MANAGED CARE January 2004. ©MediMedia USA
HEALTH PLAN 2009
Former Speaker of the House Newt Gingrich is the founder of the Center for Health Transformation (www.healthtransformation.net [1]) and the author of Saving Lives & Saving Money.
The dominant model of the 21st century will be more choices with better quality at lower cost. This is already true in nearly every segment of the market and it is what the American consumer over the last decade has come to expect. However, in health care this market dynamic is absent.
Over the next quarter century, we will see as many technological and scientific advances as we did over the last hundred years, especially in health. Despite this, plagued by lack of quality systems, health care delivery has fallen woefully behind the trend toward innovation.
Consumers regularly use technologies that they take for granted. For example, when they use an automatic teller machine, an online bill paying service, Internet travel reservations, and even self-serve gasoline pumps, consumers have come to expect the high level of efficiency and accuracy that these expert systems routinely deliver.
Yet, at the doctor's office, patients are still handed paper prescriptions and almost no one has a single comprehensive electronic medical record. In fact, most people are likely to have multiple and probably forgotten paper medical records in any number of different offices and hospitals.
The technology for electronic prescriptions and medical records already exists and is being used successfully by a limited number of providers. Some hospitals are now using bar codes to ensure patient safety and will in fact save lives and money. But notice that this technology has been familiar to consumers for nearly two decades and still, despite the proven outcomes, it has yet to be deployed systemwide.
In fact, the application of numerous expert systems to health care could save numerous lives and billions of dollars. It is difficult not to conclude that the resistance to change is simply cultural.
A failed third-party-payer system has been at the heart of this problem. Fortunately however, the recent Medicare law signed by President Bush will begin to change this cultural dynamic. Health Savings Accounts (HSAs) that were included in the law represent the most important first step.
Because individuals will own these accounts and because they can accumulate earnings tax-free from pre-tax contributions, owners of HSAs have a real incentive to not only stay healthy but also to make better choices as consumers of health care.
Because insurance usually does not cover cosmetic and laser eye surgery, the consumer must pay the full cost of these procedures. The result is that consumers actively compare quality and price when choosing a provider. The consequence is that while health care costs have skyrocketed, cosmetic surgery costs have stayed below the consumer price index and laser eye surgery costs have fallen nearly 30 percent since being made widely available.
We need to employ the same market dynamics in health care so that not only would the industry be responsive to the patient, but the patient takes control of and responsibility for his own health by actively participating in his treatment options and making the choices to stay healthy in the first place.
But to make those decisions, patients will demand more information. What will be most important to educated health care consumers will be patient safety. Any political or legislative action will have to be implemented within this standard.
Therefore, it will be necessary for providers to develop expert systems to meet the safety standards required by consumers. That system will allow a patient to own and control his own electronic health record, enabling both patients and providers to access accurate and timely information about best practices so that they can jointly decide on treatment options likely to have the best outcomes while ensuring patients' personal privacy. Such a system would make electronic prescriptions and hospital order entry systems the industry standard.
If properly designed, the system will eventually migrate toward setting the innovation trend rather than trailing it.