As of February, an estimated 500,000 California residents had lost their health insurance since the start of the economic decline, according to a recent report. Now people are cutting back on routine screenings and examinations designed to protect their health, Southern California doctors and dentists say. Those who have health insurance with high deductibles or expensive co-pays also appear to be cutting back on nonessential medical care, doctors say, possibly to save money.
More than $6.8 million in funding was awarded to community-based health centers in New Jersey as part of the American Reinvestment Recovery Act. The new funding will be used to renovate facilities and offer more primary care to New Jersey families, U.S. Sen. Frank R. Lautenberg said in a statement.
The State Council, China's cabinet, offered details on the $120-billion-plus initial phase of a healthcare revamp, which it outlined in January. Among the plans: a construction surge that by 2011 will give every village a medical clinic and every county at least one hospital. Under the plan, state subsidies for insurance premiums aim to extend at least basic coverage to 90% or more of China's 1.3 billion people within three years.
The Obama administration is working with Congress to mandate that all Medicare payments be tied to "quality metrics," but an analysis of this drive for better healthcare reveals a fundamental flaw in how quality is defined and metrics applied, according to this opinion piece published in the Wall Street Journal. In too many cases, the quality measures have been hastily adopted, only to be proven wrong and even potentially dangerous to patients, the authors write.
Pay-offs for 120 senior managers has cost taxpayers more than £8million. The pay-offs were the result of an NHS merger that combined seven primary care trusts. According to officials, the funds could have paid for 1,091 heart bypasses, or 1,097 hip replacements, or 1,137 knee replacements, or 7,765 varicose vein procedures.
Egypt is one of several countries identified by the World Health Organization as an underground organ-trafficking hot spot. Now, transplant surgeons worldwide are pushing to end the practice that has become widely used among the country's poorer citizens. Other trouble spots including China, Pakistan, and the Phillipines have already begun outlawing organ sales. Egypt has been slower to bar the practice, in part because the country does not currently have any laws regulating organ transplants. However, its parliament is expected to propose such laws within the next few months.
Healthcare in the U.S., Britain, and Canada is ailing, but in different ways. Among major concerns in all three countries is long wait times for medical care. While sometimes patients in Britain and Canada, both of which have government-run healthcare systems, are forced to wait months for elective treatments, no one goes without healthcare. Studies show that the U.S. reports much lower wait times, but this is because there is a lower number of people waiting for care, as too many simply cannot afford it.
As President Obama's administration continues its efforts to find common ground with opponents to provide universal healthcare for an entire country, one recent study has found it can be done.
According to a study published online by Health Affairs, Thailand has achieved near-universal health coverage through its 2001 health reforms. When implemented, the "30-baht health scheme" was designed to provide equal access to quality care regardless of income or socioeconomic status. One important aspect of the plan was that no individual would be required to spend more than 30 baht, or about 84 cents, per visit for either inpatient or outpatient care, including drugs.
The program seems to be working, according to the study's findings: Health Affairs data through 2005 found the 30 baht system moved toward universal coverage by adding 13.6 million previously uninsured people into the system, resulting in a coverage rate of 95.6%.
In addition, the vast majority of people covered under the 30 baht system pay nothing out of pocket for outpatient care, the study found.
As for the remaining 4.4%, the study's authors contend that lack of awareness, an absence of an identification card, and incorrect housing registration are all reasons for those left off of the rolls. One would hope that given the hype surrounding health reform in the U.S. and superior tracking systems, this would not be a problem if we ever get around to providing universal coverage.
But as the study's authors note, the expansion of government-financed health insurance programs face several potential problems. One is the emergence of informal, under-the-table payments collected by healthcare providers. Although these payments are illegal, they are often ignored by governments because they represent a source of additional financing to supplement subsidies offered by governments that may be trying to offer universal coverage but do not have the resources or political support to fund the program, say the study's authors.
"Such payments represent a large fraction of spending in some countries and are fairly widespread, especially in Asia," the authors say.
Another potential problem when rapidly expanding coverage to a large group of previously uninsured people is an immediate spike in demand despite a fixed supply of healthcare services—at least in the short term. This can lead to "queuing," the authors say, or lead to a reduction in access to care for those already in the system as well as those who recently joined it.
Thailand has avoided these problems, at least thus far, according to the study. There is no evidence that the informal, under-the-table payments seen in other Asian countries has arisen in Thailand, say the study's authors. Access to care also improved for the previously uninsured, while at the same time access does not seem to have decreased for those already in the system. Lastly, the authors note that the newly insured group has better access to care after the advent of universal coverage than it had before.
So how did Thailand avoid such problems? The authors suggest that one possibility was the country's use of the targeted payer payment system, which pays capitation directly to the clinics and hospitals that sign up to serve patients.
"This approach ensures that the funding goes directly to the facilities that have the most patients, providing them with incentives to sign up patients and the financial resources needed to add staff and other resources as needed," according to the study.
The authors admit that there were limitations to the study, and that quality of care, waiting times, satisfaction, and long-term sustainability were all dimensions of the program that need to be explored. But there is no doubt that in a few short years, Thailand has achieved what it set out to do: Provide comprehensive, affordable, quality healthcare to (virtually) all of the country's residents.
While the innumerable differences between the U.S. and Thailand health systems make it impossible for the U.S. to try to emulate Thailand's reforms, there are some lessons Americans can take from Thailand's ambitious program.
Opponents of Obama's lofty reform plans often cite they will result in socialized medicine and, as the Thailand study authors mentioned, the risk of inundating an already overly burdened healthcare system with the newly insured. But as the Health Affairs study shows, if the country has a clearly defined goal and buy-in from every aspect of the industry, it can be done.
The study also shows that it will take time—Thailand is much smaller than the U.S. and it took several years before it achieved near-universal coverage. Critical stakeholders in the U.S., as well as consumers, need to understand that the country's health reform will not happen overnight, and realize that an extended effort that will likely require adjustments will eventually benefit everyone involved by providing affordable, quality healthcare for all.
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The explosion of technologies that "connect" consumers online has shaped business models and created entirely new ways in which people network, socialize, and conduct business. E-mail, video conferencing, online retail, Google, LinkedIn, and YouTube have transformed our daily interactions with other people and the way we operate business. Ultimately, these same technologies will not only transform healthcare, but the way physicians and hospitals align to deliver care.
Consumers have demanded an enormous amount from the Internet in a short period of time. In the U.S. alone, online retail is estimated to have grown from virtually nothing a decade ago to over $130 billion a year. Consumers now routinely purchase products, pay bills, download statements, and make dinner or concert reservations online.
Although healthcare delivery has been slower to transform, many e-applications are in everyday. Among them are:
Live videoconferencing: Video and audio feeds over the Internet permit real-time communication among patients, attending providers, and consulting specialists. High resolution monitors, cameras, and broadband connections facilitate medical evaluations of patients by geographically dispersed practitioners, helping to alleviate access problems. Presently, this type of service is predominantly used by rural hospitals and clinics lacking specialty coverage. You can expect to see an increasing use of videoconferencing in clinic settings, nursing homes, emergency departments, and on acute-care patient floors, including intensive care units.
e-Interpretation services: Through the capture, storage, and forwarding of digital images and clinical data, local providers have access to specialty interpretations from remote specialists. This service is already common in specialties that rely on the review of images, such as radiology and dermatology. It is anticipated to expand to other services involving interpretations from images, including pathology, EKGs, echo-cardiograms, etc.
Patient direct e-Care: Originating from mail, telephonic, and e-mail-based technology, physicians offer consultative services directly to the patient. The services are provided through private organizations, hospitals, or through health plans with secured patient Web portals. Increasingly, the service will evolve to real-time clinical interactions using videoconferencing and electronic health records, especially as regulatory hurdles are reduced.
Remote patient monitoring: Home-based computers serve as devices to capture, trend, and transmit clinical data to healthcare professionals who monitor medical conditions of patients. Blood pressure, glucose levels, and weight changes are only a few measures that enable healthcare teams to respond quickly to clinical needs of the at-home patient. Expect to see usage of this technology expand in the home, but also in the hospital or skilled nursing settings. But what is the next phase? It is likely to focus more on the patient as consumer, with the aim of enabling hospitals and physicians to better communicate with their patients and deliver more efficient care.
Consumers will expect electronic delivery of healthcare advice and the ability to schedule services, access test results and reports, request refills, make inquiries, and dialogue with caregivers.
For certain conditions and patients, an entire episode of care may be electronic. It will include an e-inquiry into the primary care physician, followed by the medical issue identification question and answer process, to obtaining an e-consultation from a specialist, with relevant data transmitted back to the PCP and patient.
In addition to such transactions, online consumers will increasingly research the quality of providers. They will also want to socially network with their providers, either through medical blogs, online support groups, or social networking sites. Consumers will be comforted by watching YouTube-style videos of their providers performing the latest medical techniques and therapeutic applications. Healthcare providers without this virtual presence will suffer competitively.
As a result, applications such as community-oriented medical blogs, online support groups, video-based supplements, on-demand health advice, personal health records, and transactional applications will thrive. They will not only help to cement the bond between patient, physician, and hospital, but play an important role in broadening thinking regarding hospital and physician alignment strategies.
Moving forward, many alignment strategies will be a triad of hospital-physician-patient. They will be linked through systems designed to achieve clinically effective, efficient, informed, and safe care.
Recognizing this, Title XIII of the American Recovery and Reinvestment Act of 2009 (a part of the recently enacted stimulus bill) provides funding and incentives for the development, adoption, and upgrade of health information technology. The intent is to build a nationwide infrastructure that exchanges standardized health information, encourages the use of electronic health records, and trains clinicians on best practices.
As the options for "joint venture" types of hospital-physician alignment vehicles are defined through such legislation and regulation, taking ownership of the process to deploy these technologies presents an important opportunity to involve and align physicians and hospitals in a meaningful way.
The opportunity
The ability of the solo or small physician group to develop a comprehensive patient connectivity platform is relatively small. Therefore, it is incumbent for healthcare organizations to take proactive ownership of the process to build such platforms. In addition to serving as the foundation for a more highly integrated delivery system, the platform can reach out to patients and elevate their ties to both the healthcare organization and its individual clinicians.
Conceptually, the term "hospital-physician alignment" will give way to the term "hospital-physician-patient alignment," under which strategies and action plans are implemented to align the interest and needs of the hospital, physician, and the patient.
How these new affiliations mature will be just one component in a much larger strategy to reinvent healthcare delivery.
Steven A. Nahm is a vice president with the Camden Group, a hospital consulting firm in El Segundo, CA. He may be reached by e-mail at mailto:snahm@thecamdengroup.com.For information on how you can contribute to HealthLeaders Media online, please read our Editorial Guidelines.
The question of timing to get HITECH Act reimbursement is on everyone's mind for obvious reasons. On the one hand, the federal government is saying to hurry up to get the maximum reimbursement by Jan. 1, 2011. At the same time the government is also saying to wait until at least the end of the year before the regulations come to clarify what a "qualified EHR" or a "meaningful user" means. That has left many physician practices on the fence about when to make a move.
Dr. Jim Morrow, a family physician at North Fulton Family Practice in Atlanta, cut through the dilemma with some good old Southern straight talk at a crowded session on the stimulus money.
"If you want the money, pick you a vendor while you are here," Morrow says. "If you are going to be a meaningful user in 2011, the time to act is now."
Attorney Edward Shy says that with the regulations coming late in the year, "2010 will be a horse race" as vendors respond to RFPs to have physician practices up and running by 2011.
The fear among some in the industry is that even with the stimulus incentive, some physicians may still be reluctant to fully jump into EHR. Morrow, who says his practice saved more than $30 per patient visit when it digitized a decade ago, hopes his colleagues finally see the light.
"Now is the time for docs to quit crying and whining about electronic records. Now is the time to take advantage of this money because it is the most you'll ever see."
Health IT and healthcare reform
Congress is never short on creating complexity, but may just now be realizing how intricate any meaningful healthcare reform will be, especially under a deadline of July 31 to be done by the August recess. U.S. Rep Phil Gingrey (R-Georgia) points out that no fewer than three committees—Energy and Commerce, Ways and Means, and Education and Labor—will have to work concurrently.
"It's an awfully short period of time to get things done," Gingrey says. "How in the world can you get all that done and done right? We can't afford to make a mistake with 18% of our economy."
Gingrey said that if he had his choice, he would concentrate just on the IT equation. Former Wyoming Gov. Jim Gehringer, however, asked whether "we can have health IT without health reform?"
"Technology is a means to an end. Health reform is an overhaul. If we automate a bad system all we will get is a really fast bad system."
Gehringer says he expects the states to take up the cause of health reform in a way that has been unforeseen. Unlike past years, states like Minnesota and Indiana are taking up healthcare reform without politics playing a heavy role. The federal government's role will be to provide standards and leadership, he says.
Gingrey, an obstetrician by profession, says he hopes to push for incentives for doctors to spend time with patients on end-of-life care and advance directives, believing that even 45 minutes of honest conversation could provide care the patient wants and eventually save unnecessary care for Medicare.
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