Americans understand that insurance doesn’t actually pay for everything, according to a study by the Sacramento Center for Health Care Decisions. This shows that Americans are quite able to set priorities for health care on their own without leaders trying to tell them what to do. The study put health care issues into three categories; what matters most, what matters a little, and what matters least. As healthcare organizations, we can use this information to do a bit of triage on what patients deem important in their own care.

What Matters Most:

• Problems that will lead to serious medical consequences or death if left untreated
• Problems that interfere with daily life
• Problems that result in higher societal costs if left untreated

What Matters A Little:

• Problems that bring personal distress
• Problems that result in physical discomfort
• Nonmedical services that prevent disease through getting healthy and fit

What Matters Least:

• Problems that are unsightly but not harmful (i.e. varicose veins)
• Problems that delay or prevent recreation
• Treatments that are required by patients to feel reassured
• Problems that resolve without treatment
   

There are a few takeaways from this list. One of the more interesting items is that prevention, which many would have thought mattered the least, actually matters a little to most Californians who took the survey. Since California has a reputation as a healthier state than most, it would be interesting to see the same study done on a national scale to see if this still held true. Perhaps it is better to have it done at the state level in order to more accurately gauge the wishes of people in each individual state.

One of the most interesting aspects of the study is that people tended to put the welfare of their family and friends ahead of their own, and even the welfare of society. You certainly wouldn’t have expected to see “problems that have a higher societal cost” at the top of the list if you were to guess the results in advance.

All in all, a very interesting study and one that bears repeating as we forge ahead with health care reform.  More at recordnet.com.

For decades, the U.S. healthcare system was the envy of the entire world. Not coincidentally, there was far less government involvement in medicine during this time. America had the finest doctors and hospitals, patients enjoyed high quality, affordable medical care, and thousands of private charities provided health services for the poor. Doctors focused on treating patients, without the red tape and threat of lawsuits that plague the profession today. Most Americans paid cash for basic services, and had insurance only for major illnesses and accidents. This meant both doctors and patients had an incentive to keep costs down, as the patient was directly responsible for payment, rather than an HMO or government program.

We should remember that HMOs did not arise because of free-market demand, but rather because of government mandates. The HMO Act of 1973 requires all but the smallest employers to offer their employees HMO coverage, and the tax code allows businesses – but not individuals – to deduct the cost of health insurance premiums. The result is the illogical coupling of employment and health insurance, which often leaves the unemployed without needed catastrophic coverage.

Ron Paul, excerpted from Examiner Article

The first article in this series explored how we compare with other countries, in particular with the Japanese health care system. This portion of the series will look at the “good old days” of American health care, and examine if there are lessons to be learned from the past or if we are better off moving on into the future. Despite Paul’s claims, American health care costs rose almost every year between 1940 and 1990. In the 1990′s, health care costs stopped growing as substantially as they had in the past. The introduction in 1965 of Medicare and Medicaid was responsible for a more significant increase.

In 1990, most were forgoing health care spending for other purchases, as the majority of the “boomer” generation was still quite young and in good shape. Now, those boomers are older and obesity rates are much higher, making for much higher health care costs overall. Problems can no longer be ignored and most boomers go to see the doctor rather than buying a new car, as they may have done in the 1990′s.

There is a call from some quarters for the US to return to the Hill-Burton standard for American healthcare, and an end to the HMO system that so many feel is a drain on our resources. Even though there was an increase in spending, under the Hill-Burton standard this money actually went towards some useful items. The four principles of the standard, enacted under FDR, were:

1. Ensure an infrastructure of necessary facilities and medical personnel, either public or private, to meet certain minimum standards of availability for the public.
2. Provide care to those in need, regardless of their ability to pay, and worry about the costs afterwards.
3. Depend upon the growing wealth of a productive, industrial economy to make sure that sufficient resources, financial and otherwise, are being created to provide for health care needs, and associated public health needs.
4. Carry out special programs to attack and treat leading dangerous diseases, in the interest of the general welfare.
From: http://american_almanac.tripod.com/hillburt.htm

Under the Hill-Burton standard, there were about 4.5 hospital beds per 1000 people, a far cry from the overcrowding of today. It is no wonder, given the principles and the lack of crowding, that most wish for a return to simpler times.

The problem is that times are not that simple anymore. There is a possibility that the new EHR program may streamline our health care system significantly, but the realities that we are dealing with today are much more complex than those that we faced under FDR. New diseases such as AIDS and swine flu, a dated infrastructure that is groaning under the weight of the extra population, and emergency rooms packed with people who need treatment. While a revisit to the Hill-Burton principles can’t hurt, I think we can all agree that a total rehaul is in order.