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U.S. healthcare needs overhauling to cut waste, improve outcomes

The numbers aren’t good. The U.S. spends more than any other nation on healthcare. Healthcare spending represents 16 percent of the GDP (gross domestic product) in the U.S., yet the country ranks 48th in life expectancy and is in last place among industrialized nations in preventable deaths.

There seems to be agreement that there is plenty of money being devoted to healthcare in the U.S., but it isn’t being spent wisely. Dr. Daniel W. Jones, dean of the School of Medicine, University of Mississippi Medical Center and past president of the American Hospital Association, said there is absolutely no doubt that U.S. healthcare is wasteful.

“Absolutely,” Jones said. “ We spend about twice per capita what most industrialized nations spend and rank at mid-level or below in most rankings of important health measures.”

Jones said what is needed is a substantial overhaul of the healthcare system to include access to care for all, a focus on prevention, a focus on value driven by scientific evidence of what is effective and opportunities for personal responsibility.

One recommendation for reform is “paying for results.” That would involve keeping better electronic records, doing a better job managing chronic illnesses, encouraging prevention of disease and not paying for costly therapies whose value have not been proven.

Jones said paying for results is a good concept in theory, but difficult to implement. “Pay for results approaches such as ‘pay for performance’ should be considered as experiments until we have evidence that this approach improves outcomes,’ he said.

Although there is some rationale for rewarding good results, there may be more problems than benefits, said Ricki Garrett, Ph.D., executive director, Mississippi Nurses Association.

“Overall, I think Americans get good healthcare, and most healthcare professionals are deeply committed to their patients and to good results,” Garrett said. “I think there is waste is our healthcare system and that there are ways in which we could provide good healthcare at a lower cost. For example, nurse practitioners are excellent healthcare providers and often serve in rural underserved areas that have few physicians. They provide outstanding preventative care, too, at less expense.”

Garrett thinks that, in many ways, the healthcare system is broken and needs to be repaired. There should be better communication and collaboration among healthcare providers. Schools of nursing and medicine need to adapt more to changing times and utilize technology and other means to teach students and make education more accessible and relevant.

“Good healthcare and drugs should not be so costly, and we need to find a way to deal with the large number of underinsured and uninsured in our country,” Garrett said. “We also have a serious problem in our country with far too many individuals suffering from at least one and, in many cases, more than one chronic illness such as diabetes, heart problems, obesity and others. Those patients have shortened lives and put a tremendous strain on our healthcare system.”

There is no better time than now to improve the healthcare system. Garrett said with the aging baby boomer generation, there is even more impetus to find solutions to these problems before the healthcare system is overloaded even more.

The U.S. healthcare system can be wasteful and, as a nation, we can and must do better, said Shawn Lea, vice president for strategic communications, Mississippi Hospital Association (MHA).

“Hospitals need to work together with insurers, physicians, nurses, businesses, employers and individuals for better, safer and more affordable health care,” Lea said. “The MHA is working with the American Hospital Association to implement a Health for Life program to address these issues. The initiative focuses on health coverage for all paid for by all, a focus on wellness, access to the best information, the most efficient and affordable care and the highest quality care.”

Lea said key areas that must be addressed include ensuring medical practice is consistent with the most current research, coordinating care across settings and over time, and measuring and rewarding excellent performance.

The Institute of Medicine defines healthcare quality as “the degree to which healthcare services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.”

“In other words, patients should get exactly the care that they need, when they need it, without undergoing unnecessary or inappropriate treatments,” Lea said.

Measuring and reporting quality indicators is one strategy to narrow the gap between the care that is recommended and the care that is delivered. Making clinicians aware of their performance can help them detect opportunities for improvement and encourage change for the better. The Hospital Quality Alliance, along with the Medicare program, has successfully begun to collect quality data from hospitals and clinicians.

“Rewarding doctors, hospitals and others who deliver high-quality care can encourage accountability for patient care, offer incentives to coordinate care delivery and lead to better healthcare processes,” Lea said. “Since 2003, the number of both public and private programs that reward providers for high-quality care has more than tripled.”

One of the most common types of quality improvement programs is pay-for-performance programs. These programs link payment to specific steps taken or results achieved in care. According to a survey of healthcare purchasers, government agencies and health plans, at least half of evaluated pay-for-performance programs have significantly improved clinical performance.

Lea said the idea of focusing on wellness works if everyone has health coverage of some sort. But in Mississippi, approximately 17 percent of the population (418,900) does not have health coverage. People who lose their jobs often lose health coverage, and with the recent economic downturn, the number of uninsured is expected to grow.

It is no wonder the U.S. has such a high bill for healthcare when it is estimated that more than half of Americans suffer from a chronic condition such as heart disease, diabetes or arthritis. Approximately 80 percent of all healthcare dollars spent in America goes to just 20 percent of its people, most of whom have a chronic condition.

Contact MBJ contributing writer Becky Gillette at 4becky@cox.net.

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