Undoubtedly, our health care system has many faults. There is no single person or entity we can blame for all these faults – instead, it’s been a series of unfortunate decisions and events that have led us to where we are now. Health care costs have skyrocketed, health insurance premiums are often unaffordable, our medical and health records are unattainable, and Americans in general are unhealthy. And whether or not you agree with President Obama’s health care proposal, you must agree that we need some form of health care reform.
Naturally, there are a hundred different ways to approach health care reform. We can change little things, big things, a bunch of miscellaneous things – hoping to come out better in the end. You’ve probably heard several different proposals on health care reform – some good, some bad, some seemingly inconsequential. As part of the health care industry, we enjoy looking at these different ideas and envisioning how they might change our health care system – Which is how we ran across this insightful article by Don Kemper at The Health Care Blog.
Don’s strategy is simple: If you want a better system, support a smarter patient.
Don briefly mentions the significant cost comparison between McAllen and El Paso, Texas – something we’ve previously discussed. And while he acknowledges the importance of this example, Don feels that the more significant comparison is the one between American families. To prove his point, Don poses an example of two identical families – the Smiths and the Joneses – who have the same medical conditions, yet very different approaches to medical care.
The Smith family is a “doctor knows best” family that relies on the excellent physicians and hospitals in their community to keep them healthy or return them to health when they aren’t, but do little to participate in the decisions or the care. The Smiths accept whatever treatments their physicians recommend.
The Jones family also relies on the physicians and hospitals in their community. But they use health care decision tools and self-management information in combination with their doctors’ advice to make sure they’re getting the best treatment for them.
When Sam Smith’s back pain flared at age 45, he was quick to accept his doctor’s recommendation for an MRI and a visit to an orthopedic specialist to make sure it wasn’t serious. The MRI showed a possible cause of the pain and just to be sure Sam had surgery the following week, marveling at the efficiency of the system. The cost: about $40,000 for surgery, hospital, physician care and rehab.
When Jay Jones, also age 45, had an identical bout of back pain he reviewed a back surgery decision aid on the Web-even before his first visit. He learned that back surgery is not usually needed or always successful. For him the case for surgery was not very strong.
When his doctor recommended an MRI, Jay pointed out that a decision aid helped him learn that 50 percent of back pain cases go away in four weeks, 90 percent in six months, and only 10 percent of back pain cases need surgery. Jay also learned that MRI reports often find things that can lead to surgery even though they were not the cause of the pain. With that information he asked if he might put off the MRI and the surgery while he determined if his back would get better on its own-it did. The cost: $150 for the office call and $12 for the over-the-counter medications. Back surgery is among the most overprescribed treatments.
When Sam’s wife Susan, felt some chest pain after an argument with him, she went right to the ER. While the pain went away quickly, Susan accepted the recommended EKG just to be sure. And although she had no family history of heart disease, just to be sure she was also given a stress test, an echocardiogram, a mobile Holter monitor and a cardiac catheterization. She was happy to agree to anything that the doctors thought might show something. The cost was staggering-but the insurance paid most of it.
When Jay’s wife, Janice, felt similar chest pain she made a quick check with an on-line symptom guide. She self-assessed that she was not sweating, had no shortness of breath, she wasn’t vomiting or nauseous, the pain was fairly stationary and her heartbeat was steady at her normal 64 beats per minute. She also surmised that the pain could have been caused by a session yesterday on a new exercise machine at the gym. After confirming by phone with her doctor she decided to do watchful waiting to see if the pain went away-it did. The cost: $25 for the phone call to her doctor. As a bonus, her alertness to the possibility of heart pain caused Janice to renew her commitment to exercise and healthy eating.
When Grandfather Smith Sam’s dad and Granddad Jones Jay’s dad each progressed into advanced frailty with dementia, the pattern continued with the Smiths opting for a full medical response in their “at-all-costs” battle against death and the Jones opting for an approach which maximized family support and caring over treatment. The Smith to Jones cost difference was astounding.
Interesting, isn’t it? You’ve probably never considered this point of view before – we’re so concerned about medical privacy that we often don’t consider how our friends, neighbors, and family members may be approaching their health care. Yet, this argument makes sense. If the Smiths are able to take a more active role in their health care decisions, it would greatly offset their health care costs. And this is why Don Kemper proposes his two-part solution: “Supporting the Joneses” and “Motivating the Smiths.”
Supporting the Joneses
- Help people do as much for themselves as possible. We’ve been given the tools to become our own travel agents, bankers, web site developers, and video producers – the same theory should be applied to medical care. Provide easy-to-use decision aids and self-management guides to help people determine whether they should seek medical care, or monitor their own progress for a short period of time.
- Help people ask for care when they do need it. Kemper proposes we given patients easy-to-read versions of the medical guidelines that doctors use. With this resource, patients can ensure they are getting the care they need, and only the care that is medically necessary.
- Empower patients to say “No” to recommended care that is not likely to improve their health condition. With the right resources, patients should be able to decline duplicative or overly expensive testing and unnecessary drugs or surgeries that are not likely to make a positive difference in their lives.
Motivating the Smiths
- Reduce medical co-pays for services that prevent future health complications.
- Reduce medical co-pays or health insurance premiums for people who take an active role in their health care. For example, people who use online resources and patient decision aids to monitor their own health.
- Provide incentives when patients obtain and maintain certain health and wellness goals. Not only will this encourage people to maintain a healthier lifestyle, but it will drastically improve the health of our nation.
Surely this won’t be the golden rule for health care reform. There will undoubtedly be many more changes that need to be made before out health care system is beneficial to everyone involved. However, this approach would certainly benefit the system. We’re interested in your thoughts – do you think this strategy would help the system, or is it too risky to ask patients to manage their own health?
