What is the primary focus of healthcare today? Health promotion. IOM's four-level strategy for preventing medical errors. Establish a national approach to creating. To review the factors that influence the decision to undertake health reform, summarize the evidence on the effects of the law to date, recommend measures that could improve the health care system, and identify the general lessons of the Affordable Care Act for public policy.
An official website of the United States government Official websites use. gov A. The gov website belongs to an official government organization of the United States. Health care reform has been on public and political agendas since the beginning of the 20th century.
Every president, from Woodrow Wilson onward, has struggled to some extent with health care issues. President Eisenhower used the tax code to promote employer-funded health insurance; President Johnson promoted the approval of Medicare and Medicaid in Congress and the enactment of laws; President Nixon promoted the development of managed care and the HMO model, and President Bush introduced prescription drug coverage for Medicare patients. Presidents Harry Truman and Bill Clinton tried to pass a comprehensive national health insurance program, but neither succeeded. Gradual changes aside, none of these previous efforts, either individually or collectively, have achieved the overall improvements in both access and cost containment, which are fundamental to a sustainable health care system.
Gary Pettett, MD, (left) is named president of the MSMA by Lent Johnson, MD, during the Annual Convention in Kansas City. Today, the rising cost of health care in an economy that is slowly recovering from one of the deepest recessions since the 1930s has caused intense anxiety in many Americans. Just as post-World War II “baby boomers” approach retirement, the financial stability of our social safety net and Medicare is at serious financial risk unless significant changes are made to these programs. A growing number of families are deeply concerned about their future and their ability to afford health care when they need it most.
Health care reform remains a critical issue and a fundamental prerequisite for getting our economy in order. The longer the reform of the health system continues, the more precarious our system becomes and the more expensive it is to fix it. In our search for solutions, many have turned to our economic partners in the developed world for possible options. Germany, France, Great Britain and Canada provide their citizens with universal health care and do so at a cost per capita much lower than the U.S.
UU. However, with results that, in general, are better than ours. Germany and France finance their health care systems through “sickness funds” subsidized through combined contributions from patients and employers. On the other hand, Great Britain and Canada provide universal care in a fully nationalized (cradle to grave) government system.
However, regardless of how they are funded, the common variable for all of these alternatives is solid central (governmental) control of available services and their costs. At present, there is no model that successfully provides universal health care and cost containment in a totally free market system. However, the “European alternative” is not well received in this country. Even though our current system includes several government-administered health care programs, Americans have a basic distrust of the government's ability to manage their health care.
Our national culture is deeply rooted in republican concepts of individual freedom, personal autonomy, and freedom of choice. Those beliefs extend to healthcare in the sanctity of the doctor-patient relationship, respect for personal values, and freedom of choice that reflect the patient's best interests. Any reform that socializes healthcare and eliminates the element of personal choice, whether in the public or private sector, will undoubtedly quickly stoke the passions of both patients and their doctors.1 So what happens now? The ACA is a matter of law and, as such, will continue as designed, unless changes occur. That's not to say that everything is resolved.
Many of its provisions will apply over the next four to six years. How these provisions are implemented and whether their funding will actually be carried out as planned may depend on how the political winds are blowing. 2 As long as our economy is mired in a slow recovery, there will be serious jousts for federal appropriations and tax law. There doesn't seem to be any guarantee as to how things will evolve. The current law (2,700 pages) gives us a “genotype” for the ACA, but the “phenotype” remains, to a certain extent, unknown.
One of the first principles of reform is to know what is broken, what needs to be fixed and with what priority should those corrections be made. Expanding health insurance to a larger segment of the population doesn't necessarily expand health care unless there are sufficient resources to do so. It can be argued, based on fairly strong evidence, that there are not enough doctors, specifically primary care doctors, to care for the newly insured. For more than a decade, medicine has moved away from primary care specialties (for example, family medicine, pediatrics, general internal medicine) and has focused on specialties or subspecialties. In the 1960s, 70% of the doctors listed in the AMA Master Archive self-identified their offices as primary care; 30% as specialized care.
By the turn of the century, this proportion had practically reversed. Not only are there significant disparities in the workforce, but its geographical distribution is also uneven. Along with trends toward specialization, doctors tend to accumulate in urban environments and, increasingly, in corporate-style business models (e.g.Academic centers, multispecialized offices, employees in hospitals). Not only are there fewer primary care doctors, but there are also fewer doctors who practice in rural, non-urban settings.
Therefore, there is a reasonable argument that the ACA focused on the wrong problem. Expanding the number of insured patients in the absence of enough primary care doctors will cancel insurance benefits or drive more patients to emergency rooms for episodic care in one of the most expensive settings. Finally, while legal experts disagree on the merits of the legal challenges to the individual insurance mandate, they do represent a collective “sword of Damocles” on the most fundamental feature of the ACA. If the mandate alone is declared unconstitutional, it's likely that only uninsured people who most need medical care will enroll in a health insurance plan.
In all likelihood, they will be the sickest and most expensive to care for. In addition, individual penalties for not taking out insurance are not enough to compensate for the loss of premiums that these healthier individuals would bring to the insurance fund. Nor are they tall enough to persuade people to sign up before an immediate or short-term need. It seems that whatever the resolution, it is quite possible that the future of the ACA is in the hands of the courts.
So, at best, the ACA is an unfinished product. Of course, significant changes are likely to occur in the future. The nature of those changes is likely to be based on the current results of the expansion of health care and on political winds, especially if those winds come from a conservative direction. There is still a lot to do.
Organized medicine must remain vigilant both at home (at the local level) and at the national level. The fundamental reform of Medicare, which includes the repeal of the SGR and the guarantee of a sustainable program for future generations. Medical liability reforms that address the excessive cost of defensive medicine and the unnecessary cost of meritless lawsuits. Help our patients design meaningful end-of-life care that reflects their values and expectations.
I look forward to serving MSMA and Missouri doctors over the next year. National Library of Medicine 8600 Rockville Pike Bethesda, MD 20894. In the rest of my comments, I will discuss three key challenges to health system reform. These challenges are, in short, the issues of access, quality and cost. In its final version, the ACA focuses primarily on expanding health insurance coverage and makes only weak and somewhat disjointed efforts to control costs.
Issues related to combining the workforce aside, there are elements of the ACA that organized medicine can and should support. Any reform that socializes healthcare and eliminates the element of personal choice, whether in the public or private sector, is sure to rapidly inflame the passions of both patients and their doctors. The AAFP believes that APC-APM is a fundamental element of greater investment in primary care, which is essential for a better care system in the United States. Primary health care addresses the broader determinants of health and focuses on comprehensive and interrelated aspects of health and physical, mental and social well-being.
Compelling research shows that the increasing focus on resources on specialized care has created fragmentation, decreased quality and increased costs. Primary health care requires governments at all levels to stress the importance of acting beyond the health sector in order to apply a comprehensive approach to health, including health in all policies, a strong focus on equity and interventions that cover the entire cycle of life.
