Still Broken: Understanding the U.S. Health Care System by Stephen Davidson

Author:Stephen Davidson [Davidson, Stephen]
Language: eng
Format: epub
Tags: Social Policy, Public Policy, Political Science
ISBN: 9780804771344
Google: yLPocb4pKrMC
Goodreads: 35191433
Publisher: Stanford Business Books
Published: 2010-03-24T00:00:00+00:00

Chapter 8: Elements of a Solution for Increasing Access to Health Care, Improving Quality of Care, and Containing Health Care Expenditures

In the first part of this book I tried to demonstrate that the U.S. health care system faces very large problems, which must be solved. Our continuing failure to do so has, among other things, undermined the capacity of the delivery subsystem to reliably provide good care even to those of us who continue to have good insurance. I have also shown that the primary causes for all the problems are the dysfunctional incentives that operate on all parties to the system—employers, insurers, individuals and families, providers of care, and even state and federal governments. As a result of those incentives, members of each group make decisions that, while they appear to be rational for the decision makers, at least in the short term, have created a system that is the most expensive in the world by far; leaves at least 16 percent of Americans uninsured and many more underinsured; produces health statistics that are mediocre at best and worse than those of many countries that spend a lot less; delivers care of unreliable quality and safety; and leaves Americans less satisfied with their health system than citizens of other countries. The driver of these suboptimal results is utilization—the extent to which individuals and families use services (or decide not to do so), which services they use, when during an episode of illness they use them, and who provides those services. Although calling this phenomenon “utilization” implies an action by the patient (the user of services), the reality is that it is a two-party decision, made by the potential patient and provider, and often paid for (and influenced) by a third-party insurer. Therefore the focus of attention cannot be only on the patient but must include provider and payer as well, and the forces that influence them.

A better system would allow everyone to share in the enormous potential offered by modern medicine and to do so with services that in each instance are the most appropriate given the patient’s condition and are provided by the most appropriate professional, in the most appropriate setting, at the most appropriate time during the course of the illness. In addition, such a system would provide preventive services that are appropriate to the patient’s age and health condition and care for chronic illness in ways that enable patients to function optimally given their underlying condition. While everyone should have a primary care physician (PCP) with whom he or she builds a strong therapeutic relationship, that physician should be part of a multidisciplinary team not only informed by professional education and experience but aided by a robust electronic information system. That care would be less expensive than much of the care used now and would produce better health outcomes, as well as perhaps even lower levels of aggregate spending. Moreover, the beneficiaries would include not only the individuals who got that good care but also the society and the national economy of which they are members.

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