Dr. Pankaj Gupta practices Geriatric Medicine in New York, New York. Geriatricians prevent, manage, and develop care plans that address the special health problems of the elderly. Dr. Gupta works as part of a team with other healthcare providers, to address the natural aging that goes on within the body and to manage multiple... more
The current healthcare system in America is fundamentally flawed. At the core of the health care system lies a perverse incentive to reward a high volume of services. This, in turn, can lead to more physician visits, which may lead to more procedures and tests, which could lead to more complications, and consequently may lead to more hospitalizations. We must replace this system with one that rewards for patient outcomes. In order for us to realize this, physicians need to change their behavior and people need to change the way how they perceive their own health.
Making this transformation in behavior requires a tectonic shift in the way how we (the end users of the healthcare system) view our own health in this country. Is health a human right that is paid for by someone else? Is health a privilege enjoyed by the wealthy who can afford it? Or is health a state of wellness with ownership and responsibility shouldered by oneself?
Before we answer these questions, we must define what do we want out of the healthcare system. Is the goal to create a “treat me now” mindset? I argue “no” - this is the current state of affairs and is costly and is unsustainable. Is the goal to increase access to care? I argue “maybe” - provided that increasing access to care yields better outcomes instead of increasing profits on increasing volume of services. Is the goal to help the end user on maintaining good health? I argue “yes” - a healthier person is more productive and creates less strain on the limited and expensive healthcare resources.
But do people have the tools to lead a healthier life? Over the last 12 years, as a practicing physician and a Medical Director of national and regional managed care organizations, I have seen several patients and members of the health plan constantly going to the emergency room to seek care. Once in the emergency room, either the patient gets admitted to the hospital or they get sent home with a packet of pre-printed esoteric forms describing their emergency room visit. The people are not to be blamed for using the emergency room; they are sick and they need care. Who is to blame?
We, the practicing physicians and the managed care organizations, are to blame. The people look to us to help them lead a healthier life and to help them navigate the maze we call our current healthcare system. In a New England Journal of Medicine article, Dr. Schroeder stated, “The single greatest opportunity to improve health … lies in personal behavior.” N Engl J Med 2007; 357:1221-1228. The patients should seek our guidance in adopting the behaviors that will impact their health and we, in turn, should provide them with the right tools for them to lead a healthier life.
Collectively, the practicing physicians and managed care organizations need to educate the end users of the heath care system on the personal behaviors that would delay progression of chronic diseases and we need to teach our patients when and where to seek care. The ability to obtain and understand health information in order to make an informed health decision is known as health literacy.
We are here to help. Health insurance organizations are not only in the business of reviewing claims, but also they are in the business of promoting wellness. The promotion of wellness includes managing chronic conditions, helping to navigate the healthcare maze, and helping to provide the right services at the right time. Health insurance companies must partner with practicing physicians to promote wellness.
According to the US Department of Education paper in 1993, nearly nine out of ten adults may lack the skills needed to manage their health and prevent disease. Fourteen percent of adults have Below Basic health literacy.
Low health literacy is a major economic inefficiency in the healthcare system. In fact, according to a paper Low Health Literacy: Implications for National Health Policy by the National Network of Libraries of Medicine, the dollar savings that could be achieved by improving health literacy is more than one-third the Medicare budget.
My plea to the physicians and to the managed care organizations is not only to provide and oversee “treat me now” care, but also to encourage healthy behaviors, empower patients to lead healthier lives, and to enhance wellness programs that increase health literacy among the population.
Pankaj Gupta, MD MBA
Geriatrician and Medical Director EmblemHealth, NYC