NEW DIMENSIONS IN COMPREHENSIVE HEALTH, INC. 490 WEST END AVE. NEW YORK, N.Y.10024 (212) 595-8270 ADVISORY BOARD HERMAN BADILLO GILERT BENSON Paterson Youth Service Center SHIRLEY CHISHOLM PAUL DEBELL, M.D. RUTH R. FRANKEL Health Sciences, Brooklyn College DAVID M. GARODNICK DMG Consultants, Inc. ED HANZELIK, M.D. Shri Hans Humanitarian Services FARRELL JONES Human Resources Administration MARLENE N. KASMAN Huntington Mental Health Clinic RICHARD A. KELLAWAY DONNA O'HARE, M.D. New York City LIBERTAD RODRIQUEZ Coney Island Hospital EDWIN LEE SOLOT Penquis Community Action Program MEDICAL ADVISOR LIVIA S. WAN, M.D. New York University Medical Center EXECUTIVE DIRECTOR STATEMENT OF MARVIN BELSKY, M.D. ON BEHALF OF NEW DIMENSIONS IN COMPREHENSIVE HEALTH NOVEMBER 6, 1975 Quality health care requires a secure economic basis A NON-PROFIT CORPORATION IN TRAINING AND TECHNICAL ASSISTANCE (141) STATEMENT OF MARVIN BELSKY, M.D. ON BEHALF OF NEW DIMENSIONS IN COMPREHENSIVE HEALTH NOVEMBER 6, 1975 The delivery of medical care in the United States today is undergoing a process of fundamental reappraisal. New laws and new forms will undoubtedly come into being. All of us may soon be covered by National Health Insurance. Health-maintenance organizations--known as HMOs--are gaining popularity. Doctors are increasingly undergoing periodic competency reviews by their peers. But all such new forms and procedures deal primarily with the economics and technology of medical care, not its humanity or capacity for partnership between doctor and patient. Quality care requires a secure economic basis and the very best technology. But quality care depends on concerned, humanistic communication. Without it, the doctor is handicapped and the patient endangered. The combination of exotic new technology and bureaucratic forms of medical delivery make an effective doctor-patient partnership more urgent than ever. Unless the patient learns to participate in his own health enterprise, his care will become more and more depersonalized and remote. Various health insurance plans proposed concern themselves amongst other things with payment for treatment, access to medical services and health care, diffusion of technology and new techniques, peer accountability by physician and consumer input on health planning councils and advisory boards. Regrettably not enough concern or attention has been given to the likely possibility that, with broader availability of health services, there will be increased depersonalized and uncommunicative care than at present. There has been and is little recognition that the patient as consumer must participate -2 in the therapeutic process with the health care provider as the key to success of his or her own well being. Presently, physicians are thought of by the public as someone to turn to when illness or disability occurs. The physician is highly regarded--even held in awe--as a healer. Doctors easily acquiesce in this role and their exceptional training and social status reinforce feelings of separateness. Insufficient emphasis is placed on the physician's role as a teacher. Nor is recognition given to the patient consumer as an individual who, given relevant information in a motivating way, can and will actively participate in his or her own health care and learn effective health behavior as a way of life. Presently, 94¢ out of every health dollar is spent on treatment, 4¢ on research and of the remaining 2¢ for disease prevention, only 4/10¢ goes toward health education and none on patient consumer input to care. The effect of this incredibly skewed emphasis toward disease treatment may be to increase the total social cost of health care by the expense of treating sickness which may have been prevented, treating diseases and infirmities whose course may have been of shorter duration, treating recurrent incidents of such diseases involving the cardio vascular system, the pulmonary system, diabetes and the like, which may be avoided by proper health maintenance by the patient. Needless to say, the costs relating to loss of work and productivity to the individual and his or her family, to industry, agriculture and government are considerable when the Nation gives only lip service to disease prevention. The physician and the projected expanded health care system have significant roles to play as teachers and dispensers of good health behavior, considering that the number of physician visits in the United States are now running at the rate of 1 billion per year. -3 The health care system can serve as health educators to focus on health maintenance, disease prevention, patient responsiveness to medical instructions and guidance. Many studies indicate at least 1/3 to 1/2 of patients do not comply with doctor recommendations or drug regimens, at least in part or in whole, with resulting wasted diagnoses, wasted drugs, wasted x-rays and wasted opportunities for well being. This waste may be multiplied with the advent of broader health coverage if steps are not taken to more actively involve the patient in good health practices. A truly well-informed patient public which is expected to know and is encouraged to learn may well reduce malpractice, not directly associated with outright incompetence, because as consumers they will look for and get clear signals from the physician. Informed consent from a well informed patient in the context of a truly therapeutic relationship will enhance the total health care environment reducing antagonistic roles. In any new legislation, the patient as consumer will undoubtedly be represented at the macro-level on boards of health delivery systems and on advisory boards of governmental regulatory bodies. HMOs, hospitals, perhaps even PSROS, may have consumer representation, but any legislation must facilitate and integrate the individual patient consumer in an assertive, informed relationship with providers--be they doctors, nurses, or paramedical personnel or institutions. PROPOSALS Any national health insurance scheme enacted by Congress should encourage grass roots patient consumer participation by: a) underwriting or compensating through reimbursement patient education at the "teaching moment" in the health care facility or physicians's office by -4 doctors, nurses, and professional health educators as part of a health care team. (More than 70% of present care is now provided by private practitioners.) Making available coverage for providing health education and motivation may reduce the total health bill compared to a system without it. b) underwriting or providing reimbursement to health care providers (be they institutions or private practitioners) for encouraging direct patient feedback mechanisms in small groups to heighten awareness of doctorpatient/provider-user roles and responsibilities and thereby increase patient motivation towards effective health behavior. A number of hospitals now increase their effectiveness by including a patient ombudsman on their staff to relate to patient complaints and to motivate patients in good health practices when they leave the hospital. c) underwriting or subsidizing the training of health educators and para-medical personnel to serve on the staff of hospitals, HMOs, group practices and perhaps with private practitioners. d) underwriting and supporting medical school curriculum changes designed to explore and reinforce the physician's role as teacher as well as healer and to encourage a more communicative relationship of the doctor to the individual patient, the community, and to other health care providers. There is now little encouragement for the medical student to increase his human relations skills as the overwhelming emphasis is on technology. e) underwriting and supporting studies to evaluate whether patient education at the individual and community level is effective, as opposed to the cost of benefits of operating a health care system without an important health education component. Consideration should be given to broken appointments, patient failure to follow advice, recurrence of illness that may have been averted or delayed and broader social costs, such as lost productivity and disruptions. |