Overview

Repairing the Healthcare System 

Stanley

Feld M.D., FACP, MACE

The Overview

Our greatest asset is our health. Access for diagnosis, treatment and health maintenance is through our health care system.

In the past thirty six years as a Clinical Endocrinologist, I have seen many advances in health maintenance and in preventing the complications of chronic disease. I have also experienced economic and political distortions in a healthcare system that has impeded the progress of our quest for a healthier society.

We have heard that the healthcare system is broken. We have also heard that while all goods and services industries have embraced (not totally true) the electronic era, physicians have resisted the electronic revolution for some reason. If medicine is to step into the 21 century, medical practices simply how to adopt an Electronic Medical Record (EMR). The EMR will solve the problems within the healthcare system. In my opinion, this view of the solution is a very simplistic, and not correct. It is true however, that physicians have resisted instituting EMRs, and for many good reasons.

Why have physicians resisted the EMR? It is hard to find a coherent answer in the literature. Again, no one has asked the practicing physician. In the future, this blog will discuss the multiple reasons for the resistance, and probable solutions.

Since we do not have universal EMRs, we are lead to believe that all the problems with the health care system are the physicians fault for not adopting the EMR!

However, a sober look at the problem reveals all of the stakeholders are at fault. The stakeholders are the government, the insurance industry, the pharmaceutical industry, the hospitals, the physicians and the patients. We will discuss the role of each have played in the distortions and dysfunction of the healthcare system.

In my view, the patient and the physician are the key stakeholders. Without the patient and the physician, we would not need a healthcare system. The patient is the player and the physician’s role should be the coach, making the diagnosis and teaching the player what he has to do to get well and stay well.

However, in 2006, the patient and the physician are generally listed last among “important” stakeholders by government, insurance companies, hospitals and policy makers.

Since the patient is most important stakeholder. The patient should be in the forefront of policy making. The physician is second.  All the other stakeholders are in reality simply facilitators for the patient and the physician. Everything done in the healthcare system should be done for the benefit of the patient first, and not for the economic bottom line of the other stakeholders. After all it is the patients’ healthcare system! Is it not?  The demand for repairing the healthcare system and action to fix it has to be made by the patient,

The patient with his consumer power is going to have to be the one that fixes the system. None of the other stakeholders has been able to fix the system to date. In fact, the insurance industry, government and policy makers have made the health care system worse by their solutions. Systemic changes have been made over the years. The result has been further adjustments by the facilitator stakeholders for their profit advantage. These adjustments in turn have lead to further changes and further adjustment by those stakeholders. These adjustments have resulted in further distortions in the healthcare system. Presently, all the stakeholders are in pain. However, the stakeholder with the most at risk is the consumer of healthcare. His health and well being are at risk! If we stay on the present course, I predict the system will break down completely and access to care will be limit and restricted. Advances in medical care will be non existent.

The goal of this blog is to walk thoughtful people through the evolution of the problem, and the process of cure. The ultimate goal is to;

1.     Provide patients

a. with access to good care

b. ability to judge quality care

c. true assets and vehicles to be responsible for their care

d. the freedom to select the physician of their choice to deliver quality care

2.     Provide physicians

a.     A precise definition of the meaning of quality care

b.     with the opportunity to provide quality care for acute and chronic disease

c.      with an opportunity to improve the quality of care they deliver

d.     with a vehicle to prove that they are delivering quality care

e.     with a mechanism for delivering care at a transparent price’

f.       with the ability to effectively communicate with patients

g.     with the ability to develop effective patient physician relationships

h.     with the ability to help patients prevent costly complications of    chronic disease   

i.       with the ability to improve  communication and access for patient information so as to reduce the cost of redundant evaluation and treatment

3.     Provide patients with the information of their evaluations so it is truly portable

4.     Provide insurance vehicles that are affordable to everyone

5.     Provider patients with education vehicles so they can become “Professors of their Disease” and be truly responsible for their care

6.     Knowledge is power. This knowledge through education will increase patient compliance and adherence to recommended treatment and thereby reduce the cost of care.

7.     Create both quality of life and economic incentives that with stimulate patients to be responsible for their own care

8.     Decrease the overall cost of the system

9.     Eliminate the 45 million uninsured

10.  Decrease cost to the government

11.  Increase profit margins for the insurance industry

12.  provide satisfactory profit margins to Hospitals, and Pharmaceutical companies

These are ambitious goals.  Processes must change in order for the United States to deliver effect health care to our citizens now and in the future. We, the people can not leave the fix up to the minor stakeholders and policy wonks. They have failed in the past.  Their policies have distorted the healthcare system to serve their vested interest. The patient or future patients must drive process in order to repair our healthcare system.

In this blog, I, Stanley Feld M.D., FACP, and MACE, as an individual will try to stimulate you, the patient or potential patient, the major stakeholder, who presently has the smallest voice to be the most powerful stakeholder with the loudest voice. You can make effective demands for a healthcare system that works because you have been put in charge and are responsible for your care!

Comments

[Krishna]

Hello Dr. Feld,

I just wanted to drop a line to tell you that I have enjoyed the articles that you have posted so far! I am looking forward to learning more about your thoughts on the US healthcare system. Your perspective is very valuable to me as I am a budding physician myself (just finishing 3rd year of medical school) and I would like to help fix things, but it's so overwhelming from where I stand that I don't know where to start or what would be most useful for me to focus on. Do you have any advice for a beginning physician?

Thank you!

[Nari Kannan]

World Class healthcare, world class doctors, world class medicines and treatment.

Only if you are superrich and can afford to pay for it or if you have insurance and if you have the patience to sit through medical hell! The patient always seems to come last as Dr.Feld observed!

Looking forward to your blog, Dr.Feld! You may already be aware of Dr.Don Berwick's efforts in Healthcare Improvement - http://www.ihi.org/ihi. Interesting articles in this web site. Would love to hear your take on his efforts!

I think Insurance as a concept applied to Healthcare is failing. Everybody thinks somebody else is paying and everybody pays as a result! Health insurance will work only if it is for serious illnesses. For simple ailments if doctors charge and patients pay directly, a lot of the inefficiencies will be cut out and at least simple healthcare will be cheaper! That's just my guess! I am only a software engineer and somebody like Dr.Feld will throw more light on the nuances of the healthcare industry to test this theory!

Thanks & Regards
Nari

Dear Nari

My goal is going to explain how you can help repair the system. Thanks for the comment. Never devalue yourself. You know more than you think

Stanley Feld M.D.,MACE

[James]

Dr. Feld - I look forward to reading your exciting blog. Let me try and post some initial provocative comments to get your blogging juices flowing:

1. Do you really think that a healthcare system based on capitalism can be fixed? Seems like physicians want more compensation, insurers want more premiums, and patients want lower costs. The art of medicine has and will continue to be a service and not a commodity.

2. Looking at the ends of the spectrum of medical providers you will see many interesting trends. Older physicians going out of private practice and retiring sooner with less income, new physicians driven toward higher paying subspecialties and managed care organizations or groups. So where is the next generation of general care providers coming from?
I think the resistance for universalization may be largely based on fear that compensation will further decrease.

3. Patients obviously want choice in care. Even if choice were provided, is the average patient even capable of choosing? Since the beginning of managed care, there has been a hunt for control of patients and insurers have captured many populations via marketing campaigns. To what extent will patients have freedom of choice as they lock themselves into the intricacies of various plans?

4. Lastly, it is obvious that patients in the US will continue to demand the best available treatments and procedures. Can the government continue to bear the cost of reimbursements without bankrupting the country?

I look forward to your thoughts.

[email protected]

All Important questions and statements, I hope to address in the coming months. As I said the problems you raised are not going to be fixed with a patch. They will be fixed with an understanding of how we got here and how we create a paradigm shift

Stanley Feld M.D.,MACE