What Would You Change About Medical Care?

I would approach healthcare delivery like it was a brand new business. Wipe the slate clean. The first order of business would be to design or conceive of the product or service. Let’s consider outpatient care first. I would design a center in which internists and specialists from various fields worked together to diagnose a patient. All would be required to know how to read radiographs. All would have access to the same test results. All would be required to consult each other and come up with a comprehensive diagnosis before the first prescription was written.

This would prevent a patient who started taking medication prescribed by one doctor from skewing test results ordered by the next specialist, seen weeks later. This would lead to faster and more accurate diagnoses since specialists are trained only to look for disease within their respective fields. Utilizing the combined knowledge of all specialists upfront would drastically reduce the number of specialists who unsuccessfully treat a patient’s secondary symptoms while the root cause of disease goes unaddressed. This would cut down on administrative paperwork, duplicating tests, gas mileage driving to all the different specialists’ offices and drastically reduce overall cost. This would lead to greater patient health outcome and satisfaction.

Liability for patient welfare would rest equally on the shoulders of each member of the diagnosing team, hence creating an internal peer review check to reduce errors. However, should a patient file a medical injury case against the group, the case would be heard by a “health court,” a special court set up to handle medical injury cases. As conceived by Common Good and the Harvard School of Public Health with the support of the Robert Wood Johnson Foundation, health courts would feature:

* trained judges with expertise in health care
* neutral experts retained by the court to assist the judges in making decisions about the standard of care
* a schedule for non-economic damages based on patient circumstances and the severity of injury

Again, this would greatly reduce overhead costs and curb the practice of defensive medicine that unnecessarily drives up health care costs. These same initiatives could then be applied to inpatient care on a larger scale.

Now that we’ve devised a “product” that provides health care at half the current cost, increases efficiency, improves patient outcome and satisfaction, we need to find a way to fund the system whereby the maximum number of dollars stays in and works for the system. This would suggest setting up a nonprofit venture which could be a government-backed private enterprise. The mandatory difference would be in setting up a business in which the focus remained patient-centered rather than shareholder-profit-centered.

~ by doctorblue on December 17, 2008.