A New York Times editorial highlights the three factors that will determine the success of health care reform:
1) The Independent Payment Advisory Board shifting reimbursements to promote primary care to keep people well, instead of only paying big bucks after they get sick.
2) Comparative effectiveness research to promote the best treatments rather than the newest and most expensive (though if those are the best, going with them).
3) Uniting health professionals and institutions to save medical costs while promoting patient health. One example is Don Berwick’s 5 Million Lives Campaign which encouraged doctors working in hospitals to implement six simple measures to prevent medical harm. Another example is new reimbursement schemes that reward hospitals for getting—and keeping--patients well to decrease readmits.
Health care reform can improve lives while saving costs by increasing access to the right care in the right place at the right time (to borrow the catchphrase of the Urban Health Initiative at the University of Chicago, where I work).
The first factor mentioned in the editorial—a strong Independent Payment Advisory Board to shift reimbursements to primary care—made me think of the value I bring to the system as a primary care physician.
My goal as a family physician is to catch and treat disease early in a primary care setting to prevent costly unnecessary tertiary care hospitalizations. Working in the Chicago Family Health Center on Chicago's South Side, I saw one diabetic without health insurance with a foot ulcer who put off care until he was worried he would lose his foot. A friend of his told him about our health center, where government grants allow us to provide care for a sliding flat rate based on family income and size, with the lowest payments $10 for seeing a doctor and including all necessary lab work. He came to our clinic in time to get treated with outpatient antibiotics ($4 from Walmart or Target) and a refill on his diabetes medications ($4 each for two oral pills, $15 for the insulin through our clinic pharmacy). He paid less than $40 to get the treatment he needed to be well, instead of waiting until the diabetes was so out of control and the infection was so bad that he would have to be hospitalized and his foot amputated (thousands of dollars that he—or the public—would have to pay), leaving him broke on Medicaid and disability for the rest of his life (tens or more of thousands of tax payer dollars to support him). By ensuring access to primary care medicine, my federally qualified health center kept this diabetic man healthy. By providing the right care at the right time at the right place, we improved his life and saved the system money.
A healthier America based on increased access to primary care is the goal—and can be the result, if politics and special interests don’t get in the way--of health care reform.