The evidence is undeniable. By any measure, the US spends more on
healthcare than any other country in the world, yet its health
outcomes as measure by longevity are in the bottom half among
developed countries, and its health-related quality of life has
remained constant or declined since 1998. In addition to high costs
and lower than expected outcomes, the healthcare delivery system is
plagues by treatment delays as it can take weeks to see a
specialist, and many people have limited or no access to care. Part
of the challenge is that the healthcare delivery system is a large,
complex, and sophisticated value creation chain. Successfully
changing this highly interconnected system is difficult and time
consuming because the underlying problems are hard to comprehend,
the root causes are many, the solution is unclear, and the
relationships among problems, causes, and solution are
multifaceted. To address these issues, the book carefully explains
the underlying problems, examines their root causes using
information, data, and logic, and presents a comprehensive and
integrated solution that addresses these causes. These three steps
are the methodological backbone of this book. A solution depends on
understanding and applying the principles of patient-centered care
(PCC) and resource management. PCC puts patients, supported by
their primary care physicians, back in the role as decision makers
and depends on patients being responsible for their health
including making good life-style choices. After all, the best way
to reduce healthcare costs and increase quality of life is to
improve our health and wellness and as a result need less care. In
addition, health insurance must be rethought and redesigned so it
is less likely to lead to overuse. For many people with health
insurance, the out-of-pocket cost of healthcare are small, so
healthcare decision making is often biased toward consumption.
Effective resource management means that healthcare providers must
do a better job of acquiring and using resources in order to
provide care quickly, productively, and correctly. This means
improving healthcare strategy and management, accelerating the use
of information technology, making drug costs affordable and fair,
reducing the incidence of malpractice, and rebuilding the provider
network. In addition, implementation is difficult because there are
many participants in the healthcare delivery value chain, such as
physicians, nurses, and medical technicians, as well as many
provider organizations, such as hospitals, clinics, physician
offices, and labs. Further up the value chain there are
pharmaceutical companies, equipment providers, and other suppliers.
These participants have diverse and sometimes conflicting goals,
but each must be willing to accept change and work in a coordinated
manner to improve healthcare. To overcome these problems, strong
national leadership is needed to get the attention and support from
the people and organizations involved in healthcare and to make the
comprehensive changes that will lower healthcare costs, improve
healthcare quality, eliminate delays, increase access, and enhance
patient satisfaction.
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