save huge amounts of money, continually improve care quality, and vastly improve the health and wellbeing of all by:

  • Eliminating waste, over-treatment, and excessive expenses
  • Minimizing errors, omissions (under-treatment), and legal expenses
  • Fostering wise decisions and competent actions based on valid, ever-evolving, evidence-based knowledge
  • Making healthy living more feasible (e.g., making good foods more available and affordable than unhealthy foods).

Isn't it time we start figuring out how best to do this!?!

My next post expands this discussion and relates it to President Obama's healthcare reform objectives.

Related links:


Ricky said...


Thanks so much for the information and it was really helpful and I hope the article on How to Reform Health Care Sensibly will help you a lot.


Wellescent Health Blog said...

I have to completely agree that quality and knowledge are in left field with respect to the current discussions on health care reform. Value for money just seems to be a hard concept for people to wrap their heads around and instead we get a Walmart Effect where cost is the only factor regardless of loss of quality and related consequences.

As far as education and knowledge is concerned, I think that that is a very hard nut to crack because it is not something you solve once. Education is an ongoing and high effort problem to focus on. While it would be nice to encourage people to seek the most cost effective care based on knowledge and incentives, I think that many would instead try to "game" the system to get the perks and financial savings even at the expense of their own health.

Dr. Steve Beller said...

Thanks for the comments.

"Value" is equivalent to "Bang-for-the-buck" or "Getting what you pay for." The biggest problem with making value-based decisions in healthcare is that we lack the knowledge about the most effective (i.e., the safest, highest quality, and longest lasting) ways to prevent and treat most physical, mental, and mind-body health problems for particular types of people in particular circumstances. We need much more collaborative research on cost-effectiveness—via outcome studies "in the lab" and in everyday clinical practice—before we can expect to get the necessary knowledge. And this has to be ongoing research focused on building and disseminating an ever-evolving base of knowledge about cost-effectiveness. In addition, we need to implement powerful incentives to encourage everyone to use this knowledge in decision making, self-care, and treatment. Yes, people will try to game the system, no doubt, so there ought to be negative consequences for doing so.

Despite these daunting requirements, there simply is NO OTHER WAY to have a sustainable, economical, ever-improving (i.e., high-value) healthcare system!

Does anyone disagree?