The triple aim of health care, as defined by the Center for Medicare and Medicaid Services (CMS) is: improving the experience of care, bettering the health of populations, and reducing the per capita costs of health care.
This struck me as odd when I first read it. Why should the stated aim of any system become to decrease the costs associated with that system?
Which led to the next logical questions: What should be the stated aim of health care in America? And where would we need to put our money to reach that aim?
I went into family medicine, the land of community health, behavior change and health promotion, because I believe the aim of a health care system is to keep people healthy. I wanted my work in medicine to prevent disease and promote health (offering vaccines and health screenings and diet advice), as well as curing sickness as needed. But my personal aim in medicine doesn’t jibe with the American medical system.
A few years ago, my department chair summed up the underlying aim of American medicine: “to cure disease and keep people from dying.” We’re pretty good at this. Our medical system cures lots of diseases really well, thanks to surgeries and antibiotics. Intensive care units return some people to life, and for others postpone inevitable death.
And yet truly, the purpose of a health care system is to provide care to promote health. Give health? Keep health? Restore health? Who cares?
I do.
How we define “health” and what services we define as part of the “health system” changes the way our society allocates scarce resources. Right now, our society devotes an enormous portion of our budget to the medical system—curing sickness and keeping people from dying. A medical system and a health system, however, are two different things.
If we redefine a health system as any system within our society that delivers the goods that promote or destroy health, we can restructure our funding priorities to promote population health rather than individual medicine.
Is “health” turning on a faucet to obtain clean water, free of the microbes that take up residence in our intestines to kill? We’d need to allocate health care dollars to monitor our water and sanitation system.
Is “health” eating wholesome fruits and vegetables, devoid of the high fructose corn syrup that makes us fat, gives us diabetes, and kills? We need to see politicians end the era of King Corn and misguided agricultural policies.
Is “health” breathing pure, clean air, devoid of dangerous diesel exhaust and factory emissions? Let’s fund the Department of Transportation and the Environmental Protection Agency.
Is “health” having food on the table, a roof over our heads, the warmth of heat in the winter, a cool pool of water to soothe the summer, bodily comfort in a cruel world? These are the works of the departments of labor, housing, energy, parks and recreation.
Right now we define “health” as having access to the doctors and medicines and hospitals we need, as we need them, to restore health to our sick bodies so we can return to being happy, healthy, productive citizens. This is the work of the Department of Health and Human Services, and their triple aim is to improve medical care, improve population health, and do all this for less money.
Cost savings will come when all the departments of our government unite and receive the resources they need to promote health. Then we will have a health system.
Kohar Jones is a family physician who blogs at Progress Notes.
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