Four elements of a new u.s. healthcare system
OPINION PAPER BY HARRY SPRING - 2009
The United States is still looking for change to the US healthcare system. What should those changes be? If the changes are just about who pays the bill, or whether or not we have National Health Insurance, we miss an opportunity for real and meaningful healthcare change.
This opinion is about some fundamental problems with the US healthcare system and 4 elements that can help fundamental change and improvement in the system.
First, let’s review one of our healthcare system’s fundamental problems which is; we operate a HUGE medical production engine that expends all its resources on diagnosing and treating. We spend almost nothing on health! To illustrate, here’s a graph of the
2 Trillion dollar (16+% of GDP) annual expenditures of the US healthcare system; 93% of the money goes for diagnosing and treating, 7% goes for paying claims and other administrative functions.
The “healthcare spend” is 93% on doctors, hospitals, drugs, supplies nursing homes, and the like. Almost the entire amount is focused on diagnosing and treating conditions (illnesses and injuries); 7% is used to operate the system, pay the bills, perform customer service, and other administrative costs. Two glaring flaws in this system are:
1) almost nothing is spent on health; defining, preserving and pursuing good health and
2) the sicker people are, the more treatment they need, the higher the revenues to the various components of the Health Systems (physicians, hospitals, pharmacies).
This is the point at which fundamental change MUST occur for the US to sustain its health system and its place in Global leadership. The change I’m advocating is that a new US healthcare system depends on:
Conversion to a Health System From a Diagnose-and-Treat System
What a new US health system can provide is a comprehensive shift in focus to health, rather than just diagnosing and treating. I believe that is at the very core of a truly new and workable health system. Some initial details of such a reform include the following discussion.
Four elements of a new US healthcare system would focus on the improvement and preservation of good health for individuals and populations. These four elements are:
1. Health Screening (1%): The first element is broadly used health screening; a Personal Health Record (PHR) that drives a Health Risk Assessment (HRA), including basic blood chemistry values. There are 12 typical data points that give a good picture of a person’s health. These elements are as you would expect; height, weight, BMI, exercise, blood pressure, blood sugars, cholesterol. Convenient access to this screening by the entire population is a core principle. This is a critical point: if the screening just locates and guides more people into diagnoses and treatment, we will again miss the mark. Certainly the screening must couple with medical safety and realistic treatment, but the screening must closely connect people to improved health and the activities that preserve and improve health.
2. Health Improvement (3%): In the current system, screening is mostly done as a health history, and is used as a primary interaction tool with medical professionals. Currently, there is usually a straight line from screening, to problems found, to treatment, to prescriptions and an ongoing client for the health system; little is done about improving health. The newer US health system sequence from screening should be:
a. Risk appraisal by the proper health/medical professionals
b. Health improvement through health fundamentals of breathing, hydrating, eating habits, exercise and attitude also supported by the proper health/medical professionals. This process would include:
1) initial and recurring measurements
2) health goals and objectives
3) programs to pursue and achieve the goals and
4) rewards, even if the reward ends up just to be good health.
3. Education (2%): Health Education is fundamental to a new US health system. For 50 years we’ve been taught (directly and indirectly) that we can eat anything we want, drink anything we want, take crazy chances, and not exercise and “the health system will take care of you.” We’ve proven that this is just not true. The health system may extend your poor health longer, but you may be miserable in the process. Health education must pervade in a new US health system. This health education will include focuses by schools, churches, clubs, the web, specialized professionals, health systems; there will be all kinds of access to education about how to improve one’s health and effectively return to health from adverse health conditions.
4. Technology (3%): There are at least 3 functions of the new health technology mostly related to information and access to information:
1) consumer-oriented, health improvement and management support available through multiple means and with various health professionals
2) consumer connectivity across a broad spectrum of health professionals including their health system and
3) connectivity within the health systems that serve our populations to enhance efficiency, quality and safety.
Here’s a graphic of a new healthcare model expense summary:
Inclusion of these 4 critical healthcare elements that will help spring forward the US health system into a real health system rather than its current disjointed diagnose-and-treat system. By adding these 4 new elements to the system, we have opportunity to dramatically change and create a new US health system.