After following some of the presidential debates and looking for substantive answers to various issues, I thought I might help Senator Obama (and anyone else who will listen) with what I consider the principles that would comprise a rational federal health care plan. I say Senator Obama because Senator Clinton already had a go at it a few years ago and may have her own ideas.
The principles could be as few as five or as many as twenty-six. I have come up with seven principles as a framework that can be used as a "fill in the blanks" type of document to include specifics within each principle.
The first principle is access. Within this principle would be the development of primary care, ambulatory care and mental health facilities.
It would also incorporate an interesting public sector health-care concept from AMSA that "the use…when possible by publicly elected officials as an incentive toward upkeep of the public health system." It ratchets up the "mayor take the bus to work" idea in a big way.
Quality Management is second. This principle would address disparities (racial/ethnic/ gender analysis, disability) and enhance Medicare’s Pay 4 Performance (P4P) guidelines since incentives seem to work. The participation of politicians in the public health care system might also have an impact on quality of care.
Cost effectiveness/cost containment would be third. Surprisingly I would include health literacy in this principle (targeting both the general public as well as all health care professionals) since, according to the Journal of Allied Health “inadequate health literacy adversely affects health care outcomes and the quality of life of 90 million Americans and costs the health care system $73 billion annually”. Further “according to the Centers for Disease Control and Prevention, in 2000 the leading causes of death in the United States were heart disease, cancer, stroke, chronic respiratory disease, unintentional injuries, and diabetes. The most common actual causes, however, were tobacco, poor diet and physical inactivity, alcohol consumption, microbial agents (e.g., influenza), toxic agents (e.g., pollutant), motor vehicle accidents, firearms, sexual behavior, and illicit use of drugs.” Journal of Allied Health. This says to me that the focus on chronic disease and its drain on health dollars might best focus on behavioral change in future generations. Of course, to change our behavior is a gargantuan task yet the outcomes would be positive and immeasurable.
Continuity of Care is fourth. This principle would incorporate such items as prescription drugs and electronic medical record.
Constituent Participation. This principle would incorporate programs in patient education and behavioral change, and in fact, mandatory participation in these programs would be criteria for receiving health care.
Patients’ Rights is a necessary sixth principle. This principle would incorporate the right to health as a civil right along with portability and privacy.
Healthcare Sector Workplace employment is seventh. Though not a principle of direct care, the looming shortage of physicians, nurses and allied health professionals makes all of the principles moot if there is no one to care for patients; and in fact it makes patients’ responsibility for behavioral change even more important.
Hopefully this can provide a succinct foundation for the politicians, since healthcare seems to be a second-cousin to moral values, the economy, terrorism and military intervention abroad.
Hawai’i Health Performance Plan – State Health Planning and Development Agency.
Journal of Allied Health. Volume 33, Number 2, Summer 2004, pp. 150-155(6).
Journal of Allied Health. The Future of Health Care in the United States. April 3, 2007.
AMSA (American Medical Student Association). Principles Regarding Health-Care Delivery and Delivery Systems. May 7, 2007.
About the Author
Dr. Flippin brings a wealth of experience, starting with her long tenure as an attending physician at the Cook County Hospital Emergency Department. She is currently Corporate Compliance and HIPAA Privacy Officer at major Chicago hospital.