More From Health Care Community Discussion

NOTE: The opinions presented in this blog entry are based on the participants of a Health Care Community Discussion that I conducted and do not necessarily represent the opinion of the author of this blog.

MAJOR PROBLEMS WITH HEALTH CARE IN THE US
Participants of the health care community discussion identified the biggest problems in the health system as: prevention, affordability and access, lack of integration, disparities
and medical errors.

PREVENTION
The current system is focused on treating disease, not promoting health. Participants felt that health insurance companies do not focus on prevention. Payors have no incentive to promote health care on a long range basis given that members move from one health plan to another. Participants recommended that payors cover the cost of preventive services.

Providers contribute to the problem by not making prevention a priority. “Patients have to take it upon themselves to focus on exercise and diet since these are not areas that providers focus on. As a patient, it takes a lot of work to practice prevention on one’s own, to get reliable information.” Participants recommended that pediatricians, geriatricians and primary care physicians - the doctors in the best position to promote prevention - receive better training in prevention. These providers need to put particular emphasis on nutrition, exercise, and screenings.

AFFORDABILITY AND ACCESS
Participants felt this is an issue particularly for those covered by commercial insurance, where costs – premiums, deductibles, copayments, etc. - are too expensive. “Have Medicare for all,” one participant offered, adding “what do the private insures provide that Medicare doesn’t?”

Participants also remarked that it is complicated to choose caregivers; to know where to start when entering the system.

LACK OF INTEGRATION
“Health care is too disorganized; it lacks integration.” An example was: how to coordinate communications between different providers. Solutions offered included electronic medical records, personal health records and proper health IT systems.

DISPARITIES
Age and disability were the two disparities discussed among the participants. Age: coverage is better once Medicare kicks in. Disabilities: people with disabilities have a particularly difficult time finding providers who have the knowledge and skill to treat them.

MEDICAL ERRORS
Participants have experienced medical errors themselves, know of others in the same situation and are aware of it as a significant health care problem. They mentioned misdiagnoses and adverse drug events as major issues. Implementing quality improvement measures in all stages of the health care continuum is a must. Also, participants were in favor of a pay-for-performance system.

PUBLIC POLICIES TO PROMOTE HEALTHIER LIFESTYLES

CITIZENS’ BILL OF HEALTH CARE RIGHTS
Participants felt that there should be a Citizens’ Bill of Health Care Rights which would include a “floor” of coverage and minimum benefits. Examples include an annual exam and comprehensive health audit. The challenge is how to encourage and enforce this policy and whether it should be a state initiative or a federal program.

Implementation needs to be a two-tiered approach – educating the public and educating and training primary care providers (physicians, nurse practitioners, etc.) Educating the public should include traditional methods of communication and as well as taking advantage of web 2.0 and social media tactics. Training programs, that offer CEU’s, should be available for primary care providers to encourage compliance with The Citizens’ Bill of Health Care Rights

MENTAL HEALTH
Participants expressed several concerns about mental health and associated disabilities.
They raised the following issues about mental health:
· Patients self-pay which is quite costly
· There is a trend for therapists to not accept insurance
· Therapists who do accept insurance are typically not reimbursed according to their fee structures
· There is inconsistency in caring for behavioral health issues from insurer to insurer

In summary, the whole person needs to be treated - mental and physical care needs to be integrated.