One small indicator of the profound changes in healthcare since Sept. 11 can be seen by examining the national discussion about antibiotics. Before Sept. 11, the public was concerned about drug resistance resulting from overuse of antibiotics for minor conditions like colds. After that day, the concern was about the underavailability of antibiotics for such fearsome events as an anthrax attack.
It is understandably difficult to interest anyone in discussing managed care legislation or affordable prescriptions for the elderly when a more immediate concern is the adequacy of the burn unit at the local hospital. Yet as difficult as it may be to imagine, the change in national mood caused by the terrorist attack on America may yet prove a catalyst for positive changes in our healthcare system.
I believe there are two reasons for this cautious optimism. The first is a renewed sense of community. The second involves a realization of limited resources. Let's begin by looking at the second factor.
In the weeks before the attacks, the news media were full of stories about the return of healthcare inflation. The reasons were clear: the weakening of managed care cost controls, a change in the underwriting cycle and continuing strong patient demand for new drugs and devices. What was less clear, apart from some bows in the direction of defined contribution, was how those costs were going to be controlled.
Since Sept. 11, it has become painfully obvious that the explanations for rising healthcare costs are in some ways irrelevant. Healthcare is going to have to wait in line for money. The price tag of the war on terror is already well into the hundreds of billions of dollars. The federal budget surplus is evaporating at the same time that recessionary pressures are putting severe constraints on states and private payers. As a result, health plans and providers alike will soon feel intense pressure to provide demonstrably high-quality, cost-effective services.
How do you do that? The classic answer for other industries has been to invest in technology. In healthcare, for example, computerized physician order entry systems reduce mistakes (adverse drug events alone cost $2 billion annually) while helping doctors, nurses and pharmacists do their jobs better. Emergency department management scheduling systems can make individual institutions more effective while helping different institutions coordinate capabilities. Health plans can institute wide-ranging disease management systems to reduce preventable admissions.
We as a society can no longer afford to coddle healthcare as a cottage industry. Nor can we afford to indulge patients who desire unlimited care at bargain-basement prices and run to a lawyer or legislator if they don't get it. With a little luck, the sobering events of Sept. 11 will usher in a new sense of economic realism.
Another major change involves a renewed sense of community. That feeling has manifested itself in a variety of ways, including a grassroots outpouring of patriotism.
For healthcare organizations, that sense of community means that sensitivity to patients' human needs is more important than ever. Hospitals, physicians and health plans are going to have to learn to partner together for quicker payment of bills, fewer hassles on referrals, a lowered level of name-calling and--most difficult of all--treating the patient as an equal. The increased use of high tech must be accompanied by increased commitment of "high touch."
There are few areas in which such sensitivity is more important than in the realm of patient privacy. We are willing to reveal our most intimate physical and psychological secrets to health professionals because we are promised confidentiality in return. While the demand for cost-effective care will prompt a needed proliferation of computerization, organizations must remain exquisitely sensitive to how that information is used.
Data mining of clinical information is neither good nor bad in and of itself. The public must be helped to understand the benefits of expanded epidemiological studies. Still, we can expect more arguments to break out about where the boundary lies between legitimate data analysis and data "strip mining"--the Information Age equivalent of what strip mining for coal has done to the mountains of West Virginia.
Sometimes good can come from evil. The war that began Sept. 11 has not changed the basic mission of healthcare. Carrying out that mission, however, now demands that we adopt new technology and then use it effectively to provide both high quality and humane care.
Michael L. Millenson is a longtime healthcare analyst and author.