May 06, 2015

Health Care Reform Pays to be Well

No doubt you’ve seen and heard a lot about health care reform over the past decade, but what does that really mean? Contrary to some doomsayers, health care reform does not mean abandoning our current system or turning to “socialized medicine.” Health care reform, as talked about today, means improving the quality and efficiency of care - providing the right kind and number of tests, medications and treatments to get the best medical outcome.

Certainly, most doctors, hospitals and clinics have always strived for those goals, but the system, in its current form, does not sufficiently encourage their efforts.

Today, we are lucky to have advanced medical services, including sophisticated tests and hi-tech diagnostic tools that save countless lives. Most of these services, though, are expensive, driving up costs to the point that, each year in Wisconsin, 33 billion dollars are billed health care charges. Doctors, themselves, are not usually aware of the cost of the tests and procedures they are ordering. In fact, these costs may vary from one facility to another, from one region of the state to another. Through television, advertising and word of mouth, patients have come to expect, and even demand, MRIs, CAT Scans and certain drugs, even when they may not be medically necessary.

Under the current health care system, we pay doctors for each patient visit or procedure they perform. Likewise, clinics and hospitals are paid for services, supplies and procedures they provide. So their revenue is tied to quantity, not quality. Health care reform is about reversing this equation.

We can achieve the goals of improving health care quality and efficiency if all parties involved are held accountable. Payers and health care providers must end incentives that may reward excessive and unnecessary services. Drug companies must recognize that astronomical costs of their products may prevent patients from taking the medicines they need in the appropriate dosages or at all. Patients must play an active role in their health care, getting facts about quality and efficiency from reliable data and partnering with doctors to make decisions about their care.

WHIO’s mission is to provide reliable data to improve the quality and efficiency of health care and support transparency, so that patients, their families and their doctors can realize meaningful health care reform that pays for us to be well.