Way back in the past a patient went to a hospital to die. Times have changed with the hospital playing a multitasking role not only for medical emergencies and healing, but it is a place of research and a point of access for day surgery and outpatients.
At one point all hospitals were run by religious organizations and charities. Today there are for-profit and government run hospitals added to the mix.
With the upcoming tidal wave of an aging population will a different delivery model for medical services be necessary? Some of the alternative solutions to hospital healthcare are two pioneers in the concept of offsite care: the hospice and palliative care movements. More home care services will likely be necessary in future and will probably promote comfort and healing for patients. Studies have shown that higher per capita access to hospitals do not result in better health outcomes. (Dartmouth Atlas, 2008)
If one were to get a bird’s eye view of the current delivery methods of health care that view would be instructive to see how the system can be altered to most effectively deal with the future aging population. Here are some overviews of the current health system.
Projections show that health care employment is the fastest growing career path. There is already a shortage of nurses (despite nurses being cut from jobs). The US Bureau of Labor Statistics states the health care sector will grow by 27% up to 2014. The jobs most in demand will be home health care aides, offices of health care practitioners, and nurses. (www.oecd.org) Is the need for more workers being addressed?
Perhaps the first question should be about access. The lack of access to medical services often results in patients entering the medical system in a crisis of their escalating medical condition. Often these conditions were both preventable and chronic. Prominent doctors have said that patients should avoid hospitals unless absolutely necessary.(Dartmouth Atlas, 2008)
Some reliable sources have stated 2 reasons for that validity: 1. That under the current reimbursement model hospitals get paid to correct their own medical mistakes such as secondary hospital acquired infections. (Consumer Reports) 2. Up to 150, 000 hospital deaths per year are from preventable medical errors. (www.allhealth.org/briefingmaterials/Commission_framework_high_performance)
Behind that big number are real people; someone’s father, sister, aunt, niece, or friend who leave behind those who grieve for them.
There is a great deal of reliance on technology for diagnosis and cure. This is in spite of the fact that of the 30 yr extension of life span in the US during the 20th century, only 5 years of that extension is attributable to advances in technology. (Why Your Health Matters A. Weil, 2009) Part of this reliance may be due to the current reimbursement model for private insurance where payment is based on volume of care eg paid per test, procedure, prescription, or visit. Still insurers are rewarded for avoiding the sickest patients which only exacerbates access to a hospital when care becomes urgent and unavoidable.
The volume of care and number of specialist providers often leads to overlap and uncoordinated care. In the end medical outcomes are less than optimal and the patient’s perception of his her care is less than satisfactory. Currently, hospitals have no financial incentive to either prevent hospital admissions or to provide the most favorable medical outcome.
How would a future health care system look?
First of all the point of entry would be a medical ‘home’ for a first assessment. There would be an emphasis on partnership between the patient and provider. Healthy lifestyle, maintenance of optimal health, and prevention would keep chronic conditions from ballooning into a crisis. These would be the goals in a primary care clinic.
Studies have proven that more primary care providers mean a healthier population in a given area with less dollar cost. (Why Your Health Matters A. Weil, 2009; Consumer Reports, Aug 2009, July 2008) Therefore medical students wishing to enter primary care as a career must be given moral and financial support. The current situation is that specialists are accorded more status and pay.
A team of integrated health care providers will coordinate health care services. The team concept will also encourage full utilization of all medical providers. An example of this are midwives attending uncomplicated childbirths in the expectant mother’s home.
Part of the service provided by the primary care clinic would be a user friendly website where potential patients could take the first step in being active managers of their own health. They would have access to health information on prevention, nutrition, and healthy lifestyles. More importantly they would be able to access their own medical records and information. Websites such as these already exist in integrated health care clinics.
Coronary bypass surgery and angioplasty are examples of a technology intervention that has a high cost but are not the final cure. Bypass surgery costs $30-40,000 each, the cost being billions per year. Yet within 5 years half of them need to be redone. Angioplasty costs $10,000 and 30-40% of those procedures need to be repeated within 4-6 months. (www.integratedhealthcare.net) Yes those are numbers but the patients behind those numbers are real people who must undergo radical surgery. Prominent doctors such as Dean Ornish are pioneering low tech low cost lifestyle changes that are altering how heart diseases is prevented and managed. He also noted low tech answers are accessible to more patients because they are affordable to all. (www.integratedhealthcare.net)
Studies by various foundations have suggested a different payment model such as paying a set rate for different medical conditions, or paying doctors salaries instead of paying per patient visit. At present, only 7-13 minutes of a visit to a doctor is billable. Consumer Reports Aug, 2009; Why Your Health Matters A. Weil)
Offsite care will be expanded with only the patients with the most necessary medical needs going to hospital. Two groups that would benefit from this trend are expectant mothers and seniors requiring hospice or palliative care.
If a patient must enter hospital they should be given enough information about their condition so they can be actively involved in a decision regarding surgery or tests.
Many studies have proven that the US has the equipment, facilities, and manpower to provide excellent care but that is presently not occurring. The current capacity needs more efficient utilization which will have to include a discussion on access, and what role profit should play in an ideal health care scenario.
Up next: Part 3 the Versus Competition
Article © MyNursingUniforms.com / Young Lion Incorporated
