Wednesday, September 23, 2009

Criteria for a Sustainable Health System

On his blog, Vijay Goel, M.D. posted five criteria for a sustainable health system. He wrote:

Sustainable health reform requires a solid foundation…unfortunately the proposals we're seeing out of Washington create a more elaborate house of cards, as we continue to create an elaborate health care ponzi scheme. The House that built Medicare has already saddled our country with Trillions in unfunded liabilities. The proposals we see look to continue to reward a medical-industrial complex that creates and manages diseases rather than focusing on optimizing the health of people.

His criteria are:

  1. Individuals receive fair value for premiums
  2. Health Insurance is actual insurance (i.e. doesn't insure pre-existing conditions)
  3. Comprehensive services exist to Actively Manage Chronic Conditions: Chronic conditions (pre-existing) need active management
  4. Subsidies occur Transparently
  5. Retail Competition based on Differentiation.

These are all good tactics!

From a broader perspective, we've identified at least 4 goals that any government proposals ought to focus on achieving; and the proposals can be judged based on degree to which they address these 4 goals. That is, we ought to be assessing how much do the proposals focus on promoting greater:

  1. Self-Discipline?
  2. Personal Responsibility?
  3. Empathy and Compassion for the least advantaged (Social Responsibility)?
  4. Public Accountability (Transparency)?

In addition, there are at least 8 objectives that relate to those achieving those goals; and a proposal can be judged by how likely they are to achieve these objectives:

  1. Balance Investment & Spending
  2. Balance Savings & Borrowing
  3. Balance Conservation & Consumption
  4. Balance Endowments & Entitlements
  5. Connect Ends & Means (Resource Availability)
  6. Connect Should/Must Dos & Can Dos (Priorities)
  7. Preserve Security/Protection
  8. Preserve Rights/Freedoms (Opportunity & Liberty).

I suggest that the most sustainable proposals are those that focus on achieving those goals and objectives by fostering ever-increasing value to the patient/consumer through the cost-effective prevention, (self-) management, and treatment of health problems.

Continued at this link.


Unknown said...

Principles are interesting and to an extent transparent to systems. But focusing on individual respsonsibility has to take into account societal context of that responsibility. Want people to eat better diets and exercise more - well, Americans lose over 40 hours of vacation a year because they're afraid to take time off from work; average American commute is 3 hours. Add that up and you have a lot of stressed out Americans eating dinner in their cars - a recipe for hypertension, obesity, cancer, and heart disease. Oh wait! Isn't that part of the problem? I don't hear anyone agitating for more vacation days and shorter work hours!

Just as important might be: reducing the 50% of health care costs attributable to waste, according to Price Waterhouse Coopers - out of $2 trillion plus - over $1 trillion wasted. About the same as insuring everyone, huh?

Dr. Steve Beller said...

Cindy - I just responded to your comment at this link.