Health Care in the United States is a paradox. We are the most abundant, highly advanced market in the world, where research, commitment of providers, and dollars spent are unmatched. And yet… medical care is not uniformly available, is much too expensive and the quality of care is all too often less than satisfactory and not nearly safe enough. It is time for a different approach. .
There are many disruptive, often transformational changes coming, which will further complicate matters for the average patient. These changes are being driven by an aging population, our adverse lifestyles and behaviors, an increasing shortage of providers, our attitudes about the end of life, and a nascent rise in consumerism.
One of the most important changes is a shift from acute illness (e.g. pneumonia, appendicitis) to chronic diseases (e.g., diabetes with complications, heart failure and cancer) which are lifelong once developed, difficult to manage and very expensive to treat – yet mostly preventable.
There are also many misconceptions about what medical care delivery is and what it could and should be. For example, few people understand that true healthcare requires an intensive focus on both diagnosing and treating disease and injury when it occurs but also an equally intense focus on health promotion and disease prevention. Or that those with chronic illnesses require well coordinated care by a multi-disciplinary team. Or that the healthcare reform legislation will offer us better care opportunities when in fact, healthcare reform is not about healthcare; it is mostly about paying for medical care for the uninsured, eliminating some of the health insurance restrictions consumers face, and only somewhat about the rising costs of medical care.
I detail the coming disruptions to care delivery and clarify the facts regarding our misconceptions. I then offer specific recommendations that America needs to take to move from a healthcare system that fundamentally treats disease and injury, and does so poorly for those with chronic illnesses, to one that focuses on health promotion and disease prevention and provides coordinated care to those with complex, chronic illnesses.
To do this requires fundamental changes in how we pay for medical care, how we fund preventive medicine and public health, how we manage medical information, how we incentivize and pay healthcare providers, how we incentivize ourselves as consumers to take better care of our health, and how we assure that everyone has both access to care and the means to pay for it. It will mean reorganized medical care so that the consumer is the decision-maker, just as in any other industry or profession-customer relationship. In short we need a major overhaul of the entire system that realigns incentives and balances fundamental rights with corresponding responsibilities.
There will be many barriers to success but it can be done, should be done and indeed must be done or else we will continue to be a country deficient in the care that everyone could and should have while expending more on a per capita basis than other countries with equal or better health quality measures.
Does this mean that huge new sums of money will need to be spent? No. There is plenty of money is in the system now; it is “just” a matter of reorganizing so that it can be spent efficiently and effectively in a manner that will actually improve the quality of care while reducing the cost of care.
All parties will need to accept responsibilities and demand their rights, something that is not prevalent today. This will be a major task, for sure, but it is certainly not insurmountable.
The three key themes of the book are as follows:
1. the disruptive and transformational changes coming and needed
2. the clarification of misconceptions
3. the balancing of rights with responsibilities – to lead us to a true healthcare system that functions for the benefit of all.
This is a book for the common man or woman. It is designed to inform the reader of the characteristics of our current medical care delivery system, how it is changing, and how each individual’s own actions can influence their health, the quality of their care, their healthcare costs and their satisfaction with the healthcare delivery system.
About the author
Stephen C. Schimpff, MD is the retired Chief Executive Officer of the University of Maryland Medical Center and former chief operating officer of the University Maryland Medical System, today a twelve hospital system.
He is also the author of “The Future of Medicine: Megatrends in Healthcare,” which discusses the scientific advances in medicine such as genomics, stem cells, vaccines, medical devices, imaging, the operating room and information management. This sequel, “The Future of Health-Care Delivery: Why It Must Change and How It Will Affect You,” demonstrates how physicians and hospitals must and will change in the coming years.