Problems for patients. Although at any given time most people don’t have health problems, they hear horror stories from friends and family about the financial impact of an unexpected health problem. An emergency room visit may have resulted in an unexpected bill, or a prescription medication may have an unaffordable price tag. With high deductible health plans and narrow networks, having insurance hasn’t protected people from unexpected, unaffordable costs. Even with the high cost, patients may not have clinicians available when they need them. They may feel that they don’t get enough time for a real conversation about their problems when they take time out of their busy schedule to get to an appointment.
Problems for clinicians. Physicians have lost control over their practices as complex payment schemes have made it more expensive and more difficult for them to practice independently. Today they are likely to work for big organizations that demand productivity (i.e., see more patients in less time) and that documentation requirements be met, taking priority over meaningful patient interaction. This has led to frustration and more after hours work at home, as well as a feeling that they’ve lost connection with their patients. Although a high level of burnout has been reported, little is being done to solve these problems.
Solutions haven’t worked. Over the past decades, payment system reforms have been enacted. Yet high and increasing costs continue to be a problem for governments, employers and consumers. Fragmentation and complexity continue to increase. Consumers have less choice with re-introduction of narrower networks, and consolidation in many markets reduces choice even more. Because payment schemes don’t support it, clinician use of technology that enables more convenient and economic care has been difficult to implement and for patients to use.
What’s needed to make a solution work. To get to a sustainable solution, we need to have agreement among a wide range of political perspectives and backgrounds. Few people would like to eliminate public schools because most see that that the entire community benefits, even if they also pay for private school or don’t have children. A sustainable healthcare solution needs that level of support. To get there, the solution must be easy to understand and one that obviously works for all Americans. I have written a proposal that is intended to be the beginning of a conversation. This can help get to a consensus that can lead to further discussion. If this effort progresses, the proposal can be refined to meet most people’s requirements. With the obvious problems associated with our current system and its funding mechanisms, now is the time to start defining what would work for the vast majority of patients, clinicians and all who are involved in providing high quality care.