"I am a first grade teacher in a very poor neighborhood in
North Philadelphia...Many of [my students] have never seen a
family physician; many have never even been inside a public
health clinic. I was shocked to find that eight out of ten of
their absence notes are written by doctors in the emergency room
of nearby hospitals...I feel bad for my students who have never
had an ounce of preventive medicine, but I feel angry, as do many
of my middle-income peers, who are ultimately footing the bill
for the emergency treatment these children are driven to."
J.G.
Philadelphia, PA
________________________
In many parts of our nation, for many patients, the quality
of health care is unparalleled anywhere in the world. The United
States boasts the best technology, the most advanced research,
and the greatest number of medical breakthroughs of any advanced
nation. When it comes to quality, we have a great deal to be
proud of. The Health Security Act protects and improves the high
standards we have set for American medicine.
But the quality of our health care is uneven, and threatened
by serious flaws in the way we measure and report on which health
care treatments should be used and which work best. No clear
standards define what is the best medical practice; lack of
information compromises the care people get; and inadequate
attention to preventive care reduces the effectiveness of
treatment and services.
The Health Security Act includes specific provisions to make
sure that the high-quality health care delivered in some parts of
our country spreads to other areas, and becomes the standard
nationwide.
This Act takes steps to arm doctors, hospitals, and health
plans with the latest information on state-of-the art treatments
and their effectiveness, and arm consumers with information to
help them compare the quality of plans.
It measures quality and accountability, focusing on results
rather than micromanagement and filling out forms.
It increases funding for health care research to keep
American health care and technology state-of-the-art; and it
improves health and wellness through unprecedented coverage of
preventive care and steps to build a better health care
workforce.
BETTER INFORMATION FOR JUDGING QUALITY
Without the information they need to reward high-quality
plans with their business, consumers are powerless to force
health plans to compete.
Researchers and panels of health professionals have
developed new ways to measure the results of different treatments
and what type of care and treatment works best. A number of
medical professional groups have participated in extensive
efforts to develop guidelines for effective medical care for
specific conditions and illnesses. The Health Security Act will
promote greater sharing and use of information, helping more
practitioners benefit from the results.
Many programs around the country have begun using the new
approaches to quality, building on better and more available
information. Business groups are now joining with doctors,
hospitals and health plans to publish information about
comparative quality and price. In communities from Nashville,
Tennessee to Rochester, New York, and in the state of
Pennsylvania, major employers, local hospitals and state
governments have begun collecting information that allows
businesses and consumers to make valid comparisons among
hospitals and physicians.
Under the Health Security Act, American consumers will
benefit from greater access to information, which in turn will
further improve quality. They will exercise not only the right
to choose doctors, other health providers and health plans, but
also the right to make informed choices based on meaningful
information about how health plans, health professionals and
hospitals perform.
Annual performance reports provided by health alliances will
survey consumers and measure how their health plans, doctors and
hospitals perform on a set of four critical indicators:
* Access: whether care is readily and quickly available;
* Appropriateness: whether care fits the condition;
* Outcome: whether treatments produce good results; and
* Consumer satisfaction.
These information "report cards" will compare health plans
and providers, reporting how various plans performed on
carefully selected indicators. Researchers know that certain
medical indicators provide clues about overall performance: How
many children with asthma in this plan ended up in the hospital
last year? How many older people who suffered a fall didn't
recover their ability to walk? How many patients who suffered
heart attacks survived? On the simplest level: How many patients
didn't like this plan and chose another?
Performance reports based on these types of indicators will
prove valuable to consumers and health professionals. When
choosing a plan or providers within a plan, consumers will be
able to judge whether they can expect prompt access to treatment,
how the care stacks up against competitors, and what other
consumers think about the plan. Merely making this information
available will force plans and providers to focus on quality.
A reformed health care system that emphasizes accountability
can improve the quality of health care, improve safeguards for
patients and reduce bureaucratic regulation.
The Health Security Act will replace the outmoded system for
measuring quality in practice today, where government bureaucrats
and insurance companies second-guess decisions made by doctors
and their patients. In its place will be a quality measurement
system focusing on results: Was the treatment the right one?
Did it achieve the intended effect? What can we learn from the
case? Focusing on results will reduce the paperwork and
micromanagement that strangle doctors, nurses, hospitals and
clinics. It frees health professionals from intrusive insurance
companies and bureaucrats, improves morale, and creates an
environment that supports what health professionals are there to
do -- care for patients.
Under reform, doctors, clinics and hospitals will have to
examine ways to make their delivery of care more efficient while
improving quality. "Business as usual" will no longer be
profitable. Leading hospitals across the country are already
moving in this direction. For example, when doctors at the
Hospital of Latter Day Saints in Salt Lake City, Utah realized
that post-operative wound infections were causing excessive
hospital stays, they experimented with changing the timing of
administering antibiotics before surgery. Patients got fewer
infections, left the hospital earlier, and saved $450,000 in the
first year.
INVESTING IN RESEARCH
Under the Health Security Act, there will be significant
initiatives to increase research. Advances in medical science,
new medications and technology, and innovations in health care
delivery will improve the quality of life for all Americans.
Research related to health promotion and prevention of
disease will focus on many common illnesses and other priority
areas: heart disease, bone and joint disease, Alzheimer's
disease, cancer, AIDS, birth defects, mental disorders, substance
abuse, nutrition, and health and wellness programs.
Research regarding clinical practice will increase with an
emphasis on quality and effectiveness, as well as access and
financing. There will be an emphasis on "outcomes research," to
help answer questions about what treatment works best for which
conditions, so that doctors can provide the highest quality care
for their patients. Expanded research will also measure consumer
awareness, decision-making and satisfaction so that the best
information is made available to the public. This will ensure
that people can make well-informed decisions about their health
care.
EMPHASIZING PREVENTIVE AND PRIMARY CARE
Prevention is the cornerstone of the Health Security Act.
Incentives for patients and doctors alike to use and prescribe
preventive methods are woven throughout. From free coverage of a
wide range of preventive services to wellness education and
increased research funding, the plan offers unprecedented focus
on prevention.
Academic Health Centers
__________________________________________________
Academic health centers are the sites of the basic research
that ushers in modern medical advances -- new treatments and
cures for human illnesses. They pioneer advanced techniques and
procedures, from heart-lung transplants to laser surgery for
brain aneurysms.
Under the Health Security Act, academic health centers will
continue to train physicians and provide state-of-the-art care.
The Act sets aside a portion of all health insurance premiums
specifically for academic health centers. Resources will be
channeled to centers by a formula that recognizes each center's
contributions to education, research, and patient care.
While most Americans will not obtain regular care at an
academic health center, the Health Security Act requires that
everyone has access to specialized care if needed.
The comprehensive benefits package includes a broad array of
preventive services not covered by the vast majority of insurance
plans -- immunizations, mammograms, well-baby care, and other
screenings and early detection techniques to solve health
problems before they become serious illnesses. The Health
Security Act covers a wide range of preventive services with no
coinsurance or co-pay, no matter which plan you join.
The Health Security Act will fundamentally restructure
incentives in the health care system. For the first time, every
doctor, nurse and health provider will know that they can provide
the services they believe are necessary -- and know they will be
reimbursed.
________________________
"The plan recognizes that successful disease prevention and
health promotion must address the health plan of both individuals
and communities. It provides for universal coverage of clinical
preventive services that have been shown to be effective in
preventing disease and prolonging life. All these aspects
constitute an approach to prevention that is uniquely
comprehensive in scope and long overdue."
Roy L. DeHart, MD, MPH
President, American College of Preventive Medicine
________________________
As the American health care system has become more complex,
specialized, and technical, it has neglected some simpler and,
ironically, less costly needs. The cost of treatment for acute
illness has soared, but we continue to spend relatively little on
preventive and public health services.
Good primary and preventive care is one of medicine's
essential responsibilities. Meeting that need represents one of
the essential requirements under health care reform. If the
American health care system is to provide high-quality care at
affordable prices, it must strike a better balance between
physicians, nurses and other professionals who take care of basic
needs and those who provide the most sophisticated and
specialized treatment for serious illness.
Not all health problems can be addressed by providing
individual health care coverage alone. Greater public health
strategies are necessary to improve public health awareness,
quality of care, and the prevention of future epidemics.
Public health protects communities against infectious
diseases, such as tuberculosis and measles, and helps communities
discover how to control chronic disease, such as diabetes and
heart disease. It also works to protect the environment and
educate about health and related issues.
For too long, public health funds have been sapped to pay
for individual care. Under the Health Security Act, public
health dollars will reach their intended destination -- targeting
issues that plague entire populations rather than individuals
first. These efforts promise long-term savings in lives and
dollars.
Primary care doctors and nurses work on medicine's front
line. They diagnose and treat routine medical problems, refer
patients when necessary, and coordinate specialist care. Family
physicians, general internists and pediatricians are the
principal primary care practitioners among physicians, and many
women also consistently see obstetricians and gynecologists.
Advance-practice nurses and physician's assistants provide
essential primary care as well.
But the number of doctors providing basic, routine care has
declined and many states have prevented advance-practice nurses
and other health professionals from taking on as significant a
role as they might.
Chances are that if you live in the Pacific Northwest, and
you belong to a health maintenance organization (HMO), you belong
to Group Health Cooperative of Puget Sound. Founded in 1947 and
located in Seattle, Washington, Group Health is the single
largest provider of health care in the Pacific Northwest, serving
500,000 members. It offers convincing proof of the fact that
emphasizing primary and preventive care can mean high-quality
care, low costs, and satisfied, healthy patients.
Like the Health Security Act, Group Health covers a wide
range of preventive services not covered by most insurance plans.
Its efforts have brought results. In fact, Group Health formed
the basis for a Rand Corporation study that concluded that
providing high-quality care can go hand in hand with controlling
health care costs. Another important feature of Group Health is
its attention to customer satisfaction, which it measures through
regular consumer surveys -- much like the surveys proposed in the
Health Security Act for all health plans.
For decades federal policy has reinforced the trend away
from training primary care doctors and toward training more
specialists. Federal funding of graduate medical education
averaged $70,000 for each resident in 1992, with nearly all of
the money going toward training in hospitals. Little went to
other health care institutions in local communities that provide
more basic care. Between 1980 and 1993, American hospitals
increased the number of residents in training from 82,000 to
97,000, with 94 percent of the new positions devoted to training
in specialty fields of medicine.
Health care reform will increase the demand for primary care
physicians, nurses and other health professionals, correcting the
long-standing incentives that discouraged medical students from
becoming family doctors. But change won't happen quickly. To
encourage American teaching hospitals to switch some residency
positions from specialist to primary care, the federal government
must make it more worthwhile to train them.
Consequently, rather than pay for graduate medical education
without regard to specialty, public and private investment will
redistribute the balance between residency slots devoted to
primary care and those devoted to specialty training. Other
federal programs, including an expanded National Health Service
Corps, will support students studying primary care and locating
in underserved areas, such as rural and urban communities. Loan
forgiveness programs for medical students who are trained in
primary care, and re-training programs for mid-career specialists
who want to work as primary care physicians will further boost
the number of primary care doctors.
The Health Security Act also proposes several important
steps to remove barriers to practice that currently limit the
role of advanced-practice nurses. It enables qualified health
professionals who participate in health plans to fully use their
expertise and ability to provide care. In addition, federal
funds will provide additional resources for training nurses,
doubling the number of annual graduates. Support will also be
provided for training in mental health and substance abuse
treatment.
