No Payor System

The current economic model doesn't work. Both reliance upon government programs and third party insurance create a profit motive divorced from medical care. Business needs its resources to provide product while government provides support to the country's infra-structure. In both instances health care is outside the principle focus of the endeavor. Caring for patients becomes an abstract notion.

Fee for service is antiquated model

But physicians practice in a fool's paradise. They cling to an antiquated model of fee-for-service even though its economic basis no longer exists. Today, patient responsibility for payment is all but extinct. Insurance payments absolve both physician and patient of all fiscal responsibility. Physicians may remain dedicated to their patients' health but their fiscal responsibility dissolved long ago.

Call for universal health care

Old arguments are inadequate for today's challenge. Both medicine and society are now too complex for simplistic answers. The accelerated pace of scientific and social change demands flexible solutions which have the resiliency to adapt to change as it happens. Nowhere is this more evident than in medicine. The scientific basis upon which the care of patients depends now evolves almost daily. No arms length management can begin to cope with the economic urgency this creates. Universal health care is long overdue in this country. Yet it looms like an ugly cloud over our economic future. Before we act rashly, based upon existing models, let us examine a different future. What happens if the problem of cost is no longer the concern of business or government?

Proposal

When physicians develop full risk-bearing partnerships the problem of cost is transformed. By becoming the insuring entity they reassume the prerogative of their profession; they are the sellers of care. If they also abandon fee-for-service they acquire the needed flexibility to cope with the medical marketplace. Profit motive is balanced by their professional need to care for patients, including access to the latest therapies, and their rightful need to make a living. They are constrained by risk of economic losses. They face a profit motive with responsibility for a fiscal bottom line. Under this circumstance what happens to cost?

Relevance of cost

Cost becomes immediately relevant to patient care. Individual problems or complex organizational needs, when left unresolved, will add to the cost of care. In day to day operation it will be in the economic interest of the group to efficiently utilize all physician and technical expertise to expedite diagnosis. In the absence of fee-for-service this can be accomplished without artificial impediments to the exchange of information. Similarly, complications of treatment, such as Foley catheter infections, will be scrutinized because their occurrence adds unnecessarily to the cost of care. Replacement of obsolete equipment, diagnostic tests and procedures, with more efficient current technology will be a recurring task of the group as it refines its efficiency in the delivery of care. Medical problems which have major economic impact such as diabetes or stroke can be the object of intense reorganization. By focusing upon efficient delivery of complex modalities of care and establishing relevant outreach programs to enhance their delivery, cost can be controlled without compromising care. Included in these programs should be the ability to measure outcomes. If these innovations can be shown to reduce cost, part of the savings derived from the program should be used to reward the physician participants. Internal economic incentives are an integral part of the design for success. It will also be in the group's interest to participate in community wide projects such as smoking cessation, teenage drinking or other public health problems. Any common socio-economic problem will become relevant to these groups since they will recognize that these problems will impact on long term cost. In short, it will become apparent to all involved in health care that unsolved problems cost.