Seldom has there been an exciting government report, but the latest offering by the National Academy of Sciences' Institute of Medicine is real food for thought. The study, done by an appointed committee of 16 experts led by Gail Warden, paints the usual dire portrait of the U.S. healthcare system but this time offers a set of concrete ideas for how to begin fixing it.
This isn't a perfect solution, but it does seem like the best blueprint I have read for getting started on a much-needed overhaul of how we provide healthcare in this country. Even more exciting is the fact that the study was commissioned by HHS Secretary Tommy Thompson, who has promised to begin some of the demonstration projects quickly. Thompson seems to realize that you need to spend some money to create a more efficient system that saves money and lives in the long haul.
As the panel notes, "The healthcare delivery system is incapable of meeting the present, let alone the future, needs of the American public." Healthcare providers operate in silos, unable or unwilling to communicate with one another to ensure continuity of care. The system needs to focus on helping people become and stay healthy, not just treating the symptoms of chronic conditions.
But how can substantive change occur when governments are running out of funds to pay for current services? Wisely, the panel says we must start with beta tests, relatively small-scale demonstrations to prove that alternatives work before adopting them globally. But the report pulls no punches in saying that some wise investments are needed to improve information technology and widen access to care.
The five categories of demonstrations recommended in the report are reducing the toll of chronic conditions on patients and communities; building "stellar community health centers"; creating an information and communications technology backbone through which providers can communicate about individual care and care protocols; expanding some statewide health insurance; and developing a new approach to malpractice reform.
Community health centers, which now receive payments per episode of care, should get flexible payments to offer group counseling and education visits, Internet-based communication and care delivery and more extensive care coordination, the report states.
One of the more interesting recommendations is to try to sidestep the tort reform debate by taking injury compensation resolution outside of the courtroom. A nonadversarial mediation system would provide faster compensation to victims, lead to real apologies and "create an environment that encourages providers to report and analyze medical errors and to involve patients in safety-improvement activities," the panel states.
The report also calls for demonstrations in three to five states to expand coverage through tax credits, expand eligibility for public insurance or a combination of the two. Tax credits would be tied to income, while the federal government would step in to expand eligibility under Medicaid or the State Children's Health Insurance Program. Obviously, given states' dire fiscal situations, it would have to be the federal government that pays for such an expansion of coverage, likely through the kind of tax credits that President Bush has been pushing.
This report did not receive the same kind of press attention as some prior IOM reports, but it should have. It really places the onus on the administration to take the lead on health system reform. Healthcare policy has so far taken a back seat to war politics for Bush, but sooner or later he will realize that healthcare is fast becoming voters' No. 1 concern.
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