The current debate on health reform is getting lost in the numbers and dollars game in Congress. The arguments have become about price. What is the cheaper option? How can we pay for it? What is the best value? It is about the health insurance industry defending its ground, and attempting to maintain the current status quo. It is about how this industry may continue to make substantial profits out of the misery of all those patients who are sick, while maintaining a system that encourages them to avoid making payments as much as possible, to either patients or doctors. It is about a system where large special interests are able to negotiate low payments to doctors who have little bargaining power or strength, and which leads doctors to increasingly insist that patients pay them directly, rather than go through their insurers, hence letting the insurers completely off the financial hook.
Let's put a real human face on what is happening in American healthcare at present.
As a physician working in a major academic medical center in California, let me tell a few stories of some of the horrors that I have seen that are directly caused by the appalling way that American healthcare is organized and paid for. These stories are clear evidence that we cannot continue with our current system of insurance funding, and simply have to have a public insurance option available to offer choice to all Americans, and to create competition for private insurance companies which they just don't have at present.
Firstly let me say that I am extremely proud to be working in this medical center, which last year provided over $160 million of uncompensated care to the uninsured. This is about double the year before, a fact that is directly the consequence of the recession, increased numbers of uninsured patients, and an increased level of social poverty.
Think of the middle-aged homeless woman with diabetes who was admitted yet again with pneumonia. She has been sleeping rough, and in great personal danger having been assaulted numerous times. She cannot get out of a cycle of poverty, homelessness, illness and peril, and every time she recovers in hospital, it is sickening for the medical and nursing staff to know that she is being discharged to the street, where the cycle will continue. She has no insurance, no family, no future and no hope. Her medical prognosis is dreadful, she is unable to receive any regular follow up care for her diabetes, and she will probably not live for more than a few years unless there are major changes in her situation. She desperately needs good medical and social care, but there is little for her to receive, and she ends up costing society a huge amount because of her multiple expensive hospital admissions, occurring because she has no regular outpatient care. She would be so much better off with regular public health insurance, and would at least have a chance of breaking this cycle.
Think of the recently unemployed father of three young children whose wife died a year ago. He lost his company sponsored health insurance when he lost his job, and is unable to afford to pay the quoted premiums from other insurance companies because of his possible prior history of high blood pressure, found on two medical exams in the past, andwhich is seen as a risk factor for possible cardiac problems in the future.
Think of the patient with chronic schizophrenia who has suddenly had his treatment program closed by a county mental health department desperate to save money and faced with the decision to close either their firefighting or mental health services to meet their budget. This patient has nowhere to go for treatment, eventually runs out of medication, becomes psychotic again, tries to kill himself because of his delusions, and is re-admitted to an inpatient facility for several weeks at great public expense.
These are the faces of the health reform debate. These are the people that President Obama is fighting for, and which the insurance industry will not help, which they prefer to ignore. This is why we have to have a public health insurance option. And this is why we have to have true health reform in this country.
Peter Yellowlees MD has recently published “Your Health in the Information Age – how you and your doctor can use the Internet to work together”. It is available at www.InformationAgeHealth.com and most online bookstores.
Monday, July 27, 2009
Sunday, July 19, 2009
Health care reform - will Dr Obama be able to cure the US Health System?
Let’s pretend that President Obama is actually Dr Obama, and that his job is to diagnose and treat the US Health System. What will he find, how will he go about it, and what will be the outcome?
The process of diagnosis is relatively straight forward. Everyone acknowledges that the system is broken and that there are a number of agreed on symptoms of this disorder. Firstly the system is far too costly, consuming almost twice as many dollars per capita as health systems in other Western countries. And this expense is also poorly focused, with over thirty per cent being spent on administrative non-patient care costs (such as insurance companies costs and profits, and excessive administrative costs for providers), almost twice as much being spent on medications as other countries, and reimbursement inappropriately targeting piece rate medicine and rewarding doctors who perform interventions, (such as surgeons and radiologists) instead of prevention and the treatment of chronic illness (such as primary care physicians). Of course the existence of 47 million uninsured is a disgrace and a huge problem, as is the relatively poor quality of overall care provided nationally for the money spent. And finally the whole system is very patchy, with excellence provided relatively cheaply in some areas, and the opposite in many others, and this occurring in the setting of relatively little investment in electronic medical records and modern information technology, which could certainly improve the system.
So what should Dr Obama do? If he addresses some of the problems above, then the task becomes clearer. It is absolutely necessary to introduce some form of national public insurance program, both to insure the currently uninsured, and to provide competition for the excessive number of health insurance companies to make them reduce their rates, increase their cover, and provide better value services. It is likely that this process will lead to many of the insurance companies going out of business, and that is fine, because there are way to many at present, and it would be more rational for us to have fewer larger health insurance operations. At the same time the cost of pharmaceuticals has to be addressed – there needs to be a nationally negotiated formulary for core essential drugs that are paid out of the public purse. At the same time the payment structure for providers needs to be changed, and more emphasis paid for services for chronic illness and prevention, and less for interventional medicine, while also encouraging, as is happening, the use of electronic medical record systems and other health information technology initiatives. A single dramatic enhancement would come if he insisted on the introduction of a national health identifier number as this would greatly enhance the ability of providers to exchange health information when necessary, and would greatly simplify billing and administrative processes.
Many other things have to happen, of course, but will Dr Obama and his team be up to this task? We currently have a bloated and inefficient health system, and in any such system there are winners and losers. The winners in today’s health system are insurance companies, the pharmaceutical industry, and large numbers of providers who are used to receiving excessively high incomes for interventional services. The losers are patients, and the country. When looked at broadly, the diagnosis and treatment of our health system are actually relatively straightforward, but it has to be accepted that today’s “winners” will not necessarily remain in that position long term, and that there will be a number of losers as we change the system. Let’s just hope that Dr Obama, and his multidisciplinary team in Congress, are able to push through the reforms the US health system needs so that the patient is no longer the loser.
Peter Yellowlees MD has recently published “Your Health in the Information Age – how you and your doctor can use the Internet to work together”. It is available at www.InformationAgeHealth.com and most online bookstores.
The process of diagnosis is relatively straight forward. Everyone acknowledges that the system is broken and that there are a number of agreed on symptoms of this disorder. Firstly the system is far too costly, consuming almost twice as many dollars per capita as health systems in other Western countries. And this expense is also poorly focused, with over thirty per cent being spent on administrative non-patient care costs (such as insurance companies costs and profits, and excessive administrative costs for providers), almost twice as much being spent on medications as other countries, and reimbursement inappropriately targeting piece rate medicine and rewarding doctors who perform interventions, (such as surgeons and radiologists) instead of prevention and the treatment of chronic illness (such as primary care physicians). Of course the existence of 47 million uninsured is a disgrace and a huge problem, as is the relatively poor quality of overall care provided nationally for the money spent. And finally the whole system is very patchy, with excellence provided relatively cheaply in some areas, and the opposite in many others, and this occurring in the setting of relatively little investment in electronic medical records and modern information technology, which could certainly improve the system.
So what should Dr Obama do? If he addresses some of the problems above, then the task becomes clearer. It is absolutely necessary to introduce some form of national public insurance program, both to insure the currently uninsured, and to provide competition for the excessive number of health insurance companies to make them reduce their rates, increase their cover, and provide better value services. It is likely that this process will lead to many of the insurance companies going out of business, and that is fine, because there are way to many at present, and it would be more rational for us to have fewer larger health insurance operations. At the same time the cost of pharmaceuticals has to be addressed – there needs to be a nationally negotiated formulary for core essential drugs that are paid out of the public purse. At the same time the payment structure for providers needs to be changed, and more emphasis paid for services for chronic illness and prevention, and less for interventional medicine, while also encouraging, as is happening, the use of electronic medical record systems and other health information technology initiatives. A single dramatic enhancement would come if he insisted on the introduction of a national health identifier number as this would greatly enhance the ability of providers to exchange health information when necessary, and would greatly simplify billing and administrative processes.
Many other things have to happen, of course, but will Dr Obama and his team be up to this task? We currently have a bloated and inefficient health system, and in any such system there are winners and losers. The winners in today’s health system are insurance companies, the pharmaceutical industry, and large numbers of providers who are used to receiving excessively high incomes for interventional services. The losers are patients, and the country. When looked at broadly, the diagnosis and treatment of our health system are actually relatively straightforward, but it has to be accepted that today’s “winners” will not necessarily remain in that position long term, and that there will be a number of losers as we change the system. Let’s just hope that Dr Obama, and his multidisciplinary team in Congress, are able to push through the reforms the US health system needs so that the patient is no longer the loser.
Peter Yellowlees MD has recently published “Your Health in the Information Age – how you and your doctor can use the Internet to work together”. It is available at www.InformationAgeHealth.com and most online bookstores.
Monday, July 6, 2009
Jama reviews "Your health in the Information Age" very positively
I am pleased to say that a very positive review of my book, "your health in the information age" has been published in the Journal of the American Medical Association, the most prestigious general medical journal in the world. The reviewer introduced his review in the following way:
"If you have heard the joke" What kind of physician uses the Internet? A URLologist" then Your Health in the Information Age" may be just the ticket for you and your patients. This 188 page book takes on the monumental task of offering an excellent exploration of the exponentially expanding world of e-health for readers already searching for health information on the Internet, as well as for relative newbies".
And finishes with the following:
"Your Health in the information age" is not an "e-health for dummies". It is an academic and insightful look into the exciting and nascent world of online health care. Whatever your views on the flaws and failures of the US healthcare system, you have to admit that things are changing. Make no mistake: online care is a game changer."
It is very pleasing to read such a positive review, which also includes some very reasonable criticisms that I will be delighted to confront when I write the next version of the book. You can all read the full review by going to my website at www. informationagehealth.com and following the links. I hope you do, and I hope that this review encourages you to tell your friends and colleagues about the book, and to continue to think critically about all aspects of e-health on the Internet.
"If you have heard the joke" What kind of physician uses the Internet? A URLologist" then Your Health in the Information Age" may be just the ticket for you and your patients. This 188 page book takes on the monumental task of offering an excellent exploration of the exponentially expanding world of e-health for readers already searching for health information on the Internet, as well as for relative newbies".
And finishes with the following:
"Your Health in the information age" is not an "e-health for dummies". It is an academic and insightful look into the exciting and nascent world of online health care. Whatever your views on the flaws and failures of the US healthcare system, you have to admit that things are changing. Make no mistake: online care is a game changer."
It is very pleasing to read such a positive review, which also includes some very reasonable criticisms that I will be delighted to confront when I write the next version of the book. You can all read the full review by going to my website at www. informationagehealth.com and following the links. I hope you do, and I hope that this review encourages you to tell your friends and colleagues about the book, and to continue to think critically about all aspects of e-health on the Internet.
Online healthcare is a game changer
Dr Stanley Borg, in the Journal of the American Medical Association, recently wrote that "whatever your views on the flaws and failures of the US health care system, you have to admit that things are changing. Make no mistake: online care is a game changer."
I agree, but what did he mean by that?
Could he be talking about how technology is going to radically improve the way we deliver and receive our healthcare? Does he see new technologies as being around the corner, and about to envelop us and help us improve our health? What does he really mean by "online care"? Is it enough for us to communicate with our doctor on the Internet, or should we be becoming involved in online groups and counseling fellow patients? Should we have all of our medical records stored online, and be able to access them ourselves to make sure that they are correct. Should we be wearing electronic monitors of our heart, our breathing, our temperature, all of which constantly transmit our vital signs in real time to the database of our choosing? Or should we be undertaking robotic surgery using automated machines controlled by a surgeon hundreds of miles away?
Does this sound scary, or is it a form of "techno-utopia" that we should all be seeking? I can easily answer that one at least. Techno-utopia, as defined by Wikipedia, is “a hypothetical ideal society, in which laws, government, and social conditions are solely operating for the benefit and well-being of all its citizens, set in the near- or far-future, when advanced science and technology will allow these ideal living standards to exist; for example, post scarcity, changes in human nature and the human condition, the absence of suffering and even the end of death.” We are certainly not close to this.
In place of the static perfection of a utopia, others have envisioned online health as occuring in an "extropia," an evolving open society allowing individuals and voluntary groupings to form the institutions and social forms they prefer. Perhaps the web 2.0 is the beginning of this extropia?
We have to be careful not to be “techno-Utopians” - excessively, uncritically accepting of technologies. People like this don’t tend to use new technologies as effectively as they could because they view the technologies as ends in themselves, not as tools. It is commonly held that using new technologies uncritically implies bad habits of the mind. Taking television as an example, one could argue that this technology has led us to concentrate on superficial, rapid acquisition of knowledge rather than on deep thinking and careful consideration. Look at all the “news bites” prepared for TV – and how if you are trained in media skills, you are almost always taught to literally speak in short “bites” that are easily reportable but often meaningless.
Healthcare on the Internet, in partnership with your doctor, does promise huge benefits not only for us all, patients, clinicians and society in general, and is, to quote Dr Borg, a "game changer". But in embracing technology, the human factor must not be forgotten. It is not the cleverness of the technology that is important but how we use it to derive most benefit for us, for our children, and for society. We have to learn to improve, to control, and to effectively use the tools and techniques now available to deliver online healthcare to improve our health and, in doing this, to enrich the quality of our lives.
If we look at the future direction that online healthcare is moving in, and which is being supported by the Obama Administration, the following themes are evident:
§ Our future isn’t what it used to be, as we move to the era of virtual hospitals and global clinicians
§ Our health system is gradually changing and becoming electronic and distributed, with less dependency on buildings, and more on communication networks from the patients home to the operating theater
§ Research is opening up whole new ways of delivering healthcare, using all our senses, and in a much more personalized manner
§ Patients are demanding better and more accessible healthcare, and will obtain it from all around the world in future
§ The doctor-patient relationship is changing, and will become increasingly open and driven by empowered patients living in an information rich environment – where the Internet is increasingly influential and important in clinical consultations.
Online care is a game changer, and we should all embrace it and learn to use it to our best advantage.
Peter Yellowlees MD has recently published "Your Health in the Information Age - how you and your doctor can use the Internet to work together." The book is available at Amazon, iUniverse, http://www.InformationAgeHealth.com and most online bookstores.
I agree, but what did he mean by that?
Could he be talking about how technology is going to radically improve the way we deliver and receive our healthcare? Does he see new technologies as being around the corner, and about to envelop us and help us improve our health? What does he really mean by "online care"? Is it enough for us to communicate with our doctor on the Internet, or should we be becoming involved in online groups and counseling fellow patients? Should we have all of our medical records stored online, and be able to access them ourselves to make sure that they are correct. Should we be wearing electronic monitors of our heart, our breathing, our temperature, all of which constantly transmit our vital signs in real time to the database of our choosing? Or should we be undertaking robotic surgery using automated machines controlled by a surgeon hundreds of miles away?
Does this sound scary, or is it a form of "techno-utopia" that we should all be seeking? I can easily answer that one at least. Techno-utopia, as defined by Wikipedia, is “a hypothetical ideal society, in which laws, government, and social conditions are solely operating for the benefit and well-being of all its citizens, set in the near- or far-future, when advanced science and technology will allow these ideal living standards to exist; for example, post scarcity, changes in human nature and the human condition, the absence of suffering and even the end of death.” We are certainly not close to this.
In place of the static perfection of a utopia, others have envisioned online health as occuring in an "extropia," an evolving open society allowing individuals and voluntary groupings to form the institutions and social forms they prefer. Perhaps the web 2.0 is the beginning of this extropia?
We have to be careful not to be “techno-Utopians” - excessively, uncritically accepting of technologies. People like this don’t tend to use new technologies as effectively as they could because they view the technologies as ends in themselves, not as tools. It is commonly held that using new technologies uncritically implies bad habits of the mind. Taking television as an example, one could argue that this technology has led us to concentrate on superficial, rapid acquisition of knowledge rather than on deep thinking and careful consideration. Look at all the “news bites” prepared for TV – and how if you are trained in media skills, you are almost always taught to literally speak in short “bites” that are easily reportable but often meaningless.
Healthcare on the Internet, in partnership with your doctor, does promise huge benefits not only for us all, patients, clinicians and society in general, and is, to quote Dr Borg, a "game changer". But in embracing technology, the human factor must not be forgotten. It is not the cleverness of the technology that is important but how we use it to derive most benefit for us, for our children, and for society. We have to learn to improve, to control, and to effectively use the tools and techniques now available to deliver online healthcare to improve our health and, in doing this, to enrich the quality of our lives.
If we look at the future direction that online healthcare is moving in, and which is being supported by the Obama Administration, the following themes are evident:
§ Our future isn’t what it used to be, as we move to the era of virtual hospitals and global clinicians
§ Our health system is gradually changing and becoming electronic and distributed, with less dependency on buildings, and more on communication networks from the patients home to the operating theater
§ Research is opening up whole new ways of delivering healthcare, using all our senses, and in a much more personalized manner
§ Patients are demanding better and more accessible healthcare, and will obtain it from all around the world in future
§ The doctor-patient relationship is changing, and will become increasingly open and driven by empowered patients living in an information rich environment – where the Internet is increasingly influential and important in clinical consultations.
Online care is a game changer, and we should all embrace it and learn to use it to our best advantage.
Peter Yellowlees MD has recently published "Your Health in the Information Age - how you and your doctor can use the Internet to work together." The book is available at Amazon, iUniverse, http://www.InformationAgeHealth.com and most online bookstores.
Monday, June 22, 2009
Telemedicine is an essential component of healthcare reform
It is clear that most stakeholders in the health industry now support President Obama's view that it is essential that we have substantial healthcare reform, and soon. The arguments around the issue are not whether this should happen, but how and when it will occur. An excellent white paper has just been written on how national telemedicine initiatives are essential to that reform. The whole paper, primarily authored by Rashid Bashshur PhD and Gary Shannon PhD, is available for free download at http://www.liebertonline.com/toc/tmj/0/0. I strongly suggest that you read it.
In brief the paper makes the case that the need for reform stems from long-standing problems in our health system, and demonstrates that the central role of telemedicine derives from an ever-expanding body of research-and experience that attests to its merit in addressing these problems.
The paper notes that "despite the fact that the United States spends more on health care than any other country, both in absolute numbers and on a per capita basis, the health status of Americans ranks relatively low when compared with that of people in other developed nations. Moreover, the general discrepancy between expenditures and health status indicators in the U.S. masks significant differentials among segments of the population, based on socio-economic, geographic, cultural, ethnic and other factors."
The consequence of these factors is that we continue to suffer from inequities in access to health care, inefficiencies in the delivery of care, escalating costs and the prevalence of adverse life styles that exacerbate these problems.
I have just spent been on call over the last weekend working in a major Academic Medical Center Emergency Department managing acutely psychotic patients transferred there as a place of last resort because the only local locked inpatient psychiatric facility was closed to admissions because it was full as a result of major financially driven cuts to local outpatient mental health services. This is the sort of concrete evidence that the American healthcare system is broken, inefficient, disorganized and inequitable.
Why is this relevant? Simply because we must improve our system of care, make it more integrated, and start using electronic healthcare more intelligently and more frequently. Electronic health records represent a means to improving the health care system but are only a partial solution to the problems we face. The practice of telemedicine, where patients are treated by videoconferencing or email in real or asynchronous time, incorporating electronic medical records, is a much better way of working, and allows many of the geographical and cultural inequities we face in health care access to be overcome. The white paper argues effectively and strongly for those involved in planning healthcare reform to take a broad view of the use of health information technology, and to think beyond electronic health records to a time where we will be using telemedicine incorporating electronic health records.
Peter Yellowlees MD has recently published "Your Health in the Information Age - how you and your doctor can use the Internet to work together." The book is available at http://www.InformationAgeHealth.com and most online bookstores. An e-Book called "4 simple steps to better health - an insiders look" is available at Smashwords at http://www.smashwords.com/books/view/1271
In brief the paper makes the case that the need for reform stems from long-standing problems in our health system, and demonstrates that the central role of telemedicine derives from an ever-expanding body of research-and experience that attests to its merit in addressing these problems.
The paper notes that "despite the fact that the United States spends more on health care than any other country, both in absolute numbers and on a per capita basis, the health status of Americans ranks relatively low when compared with that of people in other developed nations. Moreover, the general discrepancy between expenditures and health status indicators in the U.S. masks significant differentials among segments of the population, based on socio-economic, geographic, cultural, ethnic and other factors."
The consequence of these factors is that we continue to suffer from inequities in access to health care, inefficiencies in the delivery of care, escalating costs and the prevalence of adverse life styles that exacerbate these problems.
I have just spent been on call over the last weekend working in a major Academic Medical Center Emergency Department managing acutely psychotic patients transferred there as a place of last resort because the only local locked inpatient psychiatric facility was closed to admissions because it was full as a result of major financially driven cuts to local outpatient mental health services. This is the sort of concrete evidence that the American healthcare system is broken, inefficient, disorganized and inequitable.
Why is this relevant? Simply because we must improve our system of care, make it more integrated, and start using electronic healthcare more intelligently and more frequently. Electronic health records represent a means to improving the health care system but are only a partial solution to the problems we face. The practice of telemedicine, where patients are treated by videoconferencing or email in real or asynchronous time, incorporating electronic medical records, is a much better way of working, and allows many of the geographical and cultural inequities we face in health care access to be overcome. The white paper argues effectively and strongly for those involved in planning healthcare reform to take a broad view of the use of health information technology, and to think beyond electronic health records to a time where we will be using telemedicine incorporating electronic health records.
Peter Yellowlees MD has recently published "Your Health in the Information Age - how you and your doctor can use the Internet to work together." The book is available at http://www.InformationAgeHealth.com and most online bookstores. An e-Book called "4 simple steps to better health - an insiders look" is available at Smashwords at http://www.smashwords.com/books/view/1271
Thursday, June 4, 2009
Public Health Insurance - a lifesaver for the American Health System
There is much debate around the type of insurance proposals that will be required in the new health system currently being negotiated in Congress. President Obama has just come out in support of a public health plan, which is opposed by private insurers who say that they could not compete with a public health plan that didn't have to make a profit. Supporters of the public plan proposal correctly say that it would give people more choices and create more competition. Opponents argue that private health plans would go out of business, leaving only an entirely government-run health care system.
Of course all sides are exaggerating and taking up extreme positions. They will all in time compromise and hopefully reach some form of agreement. The sad part is that at present they don't seem to be thinking of the person at the center of all this - the patient. It is widely acknowledged that healthcare costs far too much in this country, while at the same time at least 47 million Americans are uninsured. So, from a patients perspective, if you do have health insurance, you are paying way too much for it, and getting poor value, and if you don't have it, then you just continue to suffer. What a dreadful choice.
The goal of overhauling the health care system is to lower costs and extend care to the uninsured. Obama wants a bill on his desk in October. Where can Congress begin to compromise, and why is it that Republicans in particular, believe that public health plans are likely to be so dreadful. They regularly bring up the ogre of "socialized medicine" whenever public plans are discussed, but there is no evidence whatsoever that countries with more federal control over their health systems, especially in Europe, have worse health outcomes that the USA. In fact the contrary is true, health outcomes are much better overall, for a lot less money per capita.
As a physician who has lived and worked in the USA, Australia and Britain, and who has an interest in how health services are organized, I think we could move forward in a relatively simple way as long as we always keep the patient at the center, and don't try and design a health system primarily to protect profit levels for various constituents, whether they be providers, health insurers or pharmaceutical companies.
Firstly we need a public-private partnership philosophy. That means public and private, not just private. America is founded on capitalist principals, where the profit motive is central, and any new approach to healthcare must combine this with the need to develop core public services that may be less likely to ever achieve a profit. Funding for care needs to be provided on the basis of annual or episodic whole of person care, rather than on individual piece rates as at present. The primary importance of this approach is that it will force more resources into the prevention of illness - to wellness promotion - rather than into the treatment of illness that has already commenced. This is an approach that Kaiser Permanente is well known for.
The public component of the healthcare system would include universal basic health insurance (including catastrophic care insurance) and many emergency and isolated health services, as well as much more public health focus on prevention and health promotion. Public programs should also pick up much of pre/post natal and early child care to ensure all mothers and babies are properly looked after, and probably care of some special populations who cannot afford private health insurance such as the unemployed, some seniors and certain impoverished or geographically isolated groups. These are areas where there will be less competition with private insurers who have typically kept away from them.
The private component would be funded with the aid of tax incentives to encourage most people (or companies) to take out private insurance with aim that at least 80-90% of the population should have private insurance. It is crucial to reach this level of insurance to be confident that we all have "skin in the game" and are financially responsible for at least a good proportion of our healthcare costs, and do not see healthcare as something that is provided by the government for free. The private sector should offer a full range of services from birth to death - with the ability to charge extra for certain "non-essential" services such as cosmetic surgery and other niche areas - but with regulation to prevent people being excluded on grounds of pre-existing conditions.
These ideas are taken from what I consider to be the best parts of the American, British and Australian health systems. No country has a perfect health system. America is the Land of the Free and can afford to choose the best of what other countries have attempted as it debates how to improve its healthcare system. Lets hope that Congress can be creative and not get bogged down in political dogma.
Peter Yellowlees MD has recently published “Your Health in the Information Age – how you and your doctor can use the Internet to work together”. It is available at www.InformationAgeHealth.com and most online bookstores. A shortened version of the book, available as an e-Book for download to iPhones, Blackberry's, PDA's and other mobile devices called "4 Simple steps to Better Health - an Insiders Look" is available at Smashwords at www.smashwords.com/books/view/1271
Of course all sides are exaggerating and taking up extreme positions. They will all in time compromise and hopefully reach some form of agreement. The sad part is that at present they don't seem to be thinking of the person at the center of all this - the patient. It is widely acknowledged that healthcare costs far too much in this country, while at the same time at least 47 million Americans are uninsured. So, from a patients perspective, if you do have health insurance, you are paying way too much for it, and getting poor value, and if you don't have it, then you just continue to suffer. What a dreadful choice.
The goal of overhauling the health care system is to lower costs and extend care to the uninsured. Obama wants a bill on his desk in October. Where can Congress begin to compromise, and why is it that Republicans in particular, believe that public health plans are likely to be so dreadful. They regularly bring up the ogre of "socialized medicine" whenever public plans are discussed, but there is no evidence whatsoever that countries with more federal control over their health systems, especially in Europe, have worse health outcomes that the USA. In fact the contrary is true, health outcomes are much better overall, for a lot less money per capita.
As a physician who has lived and worked in the USA, Australia and Britain, and who has an interest in how health services are organized, I think we could move forward in a relatively simple way as long as we always keep the patient at the center, and don't try and design a health system primarily to protect profit levels for various constituents, whether they be providers, health insurers or pharmaceutical companies.
Firstly we need a public-private partnership philosophy. That means public and private, not just private. America is founded on capitalist principals, where the profit motive is central, and any new approach to healthcare must combine this with the need to develop core public services that may be less likely to ever achieve a profit. Funding for care needs to be provided on the basis of annual or episodic whole of person care, rather than on individual piece rates as at present. The primary importance of this approach is that it will force more resources into the prevention of illness - to wellness promotion - rather than into the treatment of illness that has already commenced. This is an approach that Kaiser Permanente is well known for.
The public component of the healthcare system would include universal basic health insurance (including catastrophic care insurance) and many emergency and isolated health services, as well as much more public health focus on prevention and health promotion. Public programs should also pick up much of pre/post natal and early child care to ensure all mothers and babies are properly looked after, and probably care of some special populations who cannot afford private health insurance such as the unemployed, some seniors and certain impoverished or geographically isolated groups. These are areas where there will be less competition with private insurers who have typically kept away from them.
The private component would be funded with the aid of tax incentives to encourage most people (or companies) to take out private insurance with aim that at least 80-90% of the population should have private insurance. It is crucial to reach this level of insurance to be confident that we all have "skin in the game" and are financially responsible for at least a good proportion of our healthcare costs, and do not see healthcare as something that is provided by the government for free. The private sector should offer a full range of services from birth to death - with the ability to charge extra for certain "non-essential" services such as cosmetic surgery and other niche areas - but with regulation to prevent people being excluded on grounds of pre-existing conditions.
These ideas are taken from what I consider to be the best parts of the American, British and Australian health systems. No country has a perfect health system. America is the Land of the Free and can afford to choose the best of what other countries have attempted as it debates how to improve its healthcare system. Lets hope that Congress can be creative and not get bogged down in political dogma.
Peter Yellowlees MD has recently published “Your Health in the Information Age – how you and your doctor can use the Internet to work together”. It is available at www.InformationAgeHealth.com and most online bookstores. A shortened version of the book, available as an e-Book for download to iPhones, Blackberry's, PDA's and other mobile devices called "4 Simple steps to Better Health - an Insiders Look" is available at Smashwords at www.smashwords.com/books/view/1271
Ready to Launch? Swine Flu phase 2?
When will swine flu reappear in the Northern Hemisphere? Next September of October is the most likely time.
Most pandemics go through a well described series of three peaks of infection rate. There is an initial outbreak, that we have just had, followed by several months of relatively little activity as the flu literally travels south to the traditional flu season in the Southern Hemisphere. The flu then returns with its largest peak of activity with the next Northern Hemisphere flu season, traditionally around September and October, before dropping away again. There is usually then a final relatively small outbreak the following flu season during the next spring.
Pandemic flu literally spreads around the world, from north to south, and currently continues to be a threat south of the equator, where countries are entering the winter months and their traditional flu season, according to Dr Christian Sandrock, a UC Davis infectious diseases expert on the effect of this virus.
According to the CDC South America has had more than 600 cases, including one death in Chile, while Australia has reported more than 500.
Overall swine flu has hit more than 60 countries, with the United States reporting the most cases — more than 11,400, including at least 19 deaths, according to the CDC, compared with just over 5,700 in Mexico.
The good news is that the swine flu does not seem to be particularly dangerous to humans, although it spreads easily, it kills in relatively small numbers and is not a very potent form of flu. This does not mean that it can be ignored because with the likely impending outbreak next autumn many patients with chronic diseases, and young children, will be at increased risk of infection and potentially fatal consequences.
What should we be doing? Apart from all the obvious things like good hygiene, avoiding contamination and reducing infection spread by self-isolation of those who are infected, this is a classic example of how we can use health informatics and information technology for the greater public good.
If we had universal electronic records, and good public health reporting systems, we would be able to both identify outbreaks earlier, and treat those with infections more rapidly, as well as possibly follow up clusters of outbreaks to prevent further spread. Have a look at the CDC home page and study their swine flu influenza surveillance systems and see the large amount of data that is able to be collected now, without universal electronic records. The data is already impressive but to collect it is difficult because it involves amalgamating so many different data sources, few of which are complete, so the data itself is still not as good as it could be. And it is not available in real time.
The Obama administration is planning a comprehensive implementation of electronic medical records nationwide within the next five years. A very positive added value effect of this important initiative will be the production of more data, much of it in real time, to combat major pandemics such as swine flu, as well as a number of other substantial public health threats such as bioterrorism. The secondary use of electronic health record data for these sorts of purposes should greatly encourage all doctors and health systems to implement electronic health records, and to make sure that they are able to exchange key health information with important national bodies like the CDC.
This article is based on excerpts from the recently published book "Your Health in the Information Age - how you and your doctor can use the Internet to work together," by Peter Yellowlees MD. Available at http://www.InformationAgeHealth.com and most online bookstores. An e-Book called "4 simple steps to better health - an insiders look" is available at Smashwords at http://www.smashwords.com/books/view/1271
Most pandemics go through a well described series of three peaks of infection rate. There is an initial outbreak, that we have just had, followed by several months of relatively little activity as the flu literally travels south to the traditional flu season in the Southern Hemisphere. The flu then returns with its largest peak of activity with the next Northern Hemisphere flu season, traditionally around September and October, before dropping away again. There is usually then a final relatively small outbreak the following flu season during the next spring.
Pandemic flu literally spreads around the world, from north to south, and currently continues to be a threat south of the equator, where countries are entering the winter months and their traditional flu season, according to Dr Christian Sandrock, a UC Davis infectious diseases expert on the effect of this virus.
According to the CDC South America has had more than 600 cases, including one death in Chile, while Australia has reported more than 500.
Overall swine flu has hit more than 60 countries, with the United States reporting the most cases — more than 11,400, including at least 19 deaths, according to the CDC, compared with just over 5,700 in Mexico.
The good news is that the swine flu does not seem to be particularly dangerous to humans, although it spreads easily, it kills in relatively small numbers and is not a very potent form of flu. This does not mean that it can be ignored because with the likely impending outbreak next autumn many patients with chronic diseases, and young children, will be at increased risk of infection and potentially fatal consequences.
What should we be doing? Apart from all the obvious things like good hygiene, avoiding contamination and reducing infection spread by self-isolation of those who are infected, this is a classic example of how we can use health informatics and information technology for the greater public good.
If we had universal electronic records, and good public health reporting systems, we would be able to both identify outbreaks earlier, and treat those with infections more rapidly, as well as possibly follow up clusters of outbreaks to prevent further spread. Have a look at the CDC home page and study their swine flu influenza surveillance systems and see the large amount of data that is able to be collected now, without universal electronic records. The data is already impressive but to collect it is difficult because it involves amalgamating so many different data sources, few of which are complete, so the data itself is still not as good as it could be. And it is not available in real time.
The Obama administration is planning a comprehensive implementation of electronic medical records nationwide within the next five years. A very positive added value effect of this important initiative will be the production of more data, much of it in real time, to combat major pandemics such as swine flu, as well as a number of other substantial public health threats such as bioterrorism. The secondary use of electronic health record data for these sorts of purposes should greatly encourage all doctors and health systems to implement electronic health records, and to make sure that they are able to exchange key health information with important national bodies like the CDC.
This article is based on excerpts from the recently published book "Your Health in the Information Age - how you and your doctor can use the Internet to work together," by Peter Yellowlees MD. Available at http://www.InformationAgeHealth.com and most online bookstores. An e-Book called "4 simple steps to better health - an insiders look" is available at Smashwords at http://www.smashwords.com/books/view/1271
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