What The Rich U.S. Health System Can Learn From The Poor

http://www.youtube.com/watch?v=4w4oa7PEaaE

A trio of superstar health innovators have a message for the broken U.S health care system: broaden the definition of health to include basic life necessities, bring care to where people live and study how it's done in poor countries where you can't always rely on expensive tests and drugs to make people better.

The persuasive new report on "re-aligning health with care" is written by Harvard doctors Paul Farmer (co-founder of the medical nonprofit Partners in Health) and Heidi Behforouz (executive director of the Prevention And Access To Care And Treatment [PACT] program) and Rebecca Onie, CEO of the nonprofit Health Leads. In it, they argue that with some rethinking, the U.S. can deliver better care at a lower price.

They lay out the central problem here:

The health care system is in crisis, driven chiefly by escalating costs, suboptimal health outcomes, scarce primary care resources, and rising poverty. At the same time...a growing number of health providers around the globe have learned to deliver high-quality health care at low cost. Now we need to align our resources in the United States to bring this knowledge fully to bear in saving dollars and lives.

Sounds great, but how to do it? The key, they write in the Summer 2012 edition of the Stanford Social Innovation Review is to change the way we view the "product" of health care, the places it's delivered and the providers who dole out patient care.

Health Includes Basic Needs

The authors cite a 2007 study at Johns Hopkins Medical Center in which 98 percent of pediatric residents said that referring well-child patients for help with basic needs could improve the children's health. "But how many of those residents routinely screened their patients for food sufficiency? Only 11 percent." The moral: Health care is much bigger than just prescribing medicine. This is the founding principle of Rebecca Onie's Health Leads, a group that recruits student volunteers to support doctors prescribing food, heat and other basics to low-income patients.

In Brazil, they deal with this problem through a program that routinely sends low-income children home after hospitalizations with resources to make sure they have access to nutrition, sanitation and psychological support, the paper notes.

But in the U.S., the current system provides few incentives to connect patients with basic needs. For example, the authors write that Medicaid reimbursements are specifically forbidden when it comes to getting patients plugged in to social services, or helping them obtain food stamps or energy assistance.

Health Workers In The Community

Paul Farmer is an authority on radically rethinking where care is provided. In Haiti's Central Plateau, with just one doctor for every 50,000 people, Farmer helped pioneer the concept of paying community health workers, or accompagnateurs, to visit the homes of patients to make sure they take their medicines, but also attend to other critical needs, like transportation, shoddy housing and emotional support. Based on this model, the PACT program was launched in Boston to serve the sickest and most vulnerable HIV-positive and chronically ill patients in the city. That model, in turn, has expanded to help other poor, chronically sick patients who live in "the shadow of Harvard's finest hospitals."

Beyond The M.D.

By expanding the ranks of community health workers, the authors note, doctors, nurses, social workers and other professionals can "practice to the top of their license" and spend more time doing what they're trained to do. This "task-shifting" also saves money and reduces inefficiencies.

The paper concludes:

It is by no means a new discovery that poverty and poor health are linked or that health resources are more likely to be used if they are offered conveniently to the recipient, or that a goal as complex and ambitious as "health" can be effectively pursued only with a multidisciplinary team of workers.

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But what's new is this: The U.S. health care system has reached a tipping point. Reform is in the air with primary care especially positioned for transformation.

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"Health" is a bold, expansive aspiration. Let's make sure what we call "health care" is broad enough to get the job done.