Experts Describe Health System In Search of New Direction

Health care costs are rising, and the economy is staggering. Consumers are complaining and health care professionals are rebelling. Very few people any longer express confidence in the capability of managed care to solve cost or quality problems.

That complicated picture of a health care system in flux emerged from panel presentations at “Emerging Health Care Market Trends,” a conference sponsored by the Center for Studying Health System Change (HSC) in December (see Original article: story on page 9).

In the conference’s keynote speech, Janet Corrigan, director of the Board on Health Care Services at the Institute of Medicine, said, “We see a lack of real clear direction for health system change.” All we see is “knee-jerk policy making. . .that responds to the emergency of the day or the need to contain costs rapidly.”

Problems are exacerbated by conflict and mistrust between key stakeholders in the health care system and the failure of the “whole national experiment with managed care” to live up to expectations, Corrigan stated. Managed care strategies relied more on a stick than a carrot approach and were viewed by clinicians and patients as attempts to control cost, rather than to improve quality.

Corrigan found two key lessons in the experience of the last 10 years. “[To] achieve real widespread change in the health care sector, the metric must include quality, in addition to cost.” Without information on quality of care, consumers and others will always assume that the steps being taken to control costs are detrimental to quality.

But, Corrigan noted, “[T]here is a sizable body of literature that substantiates [the idea] that for some types of quality shortcomings, we can decrease costs and improve quality.” Improvements of quality that target medical errors and overuse of services would lead to slower increases in health care expenditures, she said.

System Overhaul Needed

The second lesson is that “the change strategy must address fundamental overhaul of the delivery system.”

The efforts to redesign the system during the last 10 years did not include building an information infrastructure to support health care delivery or encouraging clinicians to form multidisciplinary teams.

Corrigan noted that in the mid-1960s about 100 articles were published annually that reported results of randomized clinical trials. Today, that number is more than 10,000 and continues to grow. An infrastructure that would enable clinicians to sift through that information is lacking.

Corrigan expressed hope for a future with “innovative delivery system models, much more extensive use of e-health delivery options, and an information-rich environment that would provide active support to patients, their families, and clinicians when they make treatment decisions and to legislators and regulators when they make decisions about policy.”

New Organizations Forming

Discontent about the problems with the health care system is resulting in the formation of several new organizations that address the problems identified by Corrigan and other health care analysts.

A front-page story in the Wall Street Journal on December 17, 2001, reported that these new organizations are “intent on rekindling serious discussions over the future of the health care system and on coming up with workable solutions to its refractory problems.”

Among them are the Center for Practical Health Reform (CPHR), which states that one of its goals is to “restabilize and improve health care delivery and finance through increased access, establishment of standards, introduction of accountability, and upgrading of well-understood mechanisms for all stakeholders.”

The CPHR’s advisory panel includes Harris Berman, M.D., CEO of Tufts Health Plan; John Burns, M.D., former chair of the Washington Business Group on Health; George Lundberg, M.D., former editor in chief of the Journal of the American Medical Association; and other leaders in the health care field.

Former senators Bill Bradley and David Durenberger have signed on as spokespersons for America’s HealthTogether. That organization will promote a national dialogue that will seek consensus and “real-life solutions” to the problem of providing access to quality health care.

Another new organization, the American Health Initiative, plans to “involve the nation in a strategic conversation intended to provide the direction and the political will necessary for establishing a quality health care system that assures every American equitable, affordable access.” Lundberg is its honorary chair.

The Web site for the Center for Studying Health System Change is www.hschange.org; the Web site for the Center for Practical Health Reform is www.practicalhealthreform.org; the Web site for America’s HealthTogether is www.healthtogether.org; and the Web site for American Health Initiative is www.americanhealthinitiative.org. ▪