The missing piece of health care reform.

Heath care is exactly what it says it is – health care.  The Patient Protection and Affordable Care Act of 2010 or lovingly known in the hospital world as health care reform did little to change health care as a service.  Health care finance, payment, delivery, and fraud were addressed in the bill but one very meaningful, and in my opinion, the one aspect that could have the greatest impact on health care expense in our country was left out.

The health reform law is 2,555 pages, 506 sections, affects 50 different aspects of health care delivery and health care finance, yet the ONE thing that could have the greatest impact on lowering health care expenditures in our country is missing. 

What’s missing is prevention.  Our health care system is set up to treat illness and injury and health care providers are paid to provide treatment.  Hospitals and other health care providers are given little incentive to provide preventive services.  As a matter of fact, hospitals are penalized in many ways to provide preventive or early detection services. 

When a patient is referred for an outpatient service we perform a medical necessity check.  This check requires a physician to list a problem or diagnosis and the test or service being provided must be an approved service for that problem or the hospital can’t get paid to perform the test.  What this means is, you’ve got to have something wrong with you before we can perform a test or procedure to verify that there’s something wrong with you.

What we could do is provide tests or treatments to identify things you can do to help prevent illness in the future.  Preventing future illness will go a long way to reduce health care costs for all of us. 

Most of us will end up on Medicare at some point (assuming it’s still around 10, 20, or 30 years from now).  It seems providing more preventive services to people in their teens, twenties, and thirties would have an impact on reducing Medicare expenditures in the future but you won’t find those policies in the health reform law.

What you will find instead are policies to pay hospitals and other health care providers less requiring all providers to provide care to more people for less money in hopes that health care providers will become more efficient.  While I don’t disagree that all health care providers need to be more efficient I do believe the fundamental premise of our health care system needs to change before we see a real impact on health care expenditures in our country.  Unless hospitals and other health care providers get paid to prevent illness they simply can’t afford to offer the services in a sufficient manner.  Hospitals and other health care providers are paid to make sick people healthy not make healthy people healthier. 

I don’t believe it’s the role of government to protect us from ourselves but health care reform provided an opportunity for the government to help us all become better informed about our health.  We can only act on what we know. 

Ultimately it’s our own responsiblity to make choices that affect our health.  Health care reform provided an opportunity for the government to emphasize illness prevention and help all of us become better informed about our health.  The better informed we are today the better choices we can make tomorrow. 

Making better choices tomorrow could reduce health care spending for many tomorrows to come and help assure services like Medicare are around for your child and mine.

I know that this entire post is a bunch of coulda, woulda, shoulda but isn’t that what a blog’s all about.  Tomorrow I will post information on where health care reform missed the mark from an insurance perspective.

About Craig Thompson

I am a young professional with two great sons, and I work in the healthcare setting. I am employed in hospital administration and serve as Chief Operating Officer at Golden Valley Memorial Healthcare in Clinton, Missouri. These are challenging and exciting times in healthcare and my blog will focus on healthcare, raising boys or being raised by boys, and living in mid America.
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