2009 Year in Review

To open the year in 2009, Policy Prescriptions suggested a New Year’s Resolution for then President-elect Barack Obama: focus on making meaningful change to the health care system for all Americans, people who were depending on the President-elect’s courage to do so.

We are excited that almost one year later the pending bills before Congress are similar to our 2009 recommendations for successful health care delivery and financing.  Despite the public’s hesitation toward mandates described by a June 2009 New York Times survey, both bills now focus on delivering health care through a system with an individual mandate,  guaranteed enrollment for both children and adults, and where public and private options compete in an open market to benefit patients in both cost and clinical effectiveness.  The specific benefits to be funded by public payers are yet to be outlined; however, it is clear that Congress acknowledges that effective prevention and primary care are paramount.  Most recently, honoring our country’s seniors by protecting their quality health care services has proved imperative.

The following are TEN FACTS uncovered in the science of past last year that should be noted as the health care community works together with legislators through the end of this legislative session in order to ensure reform continues to reflect real struggles and proven solutions.

1. Those providing medical care need to help dictate the definition of quality among their peers.

It seems that both existing and novel systems for measuring and providing quality are not appropriate for generalization to all of medical care.  A pilot project by CMS to reward orthopedists financially for yielded all participating orthopedists with nearly the same grade of quality.  Guarantee of payment within the global surgical period has no real-world application within care models for primary care of chronic illnesses.  Rightfully so, health providers and executives are weary of the effect of using results of comparative effectiveness analysis to guide practice.

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2.  Cost saving measures in health care delivery must go hand-in-hand with increasing quality.

Many commonly-used drugs have a proven , and more research is being conducted to grow this group of drugs.  Further research is also needed to find a method of tort reform proven to decrease costs for patients, likely by removing physician incentives for ‘defensive medicine.’ have not been successful in doing so to this point.

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3.  Increasing utilization of health information technology and patient priority-driven end of life care have proven to be high value practices, by both decreasing cost and improving quality.

The interoperable Kaiser has been proven to decrease overall health care utilization and improve rates of preventative care performed.  Additionally, patients given the option of speaking with a specialist regarding their priorities of care when faced with a spend significantly less money during their hospital stay.

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4.  Systems for financing health care that employ cost sharing mechanisms create inequalities in access to care based on income.

This is exemplified in a study comparing health systems and , which shows that the inequality exists in systems with cost sharing, independent of the use of a universal health care system.  Another article reports comments made by Milwaukee area parents regarding the new , stressing the pronounced affect a relatively small financial contribution makes on their ability to access care.

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5.  Primary care physicians are an important factor in a high quality health system.

A recent article expanded on this issue by showing that increased , especially for black populations.  In contrast, generalist currently, notwithstanding the impending influx of insured patients to come.  Policy makers and educators recognize this, and are working to increase the supply of generalists in this country.  Moreover, a panel of clinicians and medical educators recently reported that in order to make the physician population better reflect the general population in race, economic background, and geographic background, for entrance into medical school. They also recommend that more medical learning should occur within the community to increase exposure to how environmental factors affect population health.

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6.  Universal health care systems result in fewer inequalities among income groups.

As evidenced byin Paris (multi-payer universal system), London (single payer universal system), and Manhattan (multi-payer non-universal system), patients in Paris have more equality among income groups in respect to health outcomes and health care access.  Outcomes included mortality rates, possibly preventable hospitalizations, and access to specialty care.  Furthermore, after consideration of the First and Fifth Amendments, a review by the Robert Wood Johnson Foundation comments that it would indeed be constitutional to have the federal government impose a except in cases of individuals with religious objection.

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7.  Covering the uninsured is only the first step.

Different are being considered by public and private payers for those insured patients in an attempt to drive down health care costs.  For example, a recent article describes how reimbursing physicians based on episodes of care may, especially with acute conditions, decrease the cost of care by encouraging providers to decrease the volume of health services for each episode.  Another article describes the, as driven by hospital goals to have positive patient-revenue-to-cost margins.

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8.  Financial benefit of paying to insure more people is not clear in the short term.

For example, although in 2006 has decreased the amount of uncompensated care by 36 percent, health outcome benefits are yet to be proven.  Another study pointed out that areas in California that implemented new failed to show overall reduction in preventable hospital admissions.  There was a slight decrease in preventable hospital admissions in low income groups after multivariate analysis.  Although increasing access to medical care may prove to be more financially beneficial in the long term, it is hard to weigh short-term financial costs against the moral obligation to make health care available to the uninsured.

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9.  The current health care system consistently leaves under-served populations.

Locations ofare more likely to be areas with white, higher income residents than those areas without retail clinics.  Retail tend to be higher in low income areas, especially at independent (non-chain) pharmacies.  Because of the political pressure to assist children and women, before qualifying for aid with health coverage, especially if they are unemployed, immigrants, single, or have income just below the Federal Poverty Level.

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10.  Americans will always have hope for a brighter future in health care.

This was demonstrated bywho marched from Selma to Montgomery, Alabama, to ask Congress to work for the health and well-being of their communities.  Even more recently, stormed Capitol Hill to advocate for their patients and support the premise of health reform.

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by

Lisa Maurer, MD