The future of health care delivery in the United States

[Flea]

Yesterday I went to a very exciting seminar given by a behavioral health consultant on adapting to new budgets and universal health care. It goes without saying that we have major changes in the pipeline as providers become more creative in addressing age-old problems.

Ultimately, the goal is to move from a paradigm of damage control and maintenance to one of prevention and wellness-care. One major change will be to follow the example set in Britain of giving doctors bonuses for each patient who makes a full recovery, proportionate to the magnitude of the problem that initially brought them in the door.

Better yet, the trend is toward "person centered care," with the recognition that the whole person needs attention rather than just clusters of symptoms. When it comes specifically to mental health (but it really is universal to everyone,) all aspects of life are inextricably linked. You can't make a meaningful impact without also addressing poverty, diet, housing, obesity, substance abuse and its consequences, trauma, co-occurring medical disorders, legal issues, and on and on. Anything less would be a band-aid, bringing clients back for more services as individual situations arise.

As a result, we're going to see more full-service providers that look like this:

Children 1st & Child Health Communicable Disease Follow-UpEar, Eye, Dental Screening Adult Dental ServicesFamily Planning & Women's Health Services HIV Counseling & TestingImmunizations Lead ScreeningNewborn Metabolic Disease Screening Perinatal Case Management (PCM)Pregnancy Related Services Pregnancy TestingRight From the Start Medicaid ReferralsTuberculin Skin Testing Primary Care ServicesNutrition WIC Services Psychiatric Evaluation & TreatmentMedication Management Individual, Group & Family CounselingCase Management Support Services Anger ManagementCoping Skills/Stress Management Parenting SkillsCo-Occurring Mental Health/Substance Abuse GroupsMental Health & Substance Abuse Screening, Assessment & Treatment Planning​

Other services not mentioned on the website include on-site child care, workforce development and occupational training, walking paths, and a community garden.

The research finds that people often get overwhelmed and exhausted under the current system of having to run around to a dozen different offices for a dozen different sets of paperwork with a dozen different caseworkers, and thus more likely to give up and stay sick. Not only will putting all this in one place save money on infrastructure, but it will also cut way down on no-shows, response time, and paperwork. This in turn will put people on a much faster track for recovery and getting their lives back so that they can become productive wage earners and taxpayers. Win-win-win.

That's the theory anyway. Results from pilot projects like the one above have been very good.

 

[Tez3]

Doctors here don't get bonuses for patients recovery, not sure where that comes from. they get bonuses for completing so many vaccinations, smear tests etc. There's proposed changes by the government to give new bonuses for 'performance' but it's very unpopular with the doctors themselves.

http://www.telegraph.co.uk/health/h...ors-call-bonus-plan-completely-unethical.html

 

[Flea]

Thanks for the clarification. Why would doctors be unhappy with performance bonuses?

 

[Tez3]

Thanks for the clarification. Why would doctors be unhappy with performance bonuses?

It's because the bonuses won't be paid for 'doctoring' they will be paid for performance in managing. The government wants to get rid of a lot of the managers in the NHS and have the doctors do the admin, making decisions etc instead under the guise of doctors taking responsiblity for patients. It sounds good in theory but doctors aren't trained to make admin or business decisions. The numbers of managers should be cut, the NHS is top heavy but having doctors deciding admin policies etc would be a disaster, we'd either end up with the senior doctors managing hospitals full time and the junior doctors doing the medical stuff with inadequate experience or we'd have longer waiting lists because the doctors are busy managing. Giving doctors control over big budgets is giving them a job they can't do, the bonuses too are to make up for the fact they want to cut doctors pensions! Doctors doctor, accountants and managers manage budgets and hospitals.

 

[Bill Mattocks]

Remember that wellness is a catch-all. At one end of the spectrum it means that the government tells you you're too fat, and orders you to lose weight or pay a penalty - or risk losing health care coverage. And kindly do not tell me it won't happen; it already happens in the private sector. As government takes over health care, we'll see more, not less, of this. Here in Michigan, it's perfectly legal for employers to order employees to quit smoking (for example) on or off the job, and fire them if they fail to comply.

 

[Tez3]

Our national Health Service is a wonderful and amazing thing, I doubt any of us would want it gone. It was born at a time when the country was exhausted by five years of war, the material part of the country was in many places smashed by the Nazis bombing, food rationing was still in place and the people were looking for a way to go forward. before the war such extreme poverty meant many people died for the want of a doctor, so the NHS was most likely the biggest life saver any country has ever had. for all it's faults it may still be that. I doubt however you could start it up now and I doubt that you could have ever started it up in the USA at any stage.
When people talk about the 'government' taking over things, it's not how we see things here. perhaps because we are such a small place we see things as being smaller than you do in the States. the government is smaller and closer to us, more intimate if you like, easier to vote out, easier to demonstrate against, fight against and kick out. prhaps too because despite some Americans thinking we are second class citizens we know the government isn't in charge of us, the Crown is if anyone, though in reality we don't think anyone is in charge, we are quite independently minded really. Our MPs are easily contacted, they hold surgeries in their constituencies most weeks, you can write to them, phone them up, they really can't escape us, all the ministers including the Prime Minister is an MP who has to do this, my MP is the Foreign Secretary, he's quite easily cantacted and people aren't backward in coming forward with their views to him and the others. The government is only part of the 'governing' business, we have Parliament - this is the government, the Opposition, the House of Lords and the monarch. This means the government of the day has actually more limited powrs than most non Brits realise.

When people have gone to the media complaining they have been told they are too fat if you look into it there's always more too the story. The truth is that an obese person has been told by their doctor they have to lose weight for their health and/or they can't have an operation or procedure because of the dangers of being overweight, then the patients whinges that they are being told what to do by a tyrannical NHS. The truth is more often than people don't like being told their weight has caused problems the doctors can't not won't fix because of that weight. Even if they had cash in hand to pay a private doctor they couldn't be helped unless they lost weight. However you never lose healthcover here under any circumstances, people may drop under the radar such as the homeless but healthcare is never withdrawn and is not conditional, it's just that sometimes however much they want to help you and try to help you unless you co-operate they can do nothing for you, even then they still try.
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Too many people are looking at our NHS and drawing conclusions about it either for or against to use in their arguments about healthcare in America. The truth is that we are such different countries in many respects that you cannot take our model of healthcare as indictative of anything useful for healthcare arguments for you.

Looking at what Obama proposes it doesn't seem to actually be anything like the NHS,