A solution for America's healthcare crisis

February 15, 2008

These steps can mend our healthcare problems.

Our healthcare system is in crisis, yet I believe we can make it work for everyone-patients, providers, and other stakeholders-if we eliminate inefficiency and waste. We can do this by designing a plan to spend money wisely; align the incentives of payers, patients, and providers; and restore trust between the parties. Here's what we need to start doing.

Keep what's good and fix what isn't. Insurance companies and Medicare aren't perfect. But they have the infrastructure to collect premiums and pay for services. They also have the ability to establish true medical quality guidelines and customer service guidelines, so that patients will have ready access to emergency and nonemergency care.

National healthcare expenses, and especially premiums for health insurance, have skyrocketed. We need to determine where this money went, so that we can learn to make efficient use of future revenues, and therefore increase access for the uninsured, poor, and underprivileged.

Create a "home" for each patient. We should incentivize caregivers to practice preventive medicine and patients to adopt healthier lifestyles. The first step is to create a secure home for the patient's health records. Second, each patient will have a primary care provider who isn't a gatekeeper in the traditional sense, but rather acts as the "gateway" to coordinate and facilitate care. This includes referring to specialists when appropriate and ordering necessary tests. Medical specialty societies, working with Medicare and insurance companies, can craft honest clinical guidelines regarding medical necessities.

Increase funding for nurses and mid-level providers. We need more "bedside" nurses, as well as more specialized nurse practitioners and physician assistants. Nursing education should get more financial support from the government. Having a sufficient number of these personnel will increase access, decrease cost, and maintain quality.

Offer tax credits and other financial perks. All health insurance premiums and healthcare costs-whether paid for by employers, employees, or the self-employed-should be tax deductible, or, even better, be eligible for a tax credit. Another solution is for self-employed people to form a healthcare purchasing consortium to spread the risk.

Manage the emergency room better. When patients overuse the ER, as they often do, it costs the system thousands of dollars in unnecessary charges. Waits in the ER can be lengthy, but that's often because patients have no other provider to turn to.

The emergency room should be divided into three sections: real emergencies, triage, and minor ailments. The most experienced doctor can staff the triage area; he or she can quickly and accurately decide which section the patient should go to. I've noticed that in some hospitals the triage unit is covered by a less experienced provider.

Also, some doctors refuse to cover ER calls. Through a system of pay for performance, however, doctors who provide ER services would-and should-receive higher reimbursements.

Do you have a strong opinion about a healthcare issue? Let us know. Post your comments below or respond via e-mail (meletters@advanstar.com
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