Health Care Reform – Patient Delivery and Care Delivery

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An improved patient delivery system is a necessary pre-condition for affordable and quality health care.

What do I mean by a “patient delivery system”?

Understanding  patient delivery system means recognizing that people without health insurance do not receive treatment until they are in an immediate life-threatening situation.

I cannot back this up with a scientific study, only my daily experience.  But that experience contradicts an oft cited myth that no one who needs health care is turned away.  One of the most common reason that people call our office is because something happened to their health insurance that lead to a denial of treatment.

It may be as simple as the doctor calling the wrong number or it may be that the member has failed to pay their share of their health insurance premium.  But the reasons don’t make the stories any the less heart breaking.

Checkpoint Charlie for health care

To enter the health care delivery system, patients need to pass through one of the many portals that guard access to health care.

People who are employed, some people who are employed,  gain their access through employer provided health insurance.  This also permits access by their children and spouse.  Some of those may also be employed.

People over the age of 65 and certain disabled people pass through the Medicare portal.

Some people who meet certain tests for age, income, gender, and/or parental status are permitted to pass through the Medicaid portal.

Those who don’t present sufficient credentials to pass thorough one of the previously mentioned portals may be able to tap into the market for individual insurance, but only if they are healthy.

There are additional portals for members of special groups, the Veteran’s Administration or the Indian Health Service, for example.

Their common characteristic is their exclusivity; you need to pass a test to pass through the portal.  Are you working? If not, are you poor enough, or old enough, or healthy enough, or a member of an exclusive group?  And might that change next month when you have a different employer or a no employer?

The portal you pass through into the magic world of health care delivery is only the first challenge in navigating the health care maze.  That portal determines which part of the health care delivery system you have access to, how much those providers are paid, which services will be reimbursed and under what rules.

It is most unfortunate that how much providers are paid is the major factor determining which providers you will have access to.

Patient delivery and care delivery

The defining characteristic of our health care system is that patients don’t have uniform access to the health care delivery system, and that that providers don’t have consistent access to the same group of patients.

How do you coordinate care in that scenario?  Is it no surprise that millions of Americans have no primary care doctor?

There are a lot of factors contributing to the high cost of health care?  Delayed care that leads to more expensive care needs to be one of the easier causes to address.

When we deny care to millions of Americans because they have not passed through one of the approved portals and their need for treatment is not acute enough, that costs the American health care system lots of bucks.

A system that makes access to health care delivery easy can encourage primary care over expensive emergency room care.

A system that that offers the same portal into health care despite employment status or income or age permits the provider community to take a longer term view of patient care.

That is why an improved patient delivery system is a necessary pre-condition for affordable and quality health care.

Next week – why an employment based system is not an efficient patient delivery system.