Basic Health Access

Cries of victory may ring out today after the apparent defeat of the misguided Republican Replacement Plan, but the sand people will be back and in greater deception. The designs over past decades will continue to be shaped by those with their own agendas - agendas that are a poor fit with the needs of most Americans or true improvements in health outcomes. The first realization that must be made is that the designers will be back with plans that work for them, but not for most Americans. The second realization is that good intentions taken to excess have consequences as seen in austerity focus and in runaway health care costs. Austerity Focus Runaway Health Costs Cuts or prevents or diverts investments in areas that shape local determinants of outcomes Increase so rapidly that federal and state dollars are diverted to health care and away from the determinants of outcomes The Determinants of Health, Education, Economic and Other Outc...

Policy and Design Seeds of Health Improvement Fail on Barren US Soil - Any number of interventions can work in a nation that invests in children, and improved environments, situations, and social determinants. In nations failing in support, health interventions can be expensive and can fail to work. Medicaid as Savior or Betrayer of Access - Higher payments from Medicaid can increase access for patients with or without insurance. Medicaid expansion with current payments too low cannot support Medicaid patients, local providers where care is needed, or patients with insurance either. Selling and Swelling a Bigger HITECH Bubble - C herry pi cking has become essential for those who provide or insure health care. Choose the easiest route will capture more dollars with less cost of delivery - and this will earn more bonuses and assure no penalties. Changes since 2010 will reward those already doing well and will penalize those already behind. Cherry picking has apparently moved ...

An article by Andrew Weil indicates how "The Biomedical Model is Failing Us." Despite lofty claims, the drugs promoted have not done much for mental health. Not surprisingly the biomedical model may have failed most when applied to mental health where so much is about behaviors, relationships, and other people factors. Weil points out, "In 1977, the journal Science published a provocative article titled “The Need for a New Medical Model: A Challenge for Biomedicine.” I consider it a landmark in medical philosophy and the intellectual foundation of today’s integrative medicine. The author, George L. Engel, M.D., was a professor of psychiatry at the University of Rochester (New York) School of Medicine. Determined to overcome the limiting influence of Cartesian dualism, which assigns mind and body to separate realms, Engel envisioned medical students of the future learning that health and illness result from an interaction of biological, psychological, soci...

Same or better quality with lower cost is value. Those who endeavor to lower cost and improve quality as the route to "value" fail to understand the situations where value already exists. Rural health and small health has long been forced to lower spending. Being rural or small contributes to value in ways not entirely understood - but documented.  Small ball with more singles and less home runs and costly players can be more efficient - Moneyball. Health care designers have been trying to hit national home runs while failing in local day to day health care delivery. Moneyball is selecting and supporting efficient and effective care - not second-guessing or forcing the players to be something that they are not. Valuing Those of Value It is not valuable to omit small health care from discussions of health care design. The abuses of small health are even worse. Designers often assume lower quality from those smaller because of lower volume or s...

Yet another media article appears indicating the problem of medical error. At least this article notes that patients should be engaged. It's Not Physicians Who Shape Outcomes - It Is the Patient and Patient Factors Patients should indeed be engaged, educated, and changed in behaviors, situations, environments, and supports because this is 60 - 70% of health outcomes. The failure to influence patients, families, homes, communities, resources, social determinants, and child well being will continue to shape lesser outcomes in health, health status, and health outcomes. These most important areas are currently outside of our current design for health care spending.  Reformers and innovators hoped to influence improved patient outcomes by changing physician behavior. The most consistent finding in the efforts to improve quality - is no change. The outcomes have not been changing because people are not changed or being changed. Their behaviors, environments, situations, r...