Discussions on health care reform are usually concerned about access to medical care. There has been little or no media coverage for concerns about the overall effectiveness of the U.S. health care system, which has long been assumed to be the best in the world.
Nevertheless, serious questions continue to be raised about the quality of care provided. Concerned scientists have done all they can through scientific publications to bring about long-overdue upgrades for health care systems in the U.S. and elsewhere. Now, to initiate the required changes, these facts and findings published by scientists worldwide must be presented to the public more directly. A huge information gap maintains the disparity between the health care established for the general public and some of the real health care solutions available only to the well-informed.
The U.S. National Institutes of Health (NIH) addresses the information gap through the NIH National Center for Complementary and Alternative Medicine (http://nccam.nih.gov) and the NIH Office of Dietary Supplements (http://ods.od.nih.gov). However, these efforts are patterned after outdated medical concepts of health and disease. Comparisons between some natural versus pharmaceutical methods for the treatment of disease have limited impact on fundamental health care practices.
Many scientists point to alarming deficits in the delivery of health care in light of accumulated scientific knowledge. These deficits are particularly troublesome for chronically ill populations that depend heavily on medical care. It is time to initiate real health care system improvements, beginning with widespread public awareness of basic facts that can help people discover effective health care solutions for improved health.
Some facts and findings quoted from biomedical journal abstracts include the following:
The U.S. health care system is deteriorating in terms of decreasing access, increased costs, unacceptable quality, and poor system performance compared with health care systems in many other industrialized Western countries. (Geyman 2003)
Over the past three decades, evidence has accumulated that demonstrates that the US healthcare system as currently structured is untenable given the cost of healthcare, poor outcomes associated with this cost, imminent shortages in many categories of health professionals, and underutilization of other health professionals. (Kreitzer, Kligler, and Meeker 2009)
Recognizing fundamental flaws in the fragmented US health care systems and the potential of an integrative, generalist approach, the leadership of 7 national family medicine organizations initiated the Future of Family Medicine (FFM) project in 2002. The goal of the project was to develop a strategy to transform and renew the discipline of family medicine to meet the needs of patients in a changing health care environment. (Martin, Avant, et al. 2004)
It is concluded that in many cases public health will have to be reorganized as will the health care system as a whole. Health must be viewed as a social project linked to political responsibilities not as a medical enterprise. (Kickbusch 1986)
Not only must providers be able to provide high-quality acute and chronic care, but they must also begin to focus more heavily on programs of prevention. Value is created throughout the system through reducing the prevalence and incidence of disease. ... Outcomes must not only be compared to best practices, but to what is possible. (Beveridge 1997)
Challenging issues that must be faced include (1) the need to develop successful strategies to incorporate information about CAM [Complementary and Alternative Medicine] into already dense health professions school curricula, (2) the need for conventional health professionals to have authoritative resources to provide their patients information about risks and benefits of CAM practices, and (3) the need to identify appropriate roles for CAM practitioners in educating conventional health professionals about CAM therapies. (Pearson, Chesney, et al. 2007)
Evidence-based practice merges the best and most relevant clinical research data with clinician experience, pathophysiology of disease state, and the specifics of individual patient care. Currently, there is a significant gap between the best research evidence in healthcare and application of this evidence to clinician practices. (Hise, Kattelmann, and Parkhurst 2005)
Medical educators are facing a challenge today that is quite analogous to that addressed by Abraham Flexner, namely how to transform a legacy system of education that is no longer preparing future physicians adequately to meet contemporary expectations and responsibilities. (Cohen 2011)
Abstract:Medical educators are facing a challenge today that is quite analogous to that addressed by Abraham Flexner, namely how to transform a legacy system of education that is no longer preparing future physicians adequately to meet contemporary expectations and responsibilities. In facing up this challenge, however, today's educators not only must equip students to deal effectively with the rapidly changing paradigms in health care and medical practice, they also must adapt their curricula and pedagogical methods to the demanding new paradigms of medical education. Their success in addressing these dual imperatives will determine whether the educational transformations currently underway will have as momentous an effect on the public's health as did those stimulated by Flexner a century ago.
Perspectives in Biology and Medicine. 2011; 54(1):61-7.
Jordan J. Cohen
PubMed ID # 21399384
Value is created through the delivery of high-quality, cost--effective healthcare services. The ability to create value from the providers' perspective is facilitated through the development and implementation of essential, customer-focused core competencies. These core competencies include customer relationship management, payer/provider relationship management, disease management, outcomes management, financial/cost management, and information management. Customer relationship management is the foundation upon which all core competencies must be built. All of the core competencies must focus on the needs of the customers, both internal and external. Structuring all processes involved in the core competencies from the perspective of the customer will ensure that value is created throughout the system. Payer/provider relationship management will become a crucial pillar for healthcare providers in the future. As more vertical integration among providers occurs, the management of the relationships among providers and with payers will become more important. Many of the integration strategies being implemented across the country involve the integration of hospitals, physicians, and payers to form accountable health plans. The relationships must be organized to form "win/win" situations, where all parties are focused on a shared vision of creating value and none of the parties benefits at the expense of the others. Disease management in creating value requires that we begin examining the disease process along the entire continuum. Not only must providers be able to provide high-quality acute and chronic care, but they must also begin to focus more heavily on programs of prevention. Value is created throughout the system through reducing the prevalence and incidence of disease. Only through managing the full continuum of health will value be created throughout the healthcare delivery system. Outcomes management ensures that the outcomes are the highest quality at a cost-effective price. Outcomes must not only be compared to best practices, but to what is possible. Providers must constantly strive to enhance the quality of the services. Financial/cost management ensures that care is cost-effective and that a marginal profit is maintained to allow continued investment in new technology and continuing medical education to enhance the quality of care and lifestyles for all stakeholders. Information management is the binding element, or keystone, in providing value-focused care. Through the collection, storing, transfer, manipulation, sorting, and reporting of data, more effective decision-making can occur. Integrated MIS allows information to be generated about the cost-effectiveness of treatment regimens, employee productivity, physician cost-effectiveness, supply utilization, and clinical outcomes, as well as patient information to be readily available throughout the healthcare system. Having this information available will allow providers to become more cost-effective in the delivery of care, which results in perceived higher value for the services. Customers demand value. Value is created by meeting the needs and demands of the customers through the delivery of cost-effective, high-quality healthcare services that are easily accessible and meet with high patient satisfaction. Providers who can demonstrate their ability to provide the services in this manner will create a competitive advantage in the marketplace and will be perceived as the value provider of choice by loyal customers.
The Journal of Oncology Management : The Official Journal of the American College of Oncology Administrators. 1997 Nov-Dec; 6(6):16-23.
R. N. Beveridge
Richard Beveridge & Associates, Salt Lake City, UT, USA.
PubMed ID # 10174597
Evidence-based practice merges the best and most relevant clinical research data with clinician experience, pathophysiology of disease state, and the specifics of individual patient care. Currently, there is a significant gap between the best research evidence in healthcare and application of this evidence to clinician practices. Consistent with this finding, nutrition support is not always applied effectively or consistently, despite available scientific evidence that could be used to enhance a given treatment protocol. Cited obstacles that prevent the incorporation of research evidence into daily practice include lack of time, inadequate research skills, and information overload. Identification and application of the most valid primary research and evidence summaries (clinical guides to practice and meta-analyses) should, however, be an integral part of appropriate nutrition care. Consequently, it is important that clinicians develop and improve upon the basic skills required to allow efficient and accurate searches and evaluations of the literature. This review describes the basic and practical components of evidence-based medicine and provides tools to determine whether current nutrition practices are based upon an analysis of valid clinical evidence or anecdotal nutrition traditions and myths.
Nutrition in Clinical Practice : Official Publication of the American Society for Parenteral and Enteral Nutrition. 2005 Jun; 20(3):294-302.
Mary E. Hise, Kendra Kattelmann, and Melissa Parkhurst
The University of Kansas Medical Center, Department of Dietetics and Nutrition, Kansas City, KS 66160-7250, USA. mhise@kumc.edu
PubMed ID # 16207666
BACKGROUND
Recognizing fundamental flaws in the fragmented US health care systems and the potential of an integrative, generalist approach, the leadership of 7 national family medicine organizations initiated the Future of Family Medicine (FFM) project in 2002. The goal of the project was to develop a strategy to transform and renew the discipline of family medicine to meet the needs of patients in a changing health care environment.
METHODS
A national research study was conducted by independent research firms. Interviews and focus groups identified key issues for diverse constituencies, including patients, payers, residents, students, family physicians, and other clinicians. Subsequently, interviews were conducted with nationally representative samples of 9 key constituencies. Based in part on these data, 5 task forces addressed key issues to meet the project goal. A Project Leadership Committee synthesized the task force reports into the report presented here.
RESULTS
The project identified core values, a New Model of practice, and a process for development, research, education, partnership, and change with great potential to transform the ability of family medicine to improve the health and health care of the nation. The proposed New Model of practice has the following characteristics: a patient-centered team approach; elimination of barriers to access; advanced information systems, including an electronic health record; redesigned, more functional offices; a focus on quality and outcomes; and enhanced practice finance. A unified communications strategy will be developed to promote the New Model of family medicine to multiple audiences. The study concluded that the discipline needs to oversee the training of family physicians who are committed to excellence, steeped in the core values of the discipline, competent to provide family medicine's basket of services within the New Model, and capable of adapting to varying patient needs and changing care technologies. Family medicine education must continue to include training in maternity care, the care of hospitalized patients, community and population health, and culturally effective and proficient care. A comprehensive lifelong learning program for each family physician will support continuous personal, professional, and clinical practice assessment and improvement. Ultimately, systemwide changes will be needed to ensure high-quality health care for all Americans. Such changes include taking steps to ensure that every American has a personal medical home, promoting the use and reporting of quality measures to improve performance and service, advocating that every American have health care coverage for basic services and protection against extraordinary health care costs, advancing research that supports the clinical decision making of family physicians and other primary care clinicians, and developing reimbursement models to sustain family medicine and primary care practices.
CONCLUSIONS
The leadership of US family medicine organizations is committed to a transformative process. In partnership with others, this process has the potential to integrate health care to improve the health of all Americans.
Annals of Family Medicine. 2004 Mar-Apr; 2 Suppl 1:S3-32.
James C. Martin, Robert F. Avant, Marjorie A. Bowman, John R. Bucholtz, John R. Dickinson, Kenneth L. Evans, Larry A. Green, Douglas E. Henley, Warren A. Jones, Samuel C. Matheny, Janice E. Nevin, Sandra L. Panther, James C. Puffer, Richard G. Roberts, Denise V. Rodgers, Roger A. Sherwood, Kurt C. Stange, Cynthia W. Weber, and Future of Family Medicine Project Leadership Committee
Family Practice Residency Program,CHRISTUS Santa Rosa Health Care, San Antonio, Tex, USA.
PubMed ID # 15080220
Over the past three decades, evidence has accumulated that demonstrates that the US healthcare system as currently structured is untenable given the cost of healthcare, poor outcomes associated with this cost, imminent shortages in many categories of health professionals, and underutilization of other health professionals. The system also faces other challenges, such as the lack of access to care and a growing demand by consumers for healthcare that offers choice, quality, convenience, affordability, and personalized care. Workforce analyses estimating needs and anticipated shortages of health professionals are projected on the current healthcare system, which generally does not include integrative healthcare and does not include complementary and alternative medicine (CAM) practitioners. This paper examines the opportunities and implications of going beyond the current paradigm of workforce planning and health professions education and offers recommendations that detail how the health of the public may be served by incorporating an integrative health perspective into health professions education and workforce planning, deployment, and utilization.
Explore (New York, N.Y.). 2009 Jul-Aug; 5(4):212-27.
Mary Jo Kreitzer, Benjamin Kligler, and William C. Meeker
Center for Spirituality and Healing, Minneapolis, MN, USA.
PubMed ID # 19608111
The first part of this paper reviews the work of the World Health Organization's Regional Office for Europe undertaken to clarify the relevance of health promotion for all member states and regions. This work led to a definition of "health" as the ability to realize aspirations and satisfy needs and to change or cope with the environment. Health promotion was considered to 1) involve the population as a whole in the context of everyday lives, 2) be directed towards action on the determinants of health, 3) combine diverse but complementary methods or approaches, 4) aim for effective and concrete public participation, and 5) involve health professionals. Areas covered by health promotion activities include 1) access to health, 2) development of an environment conductive to health, 3) strengthening of social networks and social supports, 4) promoting positive health behavior and appropriate coping strategies, and 5) increasing knowledge and disseminating information. The next section of the paper traces the development of the concept of health promotion from its roots in health education, and the third section presents a brief history of public health to contextualize this development. The differences between the old and new approaches to public health are presented (the new role of the health sector is to ensure access to health, create advocacy for health, and move beyond health care through intersectoral action and public participation), and the new "forcefield" of public health that emerges from a conceptualization of health promotion is described. This forcefield, illustrated as a triangle linking healthy public policy, health promotion, and community action, works at all levels and is the framework for the development of appropriate strategies. It is concluded that in many cases public health will have to be reorganized as will the health care system as a whole. Health must be viewed as a social project linked to political responsibilities not as a medical enterprise.
Canadian Journal of Public Health. Revue Canadienne de Santé Publique. 1986 Sep-Oct; 77(5):321-6.
I. Kickbusch
PubMed ID # 3791112
Abstract:Medical educators are facing a challenge today that is quite analogous to that addressed by Abraham Flexner, namely how to transform a legacy system of education that is no longer preparing future physicians adequately to meet contemporary expectations and responsibilities. In facing up this challenge, however, today's educators not only must equip students to deal effectively with the rapidly changing paradigms in health care and medical practice, they also must adapt their curricula and pedagogical methods to the demanding new paradigms of medical education. Their success in addressing these dual imperatives will determine whether the educational transformations currently underway will have as momentous an effect on the public's health as did those stimulated by Flexner a century ago.
Perspectives in Biology and Medicine. 2011; 54(1):61-7.
Jordan J. Cohen
PubMed ID # 21399384
The U.S. health care system is deteriorating in terms of decreasing access, increased costs, unacceptable quality, and poor system performance compared with health care systems in many other industrialized Western countries. Reform efforts to establish universal insurance coverage have been defeated on five occasions over the last century, largely through successful opposition by pro-market stakeholders in the status quo. Reform attempts have repeatedly been thwarted by myths perpetuated by stakeholders without regard for the public interest. Six myths are identified here and defused by evidence: (1) "Everyone gets care anyhow;" (2) "We don't ration care in the United States"; (3) "The free market can resolve our problems in health care"; (4) "The U.S. health care system is basically healthy, so incremental change will address its problems;" (5) "The United States has the best health care system in the world"; and (6) "National health insurance is so unfeasible for political reasons that it should not be given serious consideration as a policy alternative." Incremental changes of the existing health care system have failed to resolve its underlying problems. Pressure is building again for system reform, which may become more feasible if a national debate can be focused on the public interest without distortion by myths and disinformation fueled by defending stakeholders.
International Journal of Health Services : Planning, Administration, Evaluation. 2003; 33(2):315-29.
John P. Geyman
Department of Family Medicine, University of Washington, Seattle 98195-4696, USA. jgeyman@u.washington.edu
PubMed ID # 12800889