2 replies »

1. Anything that makes sense and factors out new legions of government bureaucrats to run the health care system won’t fly in the current administration. Think Medicaid-plus, and you’ve got the ultimate “solution” with rationing and doctors’ leaving the system.

2. A Paradigm shift in healthcare delivery can facilitate National, Universal Access to healthcare for all Americans
   As a career federal government employee and I know that depending on the Federal government to fix the National Healthcare System is a non-starter. I’ve never been in the medical profession but I’m a Technoprogressive and a Futurist and I believe that by bringing to bear a LOT of advanced IT, and other medical technologies towards these issues we have a shot at creating a cost-effective and efficacious National Healthcare System with universal access. The model I have in mind involves the use of telemedicine to push the vast majority of primary care out of the institutional setting and down into the “Home Care” environment. I feel that by employing Telemedicine technology in the home, combined with Personal/Electronic Medical Records, that’ll enable & empower the average healthcare consumer to monitor their own health and to manage minor injuries as well as relatively complex chronic diseases and comply with healthy behavioral, dietary and lifestyle changes in a more cooperative manner. By taking advantage of the amount of households in this nation have PC’s and Internet access, the average household can access a vast array of healthcare related information and websites with all sorts of tools and plans and management protocols that can be easily modified for individual households, and families. Care plans for individual persons within a household can be implemented and compliance can be monitored through numerous telemedicine peripheral devices. Telemedicine can allow individuals to monitor their own health in the privacy in their own homes and also provide their clinicians with an unprecedented surveillance capability so that they can keep an eye on their patient’s health (subject to their patience compliance with the reporting protocol). I feel that instead of all of the classical solutions that are currently being offered, that what’s needed is to reengineer the entire infrastructure so that all care except various types of intensive care, trauma & surgeries that can’t be performed on an outpatient basis are pushed out into the community on a much more extensive basis than they are currently. The model that I’ve been developing envisions care being rendered in an inverted pyramid with telemedicine in the home at the bottom, at the next highest level of care would involve receiving a homecare visit from a trained caregiver, at the next highest level of care would be referrals to outpatient clinics, express clinics in Malls (or big box retailers like Wal-Mart or Kmart) or MRI/CT centers, Ambulatory SurgiCenters/Day SurgiCenters or specialty care clinics and at the highest level of abstraction within the health care system, care would be rendered in hospitals that render services only in an intensive, acute care setting. Hospitals would also host the central telemedicine control centers from which primary care would be rendered remotely direct into the homes of patients. All other care would be rendered at a lower (but appropriate) level of abstraction within the healthcare system. In this way, a great deal of the physical infrastructure (and its associated costs) that currently constitutes our national healthcare system can be disintermediated. In addition, all of the clinics and SurgiCenters, and the hospitals can be networked on high-speed backbone that can also support the telemedicine system so that vast amounts of data and images can be shared effortlessly. Rendering as much Primary care in the home as is practicable thru the use of telemedicine combined with homecare visits will facilitate the implementation of preventative healthcare protocols & comprehensive chronic disease management protocols. The way I see it, if you can push the “healthcare system” down into individuals homes, and use it to promote healthier, wellness lifestyles with a preventative theme, then that should lesson the necessity of so many ER visits & re-hospitalizations or the (load) that is placed on the healthcare system. If the load is lessened, then that should provide opportunities for disintermediating brick & mortar healthcare infrastructure.