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.

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