How to Improve Our Nation’s Health and Lower Cost at the Same Time

As a physician I obviously see healthcare from a different perspective than the average American. Perhaps that is why I remain so frustrated over the politicization of what is actually an individual personal service. In recent years, healthcare has become a very emotional topic, generating strong opinions on all sides. Heated arguments continue over basic questions such as who should pay for it, who should receive it and who should profit from it. The American healthcare system has become a complex milieu with numerous moral, social and political overtones. Extremists on both sides of the political spectrum are so far apart they will never agree on any proposal. However, I believe that there is a way to both improve the quality of healthcare and lower the cost no matter who is providing the services or paying the bills; its called education.

This morning I was listening to a radio talk show when the host was explaining how the Taliban has systematically destroyed schools throughout Afghanistan, insuring the population remains uneducated and thus can be more easily manipulated. For centuries repressive regimes have recognized that the biggest threat they face is an informed and enlightened population. Whether by design or neglect, the American public is, by and large, uninformed and under educated in the basics of healthcare and thus  are more easily manipulated.

A few years back I recall hearing an ad for a discount clothing store that said, “An educated consumer is our best customer.” What they were implying is that informed consumers will naturally seek value for their money and this company believed they offered a better value than their competitors. Webster defines value as “relative worth, utility, or importance.” But the problem with applying the value logic to healthcare is the fact that most patients are disconnected from the process of determining value. Third party payers offer an economic buffer between the patient and the actual cost of a test or treatment. This third party payment system also offers an effective means of controlling access to healthcare services through contractual relationships with providers, and whether they acknowledge it or not, controlling access is used by payers as a means of controlling costs.

The only safeguard the average patient has is the moral compass of their doctor who has taken a solemn oath to put the patient’s interest above their own. However, since physicians are typically paid by third parties based on specific services they provide, it only follows that some, if not most, physicians tend to order more tests and perform more procedures than they would if the patients were actually paying their own bills. Many physicians agree with this assessment. In a survey published in the Archives of Internal Medicine, September 26, 2011, forty-two percent of US doctors believe that their patients are getting too much medical care, while 28% of physicians said they felt they were treating their patients too aggressively. Only 6% said their patients were receiving too little care.

Clearly, excess utilization is contributing significantly to the overall cost of healthcare, but before we put all the blame on those “greedy doctors” this is not the whole story. Patients often request or even demand healthcare services despite the fact that they may not be absolutely necessary. Likewise, the practice of defensive medicine has led to the routine ordering of costly diagnostic studies by almost every physician, just to avoid being blamed for not testing for that rare or obscure condition. Numerous device manufacturers, pharmaceutical companies and hospital systems have successfully marketed directly to the public with the universal call to action being “Ask your doctor about x, y or z.” Armed with this new information from a TV ad, patients go to their doctor requesting a specific treatment with little regard as to the cost. The only question the patient typically asks is “Will my insurance pay for it?” This is neither an effective nor appropriate way to control costs and ensure quality care.

Our current system is quite simply an unstable and unsustainable “three legged stool” with the patients, physicians and payers each appearing to have different incentives and objectives. A fundamental change is needed, and most experts agree that healthcare reform should focus mainly on putting the patient back in charge of their own decision-making. But for patients to assume responsibility for their own healthcare choices assumes they have a basic understanding of those choices. In other words, the general public must be empowered through education.

Healthcare consumers are obviously hungry for a better understanding of all things related to their health. Witness the popularity of web sites like WebMD, and television programs like “The Doctors”, “Dr. Oz”, “Gray’s Anatomy”, “House ” and many others. But these entertainment based programs offer only tiny snippets of information based on entertainment value. True health education should start at an early age with simple but effective lessons on how the human body works. As an example, a better understanding among school children regarding practical issues like nutrition and physical fitness would help reverse the rising trend of childhood obesity. Likewise teaching children how communicable diseases are transmitted would help them assist in controlling the spread of the common cold, influenza and various other illnesses. The program would need to be continued for Junior High and High School aged students as well. These should be required courses with the objective of making every American fully aware of the basics of human anatomy, physiology and common pathologies by the time they graduate from high school. Armed with this knowledge, individuals will be able to assess their own health related situations more objectively and become better value-based healthcare consumers as adults.

Obviously a “Health” curriculum already exists in both the public and private schools, but it is grossly inadequate. Most of our kids don’t study advanced biology and even those who do may have a difficult time making any connection between the dissection of a frog and their mother’s gallbladder surgery. To develop a practical program that can achieve this objective will require a shift away from the athletic coach or physical education teacher who may currently teach a class in Health. Practicing physicians and nurses should become actively involved in the development of a more robust and practical curriculum that would be appropriately entitled “Human Health Education – a Users Guide to Your Body.” The American Medical Association along with its various Specialty Societies is the obvious organization through which such an effort should arise. They certainly possess the knowledge and given their mission statement should have the motivation. http://tinyurl.com/3gzozcc

There is another major side benefit that would most certainly arise out of this practical health education effort. More exposure to the art and science of healthcare will undoubtedly renew enthusiasm for careers in nursing and medicine. In the past, most physicians encouraged their own children to pursue the medical profession, if not directly at least indirectly, through early exposure. However, in the last few decades that trend has been reversed, in no small part due to the negative impact of third party contracts and growing government regulations on all healthcare professionals. By revealing to all young people the vast wonders of the human body and how it works, many more will be inspired to carry on the traditions of Hippocrates and Florence Nightingale providing greater value and benefit to all Americans.

The opinions expressed herein are my own and do not necessarily reflect or represent the policies or opinions of any medical organization or group.

Check out my web site at www.robertsewellmd.com