Is it possible that health care can become more effective, more personalized, more attuned to real health and wellness in a manner that truly benefits the patient as a customer/client?
The answer is “yes” but it will require understanding the dysfunction in the delivery system today, dealing with the growing shortage of primary care physicians and their non-sustainable business model, changing the insurance paradigm from prepaid medical care to (high deductible) true insurance for the catastrophic, and patients taking on greater responsibility for personal health and wellness.
There is excellent research and innovation along with superb providers is in this country. But the delivery system is dysfunctional and to date America has tolerated this dysfunction. It’s a medical care not a health care system. The emphasis is strongly on disease management and not disease prevention or health promotion. American medical care is very expensive, about $8,000 per capita, and yet outcomes are not what they could or should be. For example, America does not have the lowest infant mortality rate nor the longest life span. Other developed countries beat us on both counts. Medical care of acute illness is generally quite good in the United States but chronic diseases like diabetes, heart failure, chronic lung disease, etc. – of which there are more and more occurring – are not adequately cared for. The system is provider oriented rather than patient oriented and the patient is not the real customer of the physician or the insurer.
There is a shortage of primary care physicians and this is getting worse every year. Only 30% of American physicians are primary care physicians compared to about 70% in most other developed countries. Medical school graduates prefer to enter specialty practices. Those still in primary care practice often take less than adequate time for the prevention of chronic diseases. And too few appreciate or at least offer the time needed for chronic illness care coordination nor do they regularly integrate other options for care such as acupuncture, mind-body medicine, massage, etc.
Since today the patient is largely not the customer of the doctor, a good place to start is to change that paradigm. A high deductible health policy means that the patient will now be paying the primary care physician directly for care and thus this changes the professional-client relationship to a more normal occurrence. The physician will now become more attentive, allocate more time, offer more preventive care and will coordinate the care of chronic illnesses. True, the charge will be the same (unless the physician drops insurance entirely) which may not be any more adequate than before although the PCP should be able to save on the costs of billing and coding. When the PCP no longer accepts insurance and either charges fee for service or establishes a retainer based practice, the contractual relationship between doctor and patient is heightened.
Individuals also need to take more responsibility for their health and wellness directly. Attention to nutrition, exercise, stress and tobacco are key first steps. Work place wellness programs can materially assist. They can offer a health care premium reduction in return for engaging in added educational and action programs such as nutrition, fitness, smoking cessation and stress management to improve lifestyles.
Social networking can have an increasingly beneficial effect. Lifestyle changes are easier to accomplish in a peer group setting. Usually we think of this as a physical group setting but it can also be done through the use of social media. Groups help give a positive reinforcement for behavior change. Social networking through sites such as Facebook, Twitter or YouTube or others can be used to leverage the medical care delivery system to become more patient centered, more effective at the coordination of chronic illness, more attuned to prevention and responsive to true integrated medicine.
Everyone should have a primary care physician, one well schooled in the most current evidence-based care approaches yet who is attuned to the full gamut of integrative medical approaches such as chiropractic, nutrition, personal training, massage therapy, and acupuncture. You need to be sure that your primary care physician will spend the time needed to deal with health and wellness and not just disease. You may well need to pay your primary care physician directly rather than via insurance but the primary care physician will then be financially able to offer you the time you really need and deserve.
You deserve superb integrative health care but to get it you will need to take some action to obtain it. Call it a balancing of rights with responsibilities. It may cost you directly rather than via insurance but you may well find that the return on investment is well worth it.
Stephen C. Schimpff is an internist, professor of medicine and public policy, former CEO of the University of Maryland Medical Center and is chair of the advisory committee for Sanovas, Inc. and the author of The Future of Medicine – Megatrends in Healthcare and The Future of Health Care Delivery- Why It Must Change and How It Will Affect You from which this post is partially adapted.
