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The Values of our Health Care System

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BTE Staff

In a recent blog, Uwe Reinhardt focuses on and derides the current values that are held dear when it comes to health care. Some of these values are at the root of the current crisis in the system that is leading it to the brink of bankruptcy. They include:

  • Individualism and Personal Choice
  • Limitless resources
  • Entrepreneurial spirit and market orientation
  • Professional autonomy
  • Technology worship

These values are embedded not only in the psyche of consumer-patients, but also in the psyche of physicians and other health care professionals. And they’re reflected in the payment of choice in the industry: fee-for-service.

As we contemplate the current course of reform, we must be cognizant of these values and understand that wrenching them out suddenly will simply put reform at critical risk. We must, however, create a pathway to change these values to ones that the system really needs and that we observe in communities that have embraced change. The new values include:

  • Sense of community responsibility and accountability
  • Team work and professional collaboration centered around the patient’s needs
  • Science over technology
  • Limit on resources

While the first three are not particularly controversial, they do run against the grain of many that practice in the industry. It’s our belief – and we are currently testing that hypothesis – that moving from pure fee-for-service to episode of care payment and strong quality measurement, starts the process of change in these values in a way that is neither gut-wrenching, nor slightly incremental, but somewhere in the middle. Episode payment still leaves plenty of room for individualism, personal choice and entrepreneurialism because consumers are free to choose physicians that offer good care and physicians are free to compete for business and innovate within the episode.

It also encourages teamwork and collaboration, an understanding of results and how to use data robustly. And it fosters a focus on evidence and science over unfettered use of technology..

Finally, it creates some limits on use of resources, which brings us to the last new value. While it’s true that there are limits to health care resources and that the current willy-nilly use of services that have no impact on the well-being of patients has to stop, one of the values of the US health care system that I cherish greatly is to refuse to put a cost on human life. Professor Reinhardt derides that value, mostly because his observation of other countries clearly shows that they have made decisions on the value of a life and are willing to limit the use of resources in many instances.

This, of course, is not a debate for economists, but rather for philosophers, theologians and society. My observation of the current use of resources in the US indicates that there are at least 20% of current costs that are consumed in potentially avoidable complications. That’s a lot of money spent on things that have caused harm to patients, and so I would posit that before we put a cap on all resources, let’s focus on eliminating these avoidable costs.

Contrarily to what’s happening in other countries, we have an opportunity here to create a sustainable system in which patients get good care, costs are moderated, and life continues to be valued at every stage of a person’s time on this earth. Let’s not waste it.

Francois de Brantes, MS, MBA
Chief Executive Officer




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