FEEDBACK WK3

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I enjoyed reading your post. I particularly took notice of your comment “As a physician, I would rather concentrate on nurturing the patient’s healthcare needs and not have to focus on the insurance industry that could not address customer needs due to their socioeconomic status”. I think this comment foments a very interesting discussion about policy. The problem could be articulated as what healthcare system allows providers to focus on patient’s healthcare needs and not their socioeconomic status. I know from long experience as a provider and as a healthcare leader that the current largely fee-for-service environment incentivizes most healthcare workers to be very cognizant of economic issues such as the socioeconomic status of patients instead of being entirely devoted to what is in the best interest of any individual patient. When I was practicing at Daniel Freeman Hospital in Inglewood the number one prognosticator of whether a patient that was referred to me for an angioplasty as versus being operated on by the surgeon was whether they were a Medi-Cal patient or had commercial insurance. In the current healthcare system over 1 million patients are injured and nearly 100,000 die because of iatrogenic issues, nearly half of patients do not receive “best practice” treatment for their conditions, less than half of physicians use evidence-based algorithms of care, and as much as 40% of national healthcare expenditures are associated with “overuse, underuse, misuse, duplication, system failures, unnecessary repetition, poor communication, and inefficiency” (Committee on Engineering and the Health Care System, National Academy of Engineering, Institute of Medicine). In the policy stream, fee for service alternatives include accountable care organizations, patient centered medical homes, shared savings models, episodic or bundled payments, and partial capitation (Barnes, 2012). In my career, I have practiced in the fee-for-service environment, at the Veterans Administration, and at Kaiser. In my experience, the worst provider behavior has occurred in the fee-for-service environments whereas the best behavior has occurred in the environments where there is a complete separation between the provider’s income and the care that is provided. To be fair, I have personally observed the problem with insufficient care in the Veterans Administration and Kaiser environments. In the political stream many stakeholders cling to the idea that fee-for-service results in better care despite the fact that the United States is the most expensive healthcare system on the planet and has some of the worst healthcare outcomes as compared to other economically developed countries (Ginsberg & Amerling, 2015) (Squires & Anderson, 2015). Others call for an overhaul of the system (Barnes, 2012) (Committee on Engineering and the Health Care System, National Academy of Engineering, Institute of Medicine) (Squires & Anderson, 2015). Whereas the political window of opportunity opened up before the passage of the Affordable Care Act that that window has now substantially closed and devolved back to an environment of partisan gridlock (Escobido, 2015). However, there is some optimism that a continual presentation of the problems to policymakers along with effective policy solutions will continue to lead to change in policy agenda as it relates to the United States healthcare environment (Escobido, 2015).

Bibliography

Barnes, J. (2012, May Seven). Moving Away From Fee-for-Service. Retrieved June 26, 2016, from The Atlantic: http://www.theatlantic.com/health/archive/2012/05/moving-away-from-fee-for-service/256755/

Committee on Engineering and the Health Care System, National Academy of Engineering, Institute of Medicine. (n.d.). Building a Better Delivery System: A New Engineering/Health Care Partnership. (P. P. Reid, D. Compton, J. H. Grossman, & G. Fanjiang, Eds.) Washington DC, USA: The National Academies Press.

Ginsberg, P. B., & Amerling, R. (2015, March 22). Should the U.S. Move Away From Fee-for-Service Medicine? Retrieved June 26, 2016, from The Wall Street Journal: http://www.wsj.com/articles/should-the-u-s-move-away-from-fee-for-service-medicine-1427079653

Squires, D., & Anderson, C. (2015, October Eight). U.S. Health Care from a Global Perspective Spending, Use of Services, Prices, and Health in 13 Countries. Retrieved June 26, 2016, from The Commonwealth Fund: http://www.commonwealthfund.org/publications/issue-briefs/2015/oct/us-health-care-from-a-global-perspective