By Francis Koster, Ed.D.
In 2011, each United States citizen's share of our total healthcare expenses was $8,402. Most of us had almost no expenses; some of us had hundreds of thousands.
[i] This was roughly one dollar out of every six spent in the United States that year for everything! [ii] That is just about twice as much as the average citizen spends on food, which turns out to be $4,229 per person, per year. [iii]
There are two significant issues here - the first is that according to reliable studies done by experts from around the world, our healthcare costs twice as much per citizen as the other developed nations with modern healthcare systems. The second is that with some notable exceptions our results are worse than the cheaper systems. [iv] And to top it all off, in some parts of our country, life expectancy is actually going down[v].
You don't have to be a Futurist to know we must do something to solve this problem.
There are five major approaches to solving the problem of America's high healthcare costs. They are pretty easy to understand.
First, we could have hidden rationing, by creating a system where some people cannot locate a doctor or hospital to serve them, as is the case in many poor and rural areas, or by making healthcare unaffordable to poor people. Or second, we could have real rationing, by not paying for things that don’t work, or bring little value. For example, we could limit government funded end of life treatment choices instead of paying for heroic and painful measures in a person known to be approaching death. Multiple studies have found that between 30 and 40% of all Medicare costs occur in the last year of life, much of it gaining only a few days or weeks before the funeral.[vi]
Third, we could cut the amount of money paid to hospitals and doctors for their services, in spite of the fact that in the last decade one third of all hospitals report they are already losing money, and that this number is growing.[vii].
Forth, as a country, we could encourage and pay for prevention and health preservation through diet, exercise, vaccination, and creating a safe environment. And fifth, we can improve the efficiency of the healthcare process. Both of these pay handsome returns on investment.
Let me tell you about some locally implementable efforts to improve the quality of, and reduce the cost of, healthcare of school children.
In the State of Delaware, the Nemours/Alfred I. duPont Hospital for Children has a mature electronic medical record, and a string of pediatricians who are affiliated with the hospital who use the same electronic medical record environment. The state also has around 200,000 kids in schools. [viii] The Nemours team partnered with the Delaware School System to develop a novel approach – they would enhance communication across the continuum of care by incorporating the school nurse as part of the care team. With parental permission, the Nurse is able to access NemoursLink® a web-based portal providing access to the Nemours Electronic Medical Record.
The pilot project involved 11 schools, in two school districts. The nurses focused on sick children who were high on their radar. Early indications are that allowing the school nurse and the doctor's office to share in viewing the common picture of the child's disease is valuable enough that the project is being expanded.[ix]
Another project is underway in Louisiana, where the Picard Center is negotiating with the state Medicaid program - which covers 70% of the kids - to create a common, parent authorized, electronic medical record system so that doctors, hospitals and school nurses can all see what the others are doing.
A similar project done in Florida found that the school systems costs of the project could be covered by the tuition dollars they gained by having the chronically ill child well enough to attend school (if a sick child misses to many school days, the school does not get paid their tuition from the taxpayer). In other words, electronically connecting school nurses to the child's doctors office resulted in healthier kids, health care costs going down, school attendance going up, and both family and school system were better off financially.[xi]
Given the five choices for lowering the cost of healthcare, I would prefer to focus on prevention, and efficient disease management, as these projects have done. The savings in dollars and suffering can be considerable. And it can be done locally, using tools now well understood.
In some cases we don't need to fear the future - we need to grab for it.
[i] [i] The Kaiser Family Foundation http://www.kff.org/insurance/upload/7670-03.pdf
[ii] The Kaiser Family Foundation http://www.kff.org/insurance/upload/7670-03.pdf
[iii] http://www.ers.usda.gov/data-products/food-expenditures.aspx, Table 13, Column E, line 64.
[vi] http://www.nursingeconomics.net/ce/2014/article3003127134.pdf page 3
[vii] http://www.aha.org/research/rc/stat-studies/Studies.shtml, page 27
[ix] http://www.fierceemr.com/story/pilot-program-gives-school-nurses-access-students-ehrs/2012-05-24 and email exchanges with Nemours Public Affairs, who reviewed the content for accuracy.
[x] Personal telephone conversation with Health Sciences Director John LaCour October 16, 2012. Also http://www.picardcenter.org/Pages/home.aspx
[xi] http://www.hoise.com/vmw/06/articles/vmw/LV-VM-10-06-13.html, reporting on a project I was Principal Investigator on. Substantial other backup available.