I’m going to go out on a big ol’ limb here by saying that 90 percent of our health care problems could be solved by rebuilding and refocusing our primary care delivery system.
It’s the issue most discussed issue in reform circles (aside from single-payer) and it makes perfect sense. Toyota has succeeded because it goes to great lengths to find the true source of quality issues. They have recognized that addressing root causes significantly limits efforts needed because you avoid treating secondary level problems that occur further down the line.
A highly trained, appropriately paid primary care physician with a focus on prevention, coordination and patient education could solve so many other problems. There are many preventable chronic illnesses out there driving up our costs.
Malpractice would be less of an issue because there would be less care
episodes, and particularly less intense care episodes. Coordination
would actually be easier to accomplish because there would be less need
for it due to a decreased need for specialist services.
costs would go down because there would be fewer health care
transactions. The law of supply and demand would become more of a
factor because the decreased demand for services would have a greater
impact on physician and hospital costs, as well as drug costs.
EMR, PHR, HIT? Why are we designing elaborate systems when we don’t
even know what the ideal delivery system looks like? Technology cannot
make a bad company, service, or system great. It can only allow them to
do bad things faster.
Yes, I know I have over-simplified some things, but let’s not make this
more difficult than it needs to be. In the past I’ve spouted off about
how our problems are “multi-dimensional” and the solutions will have
“many facets.” Blah blah blah! Let’s get back to the days when the
physician-patient relationship was the center of the health care
universe, back before there were specialists and subspecialists to treat everything. I don’t need to
live to 120, because that might mean I need to work until I’m 115!
Ok, so let’s get started. Let’s reallocate the relative value units (RVU) reimbursement system to assign more
value to “cognitive” services, and prevention and coordination
activities, and away from procedures that only add value when
they’re medically necessary.
place midlevels in positions within physician practices, and allow them
to handle the primary care activities that don’t require the expertise
of a physician.
Finally, let’s step up as a citizenry, get off our duffs and exercise, forgo the trip to fast food joint, slow
down when we’re on the highways in a hurry to go nowhere, teach our
kids some responsibility, and stop and smell the roses every once in
When the smoke clears from all of that, we can address the remaining 10 percent.