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EditorialReforming Health Care:
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EditorialReforming Health Care:
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I was talking with a relative this weekend and, naturally enough, the subject worked its way around to the health care delivery system. "Why can't we have the perfect health care system?", I was asked. "What would constitute the perfect health care delivery system?", I responded. Of course, we were both at a loss for an answer. Well, this got me "thinkin'" as to what exactly should the perfect health care system involve? What are the important parameters that the health delivery system should base itself around?
First of all, the most important aspect is that the patient's needs must be met. Sounds straightforward and simple enough. Hence forth this concept will be (to steal a Star Trek term) referred to as the PRIME DIRECTIVE.
Second, the needs of those who deliver the health care must be met. Third, the needs of those paying the bills must be met. Sounds fairly basic and straightforward, but what is involved in implementation of these principles?
The prime directive implies that the patient be able to access the physician, medications and technology of their need. This should be accomplished in a proactive, hassle free atmosphere. The system should remember that these are people with illnesses, not "covered lives." Resources should be used in a specific, targeted manner with the patient's best interest in mind, depending on the condition of the patient. Obviously research needs to be supported to continuously improve patient well-being.
Second issue: the needs of the caregivers need to be met. Incumbent upon this, the physicians and allied health care professionals need to be freed from several sets of absurdities. First, society needs to stop vilifying the physicians. Doctors are inherently benevolent souls, who unfortunately take "altruism" as a compliment. I say unfortunately, because while someone who is benevolent enjoys the performance of "good deeds", an altruist has some degree of self destruction associated with the performance of these good deeds. While benevolence is an entirely appropriate emotion for a physician, altruism is not synonymous, and is detrimental to the prime directive. Physicians have the same rights to enjoy a decent living, and be able to work in a hassle free environment as any other professional. In addition, the current combative tort based maloutcome system is expensive, both in money and labor deletion, and detracts from optimum patient care, again violating the prime directive.
Third, the needs of the billpayers must be met. This would mandate that all care should be delivered in the most efficient, and cost efficient manner possible. As physicians and allied health professionals, we must continue to maintain the highest moral and ethical standards possible. It is also implicit that the third party payers would behave in a manner exemplifying the highest moral and ethical standards.
This hopefully provides a conceptual framework to use when evaluating the parameters for any future changes in the health care delivery system. Unfortunately, my gut feeling is that there will always be inherent tensions between the three key players (i.e., patients, physicians, and third party payers) in the health care system. As long as the patient's well-being remains the supreme and overriding concept, patient care will continue to excel.