The business of healthcare becomes apparent to most individuals and families either annually through employer health plan choices, through the healthcare exchange plan selections, or most frequently, through actual healthcare utilization. Isn’t utilization the very reason we are insured?
The business of healthcare is further complicated by the ongoing public debate of governmental control versus private control.
Those arguing for government control contend that the majority of funding today to healthcare organizations and individual providers is from the federal and state level.
Those advocating for private control point to government bureaucracy and inefficiency.
Public advocates point to extreme salaries paid to pharmaceutical executives and not-for-profit executives as a reason for control of the healthcare delivery system.
This argument is countered through complicated justifications including healthcare rationing and onerous regulations as a reason to support the private model.
Polls indicate the majority of Americans believe the current hybrid system is broken. This becomes obvious when the insured use the system. For example, a simple “covered” preventative procedure can suddenly generate significant out of pocket expense if the preventative procedure determines the need for additional diagnostic studies.
Many families are forced to choose between healthcare services and dollars for daily living. A family plan requiring the first $15,000 to be the direct responsibility of the insured begs the question, is the family truly insured?
We can hope that a fix to our system is forthcoming. Will the solutions to our current public/private model arise from the public or private sectors?
Fixing the system will require a basic understanding of the issues and roadblocks to change. This will require a deep ability to relate to and ultimately address the core issues driving the status quo.
Given a requirement to understand the issues, is it possible for the government alone to fix the system when those decision makers are collecting government benefits?
Can a private market relate when its decision makers are not faced with the economic realities of the average consumer?
Will organizational governance lead through removing self-interest and local politics and focus on community needs, not personal needs?
These questions are certainly difficult to assess and the solutions can become equally elusive.
In a case of certainty, we know service industries are profitable when they allow quality, not cost, to drive their mission.
Michael Leavitt, former Secretary of Health and Human Services, addressed the need to start with a Lexicon for quality. He states, “Before we were forced to choose between economic leadership and our sense of compassion. If we allow this to happen in a way that lacks organization, it could take us 80 years. We may never accomplish it. But if we establish a set of standard definitions, and we create pathways for people to achieve competency, we can accelerate the velocity of our progress.”
The recently released Leapfrog Hospital scores indicate that once again only one organization in our two-county region achieved a Safety Score of A.
Given there is empirical evidence of high quality and safety leading to a profitable organization, we need to ask the question, who is profiting from our current model?