A brand new survey from the Kaiser Family Foundation, National Public Radio, and Harvard University add new input to the discussion about reforming the health care delivery system. While many academics and ivory tower intellectuals feel that in order to improve our health care system we must (1) improve the coordination of care (2) pay health care providers for quality and not simply for activity, and (3) ensure access to primary care, the American people describe their views on these priorities.
One way touted to improve the coordination of care is changing the practice of medicine from one where a “doc-in-the-box” practices in isolation to an integrated and electronically shared health care system. While three out of every four Americans realize that electronic medical records would be a major breakthrough for our health care system, they are not duped into thinking that health information technology would make our system cheaper. Even scientifically rigorous studies have failed to show significant cost improvements as a result of information technology; mixed results exist for the myriad of quality measures reported. However, it does not negate the obvious fact in the minds of many Americans and many physicians that 21st century medicine will require an integrated, interoperable, real-time information system. Surprisingly, over half of Americans do not think we even have a problem coordinating care. Almost every doctor I work with thinks otherwise.
Probably the largest challenge facing health reform (other than providing coverage to the uninsured) is how to compensate health care providers in a reasonable and fair manner. A large majority (70%) of Americans think that the best way to compensate physicians is by fee-for-service, where the doctor gets paid for every visit. One-quarter of Americans think that capitation is a better payment methodology. Perhaps private insurers (and for that matter Medicare, MEdicaid, and other public payers) should heed these numbers and provide a mixed reimbursement package based on both per-member-per-month calculations and utilization metrics. The remaining 5 percent of the doctor’s income could be determined by pay-for-performance measures.
The new Kaiser/NPR/Harvard survey does not explore the primary care workforce directly. But considering that Americans often have to wait for doctors appointments (I certainly see plenty of primary care type visits in the ER because “the doctor didn’t have an appointment available to see me”), we all know that we could use a few more primary care doctors. Better yet, we need these often poorly compensated physicians to serve in areas of the greatest need - urban enclaves and rural towns. I hope that the pollsters start asking questions about how to accomplish this difficult feat. If we simply follow the advice of the American people, fixing the health care system might not be so hard after all.
Cedric K. Dark, MD, MPH
Founder, www.policyprescriptions.org