Question

Administrations in the United States have sought major healthcare reform since the Roosevelt administration (that's Teddy, not FDR).

What factors are associated with a successful health system reform?

Unsuccessful reform efforts?

How have we modified existing healthcare platforms (Private and Public)

Answer 1

I. Comprehensive services across the care continuum

Cooperation between health and social care organizations

Access to care continuum with multiple points of access

Emphasis on wellness, health promotion and primary care

II. Patient focus

Patient-centred philosophy; focusing on patients’ needs

Patient engagement and participation

Population-based needs assessment; focus on defined population

III. Geographic coverage and rostering

Maximize patient accessibility and minimize duplication of services

Roster: responsibility for identified population; right of patient to choose and exit

IV. Standardized care delivery through interprofessional teams

Interprofessional teams across the continuum of care

Provider-developed, evidence-based care guidelines and protocols to enforce one standard of care regardless of where patients are treated

V. Performance management

Committed to quality of services, evaluation and continuous care improvement

Diagnosis, treatment and care interventions linked to clinical outcomes

VI. Information systems

State of the art information systems to collect, track and report activities

Efficient information systems that enhance communication and information flow across the continuum of care

VII. Organizational culture and leadership

Organizational support with demonstration of commitment

Leaders with vision who are able to instil a strong, cohesive culture

VIII. Physician integration

Physicians are the gateway to integrated healthcare delivery systems

Pivotal in the creation and maintenance of the single-point-of-entry or universal electronic patient record

Engage physicians in leading role, participation on Board to promote buy-in

IX. Governance structure

Strong, focused, diverse governance represented by a comprehensive membership from all stakeholder groups

Organizational structure that promotes coordination across settings and levels of care

X. Financial management

Aligning service funding to ensure equitable funding distribution for different services or levels of services

Funding mechanisms must promote interprofessional teamwork and health promotion

Sufficient funding to ensure adequate resources for sustainable change

2. The crush of information, a plethora of new technologies, increased regulatory oversight, an aging population, and heightened consumer awareness and expectations have all contributed to the disorganization, fragmentation, and discontinuity of patient care.  Elites remain deeply divided on what to do. Solid and stubborn minorities favor enrolling everyone in a nationally administered system financed largely by taxes, shoring up the current employment-based system for workers and their families or extending tax incentives to encourage individuals to buy insurance themselves. Supporters of each approach prefer the status quo to the alternatives, so doing nothing wins.

* Eighty-five percent of Americans are insured and fear change. Repeated surveys document that most are pleased with their doctors and satisfied with their last contact with a hospital. Yes, healthcare costs them more than they would like, and insurance red tape is a huge pain. But they regard any plan that threatens their current arrangements with suspicion, particularly if it is imposed by a Congress they distrust.

* Large-scale health reform is large-scale income redistribution, and the politics of redistribution is the politics of trench warfare. Unless healthcare spending is greatly increased — something no one wants — boosting spending on some groups means cutting spending on others. Increasing one kind of care means cutting another. Those who stand to lose services can be counted on to invoke high-flown reasons why reform is retrograde. To be sure, advocates of each approach to reform claim that increases in efficiency will result if their ideas are adopted. But these claims are hard to document, and they would take years to realize.

3. The future of health will likely be driven by digital transformation enabled by radically interoperable data and open, secure platforms. Health is likely to revolve around sustaining well-being rather than responding to illness.

oday, the US health care system is a collection of disconnected components (health plans, hospital systems, pharmaceutical companies, medical device manufacturers). By 2040, we expect the consumer will be at the center of the health model. Interoperable, always-on data will promote closer collaboration among industry stakeholders, and new combinations of services will be offered by incumbents and new entrants (disruptors). Interventions and treatments are likely to be more precise, less complex, less invasive, and cheaper.

Health will be defined holistically as an overall state of well-being encompassing mental, social, emotional, physical, and spiritual health. Not only will consumers have access to detailed information about their own health, they will own their health data and play a central role in making decisions about their health and well-being.