The cost of medical care is climbing unsustainably. Many projections show that the cost will be close to 22 percent of gross national product (GNP) within the next decade, two times that of most industrialized nations. ADVERTISING The cost of
The cost of medical care is climbing unsustainably. Many projections show that the cost will be close to 22 percent of gross national product (GNP) within the next decade, two times that of most industrialized nations.
Today, the cost of a family plan is around $20,000 per year. Unless there is radical change, things are going to get worse with the aging of baby boomers and the decreasing numbers of primary-care physicians because of retirements and low pay.
I am Richard Lee-Ching, M.D., a family practice physician in Hilo for the past 35 years. Along with three other baby boomer physicians, we started the East Hawaii Independent Physicians Association (EHI). I served as president for 20 years. I am concerned that private practice in Hilo could disappear and access to even primary care will become extremely difficult as cuts in physicians’ rates, regulations and administratively burdensome quality incentives are imposed in a futile effort to bend the medical cost trend.
What’s causing the cost crisis? There are many reasons, but one fundamental problem is the payment mechanism of fee for service. We physicians are being paid for each intervention instead of managing care. We are not paid to keep people healthy but instead to take care of illness.
The only time we are really compensated for preventive care is childhood vaccinations. We also get paid to over-treat terminally ill people who may not want invasive care. This is particularly ironic because physicians in their own lives avoid this.
Physicians find themselves on a treadmill, having to increase the number of patients seen in the office per day to compensate for lower costs, even when a patient could be cared for with a phone call. The hospital is being squeezed by lower payments and higher costs. Patients are left out of the equation except as premiums, and higher premiums means lower pay for them.
What can reasonably be done? At least four things need to change.
First, we need to reform our payment system. We need to be paid for managing chronic problems and maintaining health, and not just treating illness. We need to pay for comprehensive care coordination for our most complex patients and for teaching people how to improve their health through activities like tai qi, qi gong, meditation, yoga and exercises.
Second, our computers need to be able to communicate through a common system so we will avoid duplicative services.
Third, individuals need to take responsibility for changing their lifestyle. Unless we change habits, many of the chronic problems such as diabetes, hypertension and heart disease will get worse.
Fourth, the community needs to be involved in deciding what changes to emphasize.
How can we do this? We need to recognize the problem is beyond the medical providers. We need collaboration among the doctors, the hospital, insurers and employers. Our unique strength in Hilo is our sense of community, and together we need to determine how to provide the best health care possible in our community.
What is the community good? What are the essential services we need in this community from physicians and Hilo Medical Center? Then we need to have business and community leaders at the table with the medical providers and insurers to figure out how to make it happen.
It won’t be easy, especially since we need collaboration from large players, and Hilo may be too small to be a priority from their perspective. It also won’t be easy because we have a lot of baggage between physicians and between physicians and the hospital. Maybe that’s the downside of being a small community; we tend to remember our fights a lot longer.
The good news is that under Community First and the leadership of Barry Taniguchi, we’ve created a forum where leaders from EHI, Hilo hospital, HMSA and the business/community are sitting down and already working together. Our first two initiatives are to design the best health care and to attract and retain physicians in East Hawaii.
In the past, when natural disasters struck, we would rally together to a surprising degree to meet our common challenges and resolve the problem.
This is the situation we are facing. The cost of health care is already a disaster, and losing physicians is an impending disaster. Together we can once again rally and improve health and keep health care affordable in our community.
Let’s go, Hilo!
Richard Lee-Ching is managing director of the East Hawaii Independent Physician’s Association and vice president of Community First, a nonprofit organization headed by KTA’s Barry Taniguchi, and supported by a volunteer board of local community leaders. Community First recently was established to help the community respond to the healthcare cost crisis and support initiatives that change health care from just treating disease to caring for health.
