Q. What must health care reform accomplish for it to be successful?
A. For health care reform to be successful, the system must focus on providing more primary care to more people. We know exactly what we mean when we say primary care. It is not just having a family physician or internist. It is providing services that achieve four functions. First of all, care has to be accessible, and we know that our care is not very accessible compared to countries that do much better than we do on health.
Second, care has to be person-focused over time. Now, instead of focusing care on meeting peoples’ needs, professionals define the needs – usually in terms of having a specific disease – and then forget about the people while dealing with the disease. We know from evidence that if you don’t deal with people’s problems, people are much less likely to get better. We are focusing on diseases that are professionally defined needs. We are not focusing on people-defined needs. Unless we address people-defined needs, we are not going to get good health outcomes.
The third characteristic is comprehensiveness. Instead of referring so much unnecessarily to (sub)specialists, we have to reserve (sub)specialist care for things that (sub)specialists are really needed for – the less common and complicated things – and take much better and more care of most health needs within a primary care setting.
The fourth characteristic is coordination. People have to go elsewhere for (sub)specialized services every now and then and that is good care, not bad care. When they do go, the care they receive elsewhere has to be coordinated with their ongoing care.
We know exactly what primary care is, we know exactly why systems organized around it do a better job. It is not a secret, it is not rocket science, but we don’t do it.
Dr. Starfield nails it in this interview. Our healthcare system has become a sub-specialist procedure-driven “fix it after it’s broken because fixing things is profitable” Industry.
This is what we’re throwing our money at with mandates.
We are not fixing healthcare. We are sustaining an industry that makes more money off your poor health than they do off a nation of healthy, happy people.
All of this reform and “mandated coverage” talk has blinded most of us about the main problem of our healthcare industry– its core.