Public attitudes toward healthcare reform and system redesign needs

Health Care Reform

LIFE and HEALTH at STAKE

An online survey conducted this month said that half of all U.S. adults want a major reform in the healthcare system in the next two years (Business Wire, 2010). The Harris Interactive Health Day poll surveyed 2,075 adults 18 years old and older from February 3 to 5 in time with the election of Scott Brown into the Massachusetts Senate. A large 50-27% of the respondents considered healthcare reform just as important as reducing unemployment and creating new jobs. They felt it would be bad if the reform was not instituted in the next two years. However, they did not indicate favoring the health reform proposed by President Obama and the Democrats. The public appeared split between the separate stands of the Democrats and the Republicans. The Democrats want to ensure that more people have health insurance. The Republicans, on the other hand, are opposed to increasing taxes to pay for health reform. The most important aspect of the reform is how to control the out-of-pocket costs of healthcare and health insurance. According to the Harris Poll chairman, Humphrey Taylor, the President and Congress must come up with significant legislation in that span of time. If they fail, the resulting "health fatigue" will increase and drive votes towards Republican candidates in November (Business Wire).

In its 1999 report on the Quality of Health Care in America, the Institute of Medicine Committee revealed that the healthcare system needed major repairs (English, 2001).Entitled "Crossing the Quality Chasm: a New Health System for the 21st Century," the Committee said that the system was failing because it was poorly designed. There are very few programs with multidisciplinary teams to provide comprehensive services even for the most common health conditions, such as breast cancer and diabetes. The majority of patients did not receive the services the need. Rationalizing the current system would exact much cost and multidisciplinary efforts and cooperation. The Committee's proposal included 13 recommendations and 10 rules. It also asked Congress to a $1 billion "innovation fund" for the succeeding 3 to 5 years to subsidize worthwhile programs and for healthcare reorganization. The Committee also asked the Agency for Healthcare Research and Quality to list down the 15 to 25 most common chronic health conditions for prioritizing by healthcare entities within a five-year period. And it recommended a "renewed national commitment" to information infrastructure in support of healthcare delivery, consumer health, quality measurement and improvement, public accountability, services research and clinical education. The Committee strongly endorsed the use of new technology by Congress, the executive branch, healthcare organization leaders and health informatics association and vendors (English).

Other reforms sought addressed increased healthcare spending, unequal access, delivery system and financing, and physicians' plight.

Reform for Increased Health Spending

The recent growth in healthcare spending in the last decade has largely been in response to population risk factors, such as obesity and stress (Thorpe, 2005). These disorders and new medical treatments account for two-thirds of increased spending in healthcare. Reform should shift from insurance-based approaches to health promotion, public health interventions and cost-effective medical care in order to be effective and realistic (Thorpe).

The most significant and sensible strategy to slow down on health care spending without reducing benefits is to slow down or reverse the prevalence of obesity and stress (Thorpe, 2005). This requires interventions for behavior change in diet and exercise, smoking and drinking. Targets are schools, workplaces and communities. How to gather participants and keep them is a key issue. Records show that few interventions aimed at behavioral change have been successful. Some worksite health promotion programs, however, show that they can be effective, depending on how strong the incentives are. Certain initiatives can be taken to reduce future healthcare spending. The Centers for Disease Control and Prevention may provide a comprehensive workplace health promotion program can be an incentive for employers to adopt their own. Incentives may be in the form of refundable tax credits or direct subsidies at 50-75%. Employees may join the programs through reductions in monthly health insurance premiums or cash incentives. Non-financial and proactive strategies in encouraging enrollment in behavior change programs have also been found effective. Another initiative is for schools to establish standards and funding for engaging in physical activities for at least 30 minutes each day. Parental cooperation may also be elicited in school lunch and breakfast programs. And the rise of high-cost but low-benefit medical technologies can be addressed by developing state data and assessing the costs and benefits of medical technology (Thorpe).

Extensive Healthcare Reforms

Participants at the Focused Research on Efficient Secure Healthcare or FRESH Thinking Project agreed that problems on coverage, cost and quality warrant extensive reform (Brauser, 2009). That reform should go beyond expanded access to substantial organizational change and care delivery. Stakeholders must, at the same time, enhance capabilities, infrastructure and incentives in assuring that all Americans receive high-quality healthcare they deserve. Project participants were physicians, health policy experts, health insurance executive, business leaders, hospital administrators and economists. Retaining the status quo was viewed as a significant threat to government resources, the economy, the people's standard of living and the nation's future itself (Brauser).

The participants arrived at 8 fundamental policy recommendations for reform (Brauser, 2009). These recommendations covered both delivery system and financing. They concluded that the problem on access cannot be solved without correcting the financing system. And the cost and quality problems cannot be solved in a sustainable manner without correcting the delivery system. Their recommended delivery system reforms would replace the present fee-for-service payment system with one that rewards innovation; a well-funded and independent research agency on the effectiveness of medical interventions; simplifying federal and state laws and regulations; a health information technology infrastructure for data exchange; and a national health database. Financing reforms would locate sources of revenue create a health coverage board and state or regional insurance exchanges. These insurance exchanges would pool and assess risks to provide a standard benefits package for those without employer-based insurance. The collective aim was to insure real value, that is, better quality care and improved health of the populace at sustainable growth levels and costs (Brauser).

Physicians' Reform

A recent Medscape poll showed that 76% of physicians sought healthcare reform for their patients and themselves (Terry, 2009). Deans of medical schools, chief operating officers of teaching hospitals, leaders in medical specialties, and individual practicing physicians expressed the view during a May 27 meeting on healthcare reform at the White House Office of Health Reform. For many of them, especially primary care practitioners, the major issues crying out for reform are health insurance, malpractice, fair compensation and bureaucratic interference in the physician-patient relationship. Their traditional opponents are the insurance companies, the law, and the Federal government. President Barack Obama emphasized healthcare reform for children, low-income families, the elderly, those with preexisting conditions and the unemployed and other sectors except physicians (Terry).

These physicians decried the lack of sustainability of the current healthcare system (Terry, 2009). While traditionally disinclined to lobby for their own interests, physicians now find the need to get involved in view of the lack of sustainability of the current healthcare system. As the sole owners of a license to practice medicine on which industries and other business entities build profits, they need to take solid steps to assert their rights. They listed strategies to put their situation and demands across to the current government. These strategies include a letter writing campaign, civil disobedience, a website for physician consensus, petitioning elected officials to take action on their concerns, email campaigns sent to the President and Congress, forming a physicians' union, refusing insurance and political games, and a one-day strike off their patients to draw attention to their objective (2009).

Summary and Viewpoints

A recent interactive survey showed that half of all American adults want the current healthcare system reformed (Business Wire, 2010). The Institute of Medicine Committee likewise found that the system badly needed repairs (English, 2001). In addition to 13 recommendations and 10 rules, it sought a $1 billion innovation fund, a list of the most common and chronic medical conditions and disorders from the Agency for Healthcare Research and Quality, and renewed commitment to information infrastructure and new technology (English, 2001). Thorpe (2005) suggests addressing increased health care spending in a number of ways. One is through a CDC-prepared comprehensive workplace health promotion program, which can provide strong financial and non-financial proactive incentives to both employers and employees. Another is the introduction of standards for regular physical activity in schools. The high cost but low benefits derived from medical technologies may be addressed by developing state data and assessing the costs and benefits of medical technology. This is the third initiative. Levine and co-authors (2007) perceive access to healthcare as an ethical or moral issue and propose four reforms. Healthcare leaders, on the other hand, propose a combination of reforms that will address and correct the current delivery system and financing inequities (Brauser, 2009). And physicians feel it is time they lobby for their own professional interests and send their clear message to the President, Congress and the public (Terry, 2009). Writing letters and petitions, a website for their consensus, civil disobedience, unionization, avoiding insurance and political games and a one-day strike from practice to call attention to their concerns. All these reforms have their respective merits but the one deserving of greatest support is treating healthcare as an ethical and moral issue. It underlies the basis of all other reforms. #