Physicians outline critical issues facing US health care

A group of physician researchers today outlined what they believe are the most critical issues now facing health care in the United States.

Starting with a presentation on the “Anatomy of Health Care in the United States,” Hamilton Moses III, MD, lamented over the “disempowering of the patient as consumer” at a press conference hosted by The Journal of the American Medical Association.

“The individual has been marginalized. This creates a tension in the system,” Moses, of the Alerion Institute, North Garden, Va., and Johns Hopkins School of Medicine, Baltimore, said during a press conference in Washington. “The marginalization of the consumer is the main source of instability in our view.”

The findings also focused on consolidation in health care and insurance, plus the increasing demands for quality measurement.

“It is not clear that patients will be willing, or even that they should be asked, to shift their allegiance and trust to a health system or insurer rather than a clinician,” wrote authors in the accompanying JAMA Special Communication.

The authors also wrote that “a central economic question about the emerging health system is whether consolidation of large hospital institutions is beneficial or harmful,” while admitting that as the health care system is realigned, “the larger focus on population health may be inevitable.”

Moses went a step further, saying, “The era of the individual physician is over.”

A separate analysis described the current state of health care quality of care measurements as “on occasion, disorganized, inefficient, confusing and misleading … .”

“The challenge is to move from measurement that is better than no measurement, to measurement that unambiguously delivers all of the necessary information to improve care while not interfering with the delivery of that care,” wrote the authors.

In response to these challenges, Ezekiel J. Emanuel, MD, PhD, of the Perelman School of Medicine and the Wharton School, University of Pennsylvania, called for an approach to reform that echoed President John F. Kennedy’s national moon landing challenge in the 1960s.

The new goal, according to Emanuel, should be per-capita annual health care costs by 2020 that increase no more than the annual gross domestic product.

“It’s clear and easily measured,” he said. “But it’s not going to happen overnight.”

It would require a “renewed, systemwide focus on transforming the delivery system to improve the way we care for the chronically ill,” said Emanuel, because 10% of the population with chronic illnesses now consumes nearly two-thirds of health care dollars.

Another recipe for reform was offered by Joanne Lynn, MD, of the Center for Elder Care and Advanced Illness, Altarum Institute, Washington.

“We almost all get to grow old; it’s the terrific success of modern medicine,” she said, but the system hasn’t evolved to cope with this reality.

“It’s not a hotshot pill anymore, it’s how people are going to live with these conditions,” Lynn said. “We have about a decade to get it right.”

Her recipe for reform includes a 911-like emergency response system for urgently needed medical caregivers.

“I can write a prescription for a drug that costs $100,000,” Lynn said. “But I may not be able to get my patient what they really need.”