Many medical professionals and politicians looking toward alternative methods of providing health care are finding examples of communities within the US and in the developing world that have been able to give quality care without skyrocketing costs.
A June article in the New Yorker by Atul Gawande, which is reportedly required reading at the White House, examines the costs of health care by looking at the most and least expensive health-care markets in the US. In particular he studies McAllen, Texas, which has one of the highest costs of medical care per person in the country, and Rochester, Minnesota (home of the Mayo Clinic), which has among the lowest. Rochester also provides some of the best quality health care in the nation. Gawande’s findings led him to conclude that the Mayo Clinic system, which pays doctors an annual salary to keep them from treating their practices like “profit centers”, and emphasizes a peer-review process to improve quality of care, are the best hope for improving American health care. This requires breaking the “untenably fragmented, quantity-driven” systems that are becoming the norm in US medical care.
Gawande notes at the end of his piece that the decisions that need to be made about America’s health care system are greater than the public versus private insurance debate; rather, they involve a total reorganization of the health system. Enacting the principles already in place in the lowest-cost, highest-quality medical institutions in the country – removing any financial incentive for doctors to order unnecessary procedures and taking collective responsibility for patients – require a significant reordering of our priorities.
Others are also looking outside of the political discussions that focus on either “raising taxes or cutting care,” instead seeing a better way: “redesign.” Medical professionals from ten communities across the country with below average health spending and above average health outcomes recently traveled to Washington DC to discuss how changes they have implemented have lowered cost without reducing quality. Gawande, one of the meeting’s organizers, explained that change in these communities occurred quickly, as “[h]alf of these communities used to be high cost and transitioned to low cost over the last decade,” suggesting that national reform is also possible.
The meeting, organized by the Institute for Healthcare Improvement, allowed professionals from low-cost, high-quality hospital groups to exchange ideas about cutting costs and preventing unnecessary care. For example, physician groups in Everett, Washington were combined and two hospitals were merged while health coaches counseled healthcare workers to smooth admission and discharge practices. A health group in La Crosse, Wisconsin, has focused on working with elderly patients to create advanced directives, a crucial component of end-of-life care that can also help lower healthcare costs significantly. These methods, along with a shift to electronic medical records, improvement in health care data collection and better coordination among providers, were among the most common steps cited by medical groups seeking to restrain expenses.
Similarly, health care practitioners in Birmingham, Alabama studied a health program in Zambia to create their own AIDS clinic based on the Zambian model. At this clinic, called “Project Connect,” patients receive appointments in five days or less after calling, and social workers interview all patients to address issues that might make it difficult for a patient to return for follow up appointments. Another example is the Prevention and Access to Care and Treatment Program, a community-based project that uses community health workers to assist HIV/AIDS patients in staying adherent to treatment. The program, modeled on work begun in Haiti under Partners in Health, has been adopted for use in inner-city Boston and is expanding to include New York City and Miami.
Mark Dybul, the former US Global AIDS Coordinator, explains why methods of care in poorer nations are now receiving greater attention: “We learned from Africa that in a very resource-limited setting, you can do very effective chronic care delivery that doesn’t have to be overmedicalized.” With much of the debate on health care reform focusing on lowering expense, it appears that these cost-effective programs from the developing world will become more popular to US health care providers.
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