Basic Health Access

Health designs in the United States work for few people in a few locations at high cost. This health design spends so much on administrative and highly specialized services that basic services and basic health access are insufficient for most Americans. A major reason for decades of failure is the maldistribution of health information. The scientific process begins with awareness of the problem. Those who design health care are raised and trained and constantly immersed in top concentrations far away from most Americans - and far away from the awareness needed to lead the nation in health access, basic services, primary care, and care where needed.  Medical Group Management Association statements have consistently acknowledged the information arising from the largest and most organized practices. When very little arises from the smallest and least organized, awareness is maldistributed. Where funding is missing, facilities and practices and workforce are missing. This also re...

I find it interesting that CMS overpays for high risk or complex patients, even when there is overcoding and fraud via Medicare Advantage. Yet CMS will not pay more for truly complex patients across rural and underserved areas. The largest do well and the smallest struggle to survive. This is the payment design, the administration design, and the enforcement design. Behind each design and designer is a serious lack of awareness of the consequences for Americans most in need of care. From NPR by Schulte - "Instead of winnowing out abusive corporations, all insurance participants were punished: The study said that a number of large Medicare health plans, which were not named, raised risk scores far above their peers. But the agency chose not to ferret out the worst offenders to discipline them. Instead CMS cut rates industrywide in 2010 by 3.41 percent to offset the jump in risk scores." As noted in the NPR article, the Obama plan has cuts planned for Medicare Advantage, but...

Home school is most local by design. Primary Care Medical School is only about primary care without the option to leave primary care after graduation. The Primary Care Medical Home School is local, primary care, where needed by design. The current health professional training designs for MD, DO, NP, and PA all fail for primary care workforce result. Recovery of primary care is about all influences lined up most specific for recovery. Medical education is not the only higher education in need of redesign. College is too expensive, fails in relevance to career, and often forces students to leave locations where care is needed to go to exclusive settings attending college with exclusive students. Local, normal, and relevant can go hand in hand with online and other modes of advanced education.  The best model for health access recovery is specific to primary care across preparation/college, medical school,  and residency training. A specific design is not difficult to visua...

It is a time when we should be more scientific, but we seem to have more nonsense than sense both inside and outside of science. National Geographic published "Why Do Reasonable People Doubt Science." I would indicate that there are scientific leaders, particularly in health care, that fail to process scientifically. Science journal also pointed out the many failures in scientific studies with regard to scientific approaches - especially the lack of randomized studies regarding health care delivery. Reasons for Science Confusion Those that profit from anti-science - This includes those who profit from controversy and those who profit by paying for their own researchers to "prove" what they want to have proved. Poorly done scientific studies plague both. Major foundations and think tanks often shape support and findings along political or economic lines. Attempts to prove the Triple Aim start and end with this proving focus rather than objective approaches. T...

The 3138 US Counties can be coded by physicians, by types of physicians such as active family physicians seen here, by population and by other demographics, including those age 65 that are increasing rapidly and even more in health care demand. As previously noted, the locations with top concentrations of physicians have lowest proportions of family physicians and primary care.  Numerous forces interact to shape higher proportions of family physicians where care is most needed and where higher proportions of elderly are found. These are counties most behind in education, employment, and poverty in addition to health spending, health facilities, and health care workforce. Slowest population growth is seen in counties most concentrated in health workforce. Highest cost of living and health care may shape most Americans elsewhere, especially the elderly and those on fixed or lower incomes.  Designs for health, education, and economics fail where neede...

The following is a 2004 prediction specific to the year 2014 made by US Health Experts as captured by US News and World Report: In 10 years, the increasing use of online medical resources will yield substantial improvement in many of the pervasive problems now facing healthcare—including rising healthcare costs, poor customer service, the high prevalence of medical mistakes, malpractice concerns, and lack of access to medical care for many Americans. Ten Years After By assumtion and belief backed by the creation of programs and expenditures, the US has actually helped to distract spending toward administrative costs and away from direct spending on those who deliver care - failing to meet increasing needs for workforce and services. Experts failed to understand the limitations of various designs. Care management, even using the most promising designs, did not result in appreciable savings. The cost of doing the management often ate up any savings as investigated b...

Spending Designs Discriminate Designs for spending send less to counties in most need of care that have populations with multiple dimensions of "left behind." This can be tracked by measuring distributions of Medicare dollars or by measuring workforce distributions. Counties with lower to lowest concentrations of workforce not only have fewer services, they have higher proportions of primary care and basic services. In other words they have less of the services and providers that generate the most revenue under US design. Thirty or more states, 2600 counties, and 40,000 zip codes geographically map discrimination. Discrimination can also be mapped by economics, race, ethnicity, age, income, education, and other measures. Decades of inaction indicate continued Discrimination by Design. American health spending, like workforce, is concentrated in 6 states, 250 counties, and 1100 zip codes. Spending design favors those doing well across a wide range of social determinant ...