A Time for Revolutions — The Role of Clinicians in Health Care Reform

Here are excerpts from a fantastic article written by Dr. Ara Darzi in NEJM.
There is a message in the article for all doctors and medical policy makers regarding medical insurance and policy making towards it. The message is very pertinent not only to western countries but India as well.

"William Beveridge, the economist whose 1942 report led to the founding of Britain’s National Health Service (NHS), famously said that “a revolutionary moment in the world’s history is a time for revolutions, not for patching.”¹ Given the combination of the global downturn and the time bomb that is health insurance costs, there is no denying that health care in the United States has reached such a moment. This matter is too important to be left to the politicians and policymakers; there is an urgent requirement for professional clinicians to step up and lead the debate.

Every country in the developed world confronts a similar challenge right now: finding a way to create a well-resourced but sustainable system that provides care of the highest quality to those who need it. One would be hard-pressed to find credible opponents — regardless of their political stripe — to the goal of providing “universal health care.” The disagreement arises when the discussion turns to the best way to achieve this aim. Each country needs to discover the formula that suits it best.

In 1997, Britain had a new government, which had inherited a health care system that was chronically underfunded and suffering from a lack of capacity, with average waiting times of 18 months from referral to treatment. Funding for 1997 was £35 billion; for 2010 it is £110 billion, and waiting times are now as short as they’ve ever been — 10 years ago, patients waited approximately 18 months for treatment, and now they wait only a few weeks. Although both the causes of and responses to reform were very different from those in the United States today, the NHS’s experience can provide some valuable lessons.

A key insight to be gained from the post-1997 NHS “revolution” is that it is important for clinicians to be involved in both informing and leading change. Successive attempts at top-down regulation and reform in Britain damaged clinicians’ morale and bred distrust between them and politicians. Not having been central to the decision making, clinicians subsequently didn’t trust the proposals or fully understand their purpose.

Clinicians should bear three things in mind as they consider how to approach this debate.

1. Politicians must be made to recognize the role of clinical leaders in shaping a transformed but effective health care system
2. Clinicians need to be involved in defining the link between funding and the care provided.
3. Finally, clinicians must educate both policymakers and the wider public about appropriate levels of care. Health care systems all suffer from a disproportionately heavy focus on the treatment of acute illness and injury — the type of medical work glamorized on television — which consumes by far the most resources. But primary care accounts for most of the health care that is delivered: nearly a billion visits are made to physicians’ offices every year in the United States, but there are fewer than 40 million hospital stays. The current system of insurance and referrals can often lead to the unintended consequence of unnecessary referrals for the most expensive tests and treatments.

Health problems related to lifestyle, such as obesity, smoking, and diabetes will be solved not by high-tech robotics and bigger hospitals but rather through access to family doctors, innovations in public health, and lessons from the emerging discipline of behavioral economics.
The best outcomes can be achieved only when the system itself is healthy and built on real partnerships between patients and clinicians.

http://healthcarereform.nejm.org/?p=999?query=TOC