A Vision For Health Care Delivery - The Future of Healthcare Delivery

So what should the vision for tomorrow’s health care be? It should be about health, not just diagnosis and treatment of illness. It should focus on protecting, nurturing, and preserving health. It should address our behaviors, our environment, and our social situations so that everyone can have the benefit of a healthy lifetime. We cannot change our genes, but we can understand them, and when disease is predicted, we can plot preventive approaches. We can provide everyone with the available vaccines to prevent infections that maim and kill. We can incentivize physicians and other health-care providers to spend time and energy with each of us and educate us about the best ways to preserve our health or return to a state of good health. We also can incentivize our physicians so that more will become generalists and, with the right opportunities, will want to practice in underserved communities. We can encourage the development of nurse practitioners, physician assistants, pharmacists, social workers, and other health-care providers to augment the role of the generalist physician.

We also need to create incentives for ourselves to live a healthy lifestyle. This point might sound counterintuitive since everyone wants to be healthy, but many of us engage in behaviors that are not conducive to good health, and an incentive system will be critical to help us overcome them. The purpose of the incentives actually is to help us take responsibility for our own health. Good health comes with its own set of responsibilities and requirements.

We recognize that the chronic diseases that now beset our population need a new approach to care, one that addresses long-term, coordinated disease management rather than the episodic interventions that medical care has provided until now. We will insist on team management for complex diseases and arrange our payment systems to ensure it will occur. We can also appreciate that because most complex, chronic diseases are caused by our behaviors and are therefore preventable, our personal behaviors need to change. Regarding our national approach to nutrition and food safety, we need to encourage agriculture to produce quality, nutritious foodstuffs and to empower the USDA and the Food and Drug Administration to make certain foods are free of infection or toxic potential.

In this new vision of health care we will focus more on the individual thanks to our ability to look at his or her genome, to design individual vaccines, and to plan surgery with the individual’s CT scan as a guide. We will set up wellness programs to prevent the diseases for which our genetics put us at risk and use vaccines to prevent not only infections but also chronic diseases like cancer, atherosclerosis, and possibly even Alzheimer’s . We will have the ability to repair many failing organs with new and improved approaches from our incredible biomedical research output and with the efforts of engineering and computer scientists to create medical devices, imaging equipment, and operating room (OR) technologies. We will have instantly accessible medical information no matter where we are. We will find ways to dramatically improve patient safety and clinical quality.

And now, understanding what system of care we want for America, let us consider the organizational structure, or the “form” to follow the “function” of our vision. We must come to grips with the uninsured in a manner that not only creates financial coverage but also actually offers real access to providers, especially primary care providers. Then everyone—no matter where they live, what they earn, or what their age—will be ensured complete health care.

With an understanding of the desired system, we can then address the means to pay for it. I would suggest that we require everyone, except the poor, to pay for basic care out of pocket. Everyone would have a high-deductible catastrophic insurance policy that is portable, cannot be cancelled for a preexisting condition, and has no co-pays. We would establish health savings accounts and incentives to encourage us to invest pretax dollars so that we would have the funds to pay for routine care and even predictable yet expensive needs such as drugs, vaccines, colonoscopies, or even routine childbirth. Insurance would pick up the costs whenever they become too burdensome. Also, once the deductible has been reached, insurance would pay not only for hospital and doctor visits but also for e-mail consults, telemedicine, and telediagnosis; for the time needed to coordinate care of chronic illnesses; for preventive care; and for any other aspect of care that is proven of value. We would expect insurance to do so without excess bureaucracy and frustrating delays and denials.

As we modify the current broken medical care system into a true health-care system for all, it is essential that we address the high and rapidly rising costs of care. Only by controlling costs will we have the resources to make the other, necessary changes to ensure better care, better health, and longer, more productive, more satisfying lives. By focusing on preventive care and care coordination along with quality and safety enhancements, we can go a long way toward making care less expensive as well. By correcting the current, perverse insurance arrangements so that the patient has a direct financial contract with the provider, we will have created a strong incentive to improve quality, manage costs, and prevent fraud and abuse.

All of these changes should occur in a setting where the patient comes first and is treated with respect, prompt responses, good communication, and easy access to care and full information. The patient must no longer be marginalized; instead, he or she must become the center of the system. Nothing less will be acceptable in this consumer-driven health-care system.

To achieve this vision will require real leadership, which I define as having three essential steps. First is setting the vision. Next is then persuading all parties involved to commit to realizing the vision. And the final step is getting the key players actually to make it happen. Some of this leadership will need to emanate from our president. It will also require the leadership of those who control much of the funding: the insurance industry, large corporations, unions, and Congress. But we do not have to wait for action from the executive branch and legislators. There is much that individuals and a combination of the leaders in medicine—physicians, hospitals, pharmaceutical firms, and medical device manufacturers—can do immediately.


Last Modified: December 13, 2011

Copyright (c) Stephen C. Schimpff, MD