Today, health care in the United States is facing a series of important challenges. Only with dramatic improvement in the health-care system will there be lower costs, higher quality, greater efficiency, and improved access to care (Frist, W.H. Health Care in the 21st Century. New England Journal of Medicine. 352:2670272, 2005).
Currently, our health-care system has significant deficiencies - marked inefficiencies, increasing already-high costs, increasing numbers of uninsured, questions as to quality, and health-care disparities.
This situation is startling because the American population regards health care as a commodity. Almost 15 percent of our gross national product goes to health care. The average annual health insurance costs for a family are $9,068, and are increasing annually. This represents 21 percent of the median household income of $42,409. On average, $5,540 is spent per person each year in the United States on health care.
So, what do we receive in return on our investment? There are some definite positives. During the past 100 years, the average life expectancy has increased from 47 to 77 years. Hundreds of drugs that treat a variety of maladies have become available. We now can determine quickly the cause and modes of transmission for emerging diseases. Public awareness has resulted in decreased use of illicit drugs, tobacco, and alcohol.
However, there are many signs that the American health-care system has problems. There is uneven access to care; an estimated 45 million people are uninsured. The overall quality is in question. One study indicates that, at best, Americans received only 55 percent of recommended care for a variety of common conditions. Disparities exist based on race, ethnicity, geography, and socioeconomic status. The U.S. spends more for health care than any other country. Yet, according to the World Health Organization, this country ranked 37th in quality of service and 27th in rates of infant mortality. Life expectancy is less than several European countries which spend much less on health care.
So, how can the system be improved? First, some type of guiding principle must be established. This could be that all Americans deserve life-long, affordable access to high-quality, health care. The key word is all. We must concede also that such a goal cannot be achieved without significant change. A widespread transformation must occur. Should the future health-care system be patient-centered? Consumer-driven? Provider-friendly? Perhaps it should be a combination of all three.
Patient-centered health care means universal coverage, independent of the ability to pay directly or by purchasing insurance. The patient is the first priority and the focus of the transformation. Consumer-driven health care means that an improved system favors the consumer rather than third-party payers, such as employers, insurers, and the government. Consumers are empowered to make decisions, to choose how the system will impact their health. Empowerment gives consumers a greater stake in and more responsibility for their own health care. Provider-friendly health care means the reestablishment and promotion of the value of the health-care provider/health-care recipient (doctor/patient) relationship. For improvement to occur, there must be a coordinated effort by three parties - providers, patients, and consumers. All parties are challenged to improve, yet all three also are empowered. All three have rights and responsibilities.
Three elemental forces must be in play - access to accurate information, choice (to choose what is best), and control, which assumes that empowered and informed patients and consumers will make better decisions. Providers must have improved controls so that they can compete, assume risks, and innovate.
There are concerns for a competitively driven marketplace plan to help improve the American health-care system. Some feel that current problems can be associated with the marketplace model. The role of government and policy makers must be considered. Universal health insurance will not occur without the cooperation of the federal government, health-care facilities, and providers. One point of common agreement is that the solutions to the current problems will be difficult to attain, and will require the cooperation of all parties.
OSAP, the Organization for Safety & Asepsis Procedures, is dentistry’s prime source for evidence-based information on infection control and prevention, and human safety and health. More information about health care is available on the OSAP Web site at www.osap.org.
Dr. Charles John Palenik is an assistant director of Infection Control Research and Services at the Indiana University School of Dentistry. Dr. Palenik is the co-author of the popular “Infection Control and Management of Hazardous Materials for the Dental Team.” He serves on the Executive Board of OSAP. Questions about this article or any infection-control issue may be directed to [email protected].
