Articles, PSQH January 21, 2008

Healthcare IT: Slogan or Solution?

by Barry P Chaiken, MD

In 1980 a Stanford University School of Business professor Alain Enthoven authored a book titled Health Plan: The Only Practical Solution to the Soaring Cost of Medical Care. Dr. Enthoven provided the theoretical underpinnings of managed competition, an approach to reducing healthcare costs embraced by the Clinton administration’s Task Force on National Health Care Reform. Chaired by the then first lady Hillary Rodham Clinton, the task force failed to convince Congress to pass comprehensive healthcare reform legislation. This unsuccessful “breakthrough solution” was just one of many proposed over the last 30 years to save our healthcare system from collapse.

On the first page of Enthoven’s book he wrote about the strain healthcare costs were putting on federal, state and local governments. He then addressed the private sector, particularly the automobile industry, where soaring health insurance costs were a difficult burden on employers. According to Enthoven, healthcare costs made up 6.2% of GDP in 1965 and ballooned to 9.1% in 1978. (1) Today, healthcare costs eat up over 16% of GDP. In the 27 years since Enthoven published his book the United States has seen little progress in controlling healthcare expenditures.

Although our healthcare system struggles with access, covering the uninsured, and medical errors, generally Americans receive pretty good healthcare, especially when their illness is not routine. Unfortunately, the resources currently required to provide that level of care are beginning to impact our standard of living and competitiveness in the world.

Unequivocally, healthcare information technology alone cannot solve the problems our nation faces in delivering high quality, affordable healthcare to all Americans.

A comprehensive approach to healthcare reform is necessary. Everyone, including physicians, nurses, patients, administrators, and insurers must work together to form the solution. Continuing to approach illness and deliver care the same way we have been doing for decades is sure folly.

Physicians and nurses must begin to see their responsibilities in a different light and begin to do their tasks differently. Administrators and insurers must assist and incent them. Patients must take responsibility for their care and work to prevent illness rather than wait passively for resource intense medical miracles to fix them.

Therapies need to be driven by science and rational thinking rather than habit and personal preference.

Healthcare information technology can provide some critical tools to achieve this necessary change, but those working within the healthcare system must employ these tools in different workflows and processes. Utilizing the tools to “automate” existing processes only works to continue delivering unacceptable outcomes.

If we want to truly address our problem of spiraling healthcare costs, it is time to get to work fostering the change management necessary to reform our healthcare system for the better. Otherwise, we will read Enthoven’s book a decade hence and realize nothing has changed except for the slogan.

Excerpts from: Healthcare IT: Slogan or Solution?, PSQH, January/February, 2008

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