There's more to healthcare reform than money
With as much focus as has been placed on health insurance reform as a major component of the health care bill, it's easy to forget that there's more to this than money. And I'll fess up: I'm as guilty as anyone of focusing too much on the money angle. With as much as I'm paying for insurance right now--and probably you as well--can anyone blame us?
But, for all that insurance reform is honestly necessary and critical right now, it's only half the battle. At last November's TEDMED conference, Intel researcher Eric Dishman gave a great talk on what the other half of health care reform is.
And it's a big, big other half.
Two factors come into play: demographics and central-vs-local delivery of health care. I highly suggest you watch Dishman's talk at the above link, but if you haven't got 20 minutes to do so, I'll try to sum up:
Demographics: Basically, the population is aging. Advances in health care, delivered in spite of insurance companies if not through them, have led to longer life spans.
This is a good thing, but it puts us in a situation where for the first time in history there are more middle-aged and elderly people than young people. Low birth rates in the developed world, and increasingly so in the developing world, mean that this will continue to be true.
Because there aren't any "death panels" in the health care bill that will be hunting down the elderly (really, there aren't), this means that in about ten years gerontology is going to be the biggest factor governing health care delivery and expenditures nationwide.
Dealing with dementia, reduced capacities of the elderly to live independently, falls and hip fractures leading to assisted living, that's where growth in health care is now. And it's only accelerating.
Central-vs-Local: Health care today is delivered primarily at hospitals and doctors' offices. It is centralized. You get sick, you go to the hospital. Time for your annual physical, you go to your primary care physician's office. It's not like in the good old days when the country doctor made house calls. That was a distributed model of health care. Very local. But that's just not how medicine works today. Today, everything is very centralized.
And often, there are good reasons for this. It is truly impractical to provide certain health care services in the home. I'm guessing you wouldn't want a team of surgeons and nurses descending on your home to perform a hip replacement operation. Nor would you want them wheeling an MRI machine into your living room to give you a scan. For one thing, your house probably isn't wired to provide enough current to even run the machine.
But centralized delivery isn't appropriate for everything, and gerontology is where these two trends collide.
For elder care, it's all about extending life and preserving the quality of life. Preserving freedom, mobility, and independent living for as long as you can. For that, you absolutely want as many services as possible provided within the home. With senior populations growing at many times the rate of the younger crowd (all those baby-boomers reaching middle age), it is neither practical nor effective to deliver health care in a centralized model.
The reason why is that elder care demands a focus on maintenance and monitoring. It's all about maintaining a person's capabilities for as long as possible, which you do by monitoring those capabilities so you can spot problems early. But monitoring, by its very nature, is not something you can do effectively in a fifteen minute doctor's office visit.
You won't spot the subtle signs of diminishing mental capacities, which may impair someone's ability or likelihood of taking their medicines on the right schedule, in an office visit. You won't spot the subtle signs of muscle tremors and diminished balance that raise the chances someone will suffer a debilitating fall if you're examining your patient once every few months while they're sitting on an exam room table.
You can only spot these things in the home, in a person's natural setting, with a care model that makes use of modern technology to watch for these subtle signs.
We can't do this in a centralized model. We need a revolution in health care away from treating hospitals as "cathedrals of health care" and towards a decentralized model where, as Eric Dishman calls for, at least 50% of health care is delivered in the home. That being the 50% that needs to be done in the home, that you want to be done in the home, and--because it's there to catch problems early--that reduces the need for the other 50% as well.
That's the other half of the health care reform puzzle. And we need to figure out how to do it pretty fast, because our parents and grandparents are going to need it pretty darned soon.
But, for all that insurance reform is honestly necessary and critical right now, it's only half the battle. At last November's TEDMED conference, Intel researcher Eric Dishman gave a great talk on what the other half of health care reform is.
And it's a big, big other half.
Two factors come into play: demographics and central-vs-local delivery of health care. I highly suggest you watch Dishman's talk at the above link, but if you haven't got 20 minutes to do so, I'll try to sum up:
Demographics: Basically, the population is aging. Advances in health care, delivered in spite of insurance companies if not through them, have led to longer life spans.
This is a good thing, but it puts us in a situation where for the first time in history there are more middle-aged and elderly people than young people. Low birth rates in the developed world, and increasingly so in the developing world, mean that this will continue to be true.
Because there aren't any "death panels" in the health care bill that will be hunting down the elderly (really, there aren't), this means that in about ten years gerontology is going to be the biggest factor governing health care delivery and expenditures nationwide.
Dealing with dementia, reduced capacities of the elderly to live independently, falls and hip fractures leading to assisted living, that's where growth in health care is now. And it's only accelerating.
Central-vs-Local: Health care today is delivered primarily at hospitals and doctors' offices. It is centralized. You get sick, you go to the hospital. Time for your annual physical, you go to your primary care physician's office. It's not like in the good old days when the country doctor made house calls. That was a distributed model of health care. Very local. But that's just not how medicine works today. Today, everything is very centralized.
And often, there are good reasons for this. It is truly impractical to provide certain health care services in the home. I'm guessing you wouldn't want a team of surgeons and nurses descending on your home to perform a hip replacement operation. Nor would you want them wheeling an MRI machine into your living room to give you a scan. For one thing, your house probably isn't wired to provide enough current to even run the machine.
But centralized delivery isn't appropriate for everything, and gerontology is where these two trends collide.
For elder care, it's all about extending life and preserving the quality of life. Preserving freedom, mobility, and independent living for as long as you can. For that, you absolutely want as many services as possible provided within the home. With senior populations growing at many times the rate of the younger crowd (all those baby-boomers reaching middle age), it is neither practical nor effective to deliver health care in a centralized model.
The reason why is that elder care demands a focus on maintenance and monitoring. It's all about maintaining a person's capabilities for as long as possible, which you do by monitoring those capabilities so you can spot problems early. But monitoring, by its very nature, is not something you can do effectively in a fifteen minute doctor's office visit.
You won't spot the subtle signs of diminishing mental capacities, which may impair someone's ability or likelihood of taking their medicines on the right schedule, in an office visit. You won't spot the subtle signs of muscle tremors and diminished balance that raise the chances someone will suffer a debilitating fall if you're examining your patient once every few months while they're sitting on an exam room table.
You can only spot these things in the home, in a person's natural setting, with a care model that makes use of modern technology to watch for these subtle signs.
We can't do this in a centralized model. We need a revolution in health care away from treating hospitals as "cathedrals of health care" and towards a decentralized model where, as Eric Dishman calls for, at least 50% of health care is delivered in the home. That being the 50% that needs to be done in the home, that you want to be done in the home, and--because it's there to catch problems early--that reduces the need for the other 50% as well.
That's the other half of the health care reform puzzle. And we need to figure out how to do it pretty fast, because our parents and grandparents are going to need it pretty darned soon.
# Posted by Jason Black : 11:10 AM
Comments:
We won't have health care reform in any sense without government regulation of health insurance that works the way government regulation of utilities does.
Other advanced countries do deliver healthcare in the home. Martha may correct me, but isn't it Germany were home doctor visits are common?
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